Report Says CMS Falling Short on Policing MA Plan Marketing Problems
CMS lacks a mechanism for determining the full scope of inappropriate marketing practices by private insurers that participate in Medicare programs, according to a new Government Accountability Office report, CQ HealthBeat reports.
The report credited CMS with taking steps to counter marketing abuses in the three years ending in February 2009, but it also showed that CMS did not start tracking two types of actions against plans -- warning letters and notices of non-compliance with marketing regulations -- until June 2008.
The GAO report showed that 73 MA plans -- which enrolled 7.4 million beneficiaries, or 71% of the MA population -- were subject to compliance and enforcement actions between January 2008 and February 2009.
GAO also found that CMS issued 37 directives for compliance action, took five enforcement actions and mailed 76 warning letters to MA insurers.
Incidents of marketing abuses included sales agents' misrepresenting benefits in MA plans, offering illegal inducements such as meals or gifts for potential enrollees and marketing door-to-door without a prearranged appointment.GAO recommended that CMS gather more data on the extent of marketing abuses, and CMS agreed it would do so. The report noted that CMS plans to conduct a survey of beneficiaries who dropped MA plans to learn more about their decisions to cease enrollment, adding, "Depending on the specific questions included, such a survey could provide information about the number of beneficiaries who experience inappropriate marketing and identify plans, plan types and geographic locations where inappropriate marketing problems are most prevalent" (Reichard, CQ HealthBeat, 1/20). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.