MEDICARE HMOS: Mislead Seniors about Benefits, Says GAO
The Senate Special Committee on Aging is scheduled to hold a hearing today on two new General Accounting Office reports that criticize Medicare HMOs for providing inaccurate information and HCFA for supplying insufficient safeguards to beneficiaries. The first study finds that Medicare HMOs "routinely" distribute materials containing "significant errors and omissions" about benefits, even though such materials are often the only available detailed source of information. The second study faults the HMOs for failing "to inform Medicare beneficiaries that they could appeal decisions to deny care or payment," and criticizes HCFA for insufficient oversight of the appeals process (Pear, New York Times, 4/13). The survey of 16 Medicare HMOs in four regions found marketing materials across the board that were "inadequate or erroneous" and faulted HCFA for "weak oversight" of those materials (McGinley, Wall Street Journal, 4/13). The surveys also found that some HMOs told women they must have a referral to get a mammogram, in direct violation of federal rules prohibiting such a requirement. In addition, some HMOs have misrepresented the prescription drug coverage available under their plans, and in one case, Medicare paid an HMO to provide $1,200 annually for drug coverage, but the HMO told members it would only cover $600 a year (Times, 4/13).
HCFA Under Fire
The GAO reports noted that although HCFA had reviewed Medicare HMOs' materials, the agency failed to ensure that errors were corrected before publication. The surveys also found that HCFA was not adequately monitoring the appeals process. Carol Cronin, director of the Center for Beneficiary Services for HCFA, said, "The new GAO reports make clear that we must do more to ensure that beneficiaries receive accurate information about their rights and options." HCFA has pledged that it will monitor the appeals process more closely and ensure that HMOs make required changes to their documents. HCFA also plans to standardize the language and format for describing benefits (Journal, 4/13).
Karen Ignagni, president of the American Association of Health Plans, said, "We have an obligation to provide Medicare beneficiaries with accurate information in an understandable form." Sen. Charles Grassley (R-IA), chair of the Senate Special Committee on Aging, said, "[I]f we want Medicare beneficiaries to have more choices, we have to give them the tools to choose" (Times, 4/13).