MEDICARE HMOS: Study Finds Widespread Marketing Abuses

      A national undercover sting operation of Medicare HMOs has determined that plans often mislead seniors in their sales pitches. The University of Massachusetts Gerontology Institute, in conjunction with national advocacy group Community Catalyst, recruited volunteers in Boston, Chicago, New Orleans and Portland, OR, to call Medicare HMOs, attend marketing meetings and receive home visits from marketers. The Hartford Courant reports that investigators found several potential violations of federal law: refusals to give information by phone, instead requiring callers to attend meetings or receive home visits; requests for personal health information from senior callers; and "significant gaps" in information presented at more than 40% of marketing meetings, such as "limited doctor/hospital networks and grievance procedures" (Levick, 2/25). The Boston Herald reports that Michael Miller of Boston-based Health Care For All, which also participated in the report, said, "This study shows that [seniors and the disabled are] often getting poor information from the HMO marketing people -- information that downplays the risks, and their rights." Study co-author Nancy Turnbull of the Harvard School of Public Health said seniors are "especially vulnerable" because many "have not had much experience with managed care."

Objective?
      The study authors call for "increased federal oversight of HMO marketing," especially as the federal Medicare commission is close to recommending premium-support reforms that would move a large number of seniors into managed care plans (Convey, 2/25). But "industry officials questioned the study's methods and researchers' motivation" for the inquiry. A spokesperson for Aetna U.S. Healthcare, singled out in the study for possible violations in Chicago and New Orleans, said the company is "surprised at the findings, 'because of the rigor we apply to training' Medicare HMO" marketing staff. American Association of Health Plans CEO Karen Ignagni said the AAHP "would take the UMass study seriously and see if it could learn something useful from it," but she questioned the sponsoring organizations' political motives (Courant, 2/25).