Private plans fail Medicare audits
Medicare Audits Show Problems in Private Plans
By Robert Pear
The New York Times
October 6, 2007
Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.
The problems, described in 91 audit reports reviewed by The New York Times, include the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.
Of the audits conducted by the Department of Health and Human Services, 39 focused on drug benefits, 44 focused on managed care plans and 8 examined other types of private plans.
The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint.
The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications.
For years, Democrats have complained about efforts to “privatize Medicare,” and they are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients.
Medicare has taken “vigorous action” to halt marketing violations, said Abby L. Block, a Medicare official.
But David A. Lipschutz, a lawyer at California Health Advocates, a nonprofit group, said that Medicare’s generous payments to private plans still encouraged predatory sales practices.
“Every enrollee in a private Medicare plan is a potential source of substantial profits,” Mr. Lipschutz said.
http://www.nytimes.com/2007/10/07/us/07medicare.html?ref=health&pagewanted=all
Comment:
By Don McCanne, MD
So Democrats “are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients.” So why do the leading Democratic candidates insist that private insurers be included in their models of health care reform for the rest of us?
Not only can the private insurers not be trusted, but they waste resources that should be redirected to health care. And we all pay for that waste, directly or indirectly.
When is enough enough?