Four Health Insurers To Resume Marketing Of Medicare Advantage Plans After Suspension

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance
Article Date: 27 Sep 2007 - 7:00 PDT

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CMS on Monday said that four health insurers can resume marketing of private fee-for-service Medicare Advantage plans after they entered into a voluntary agreement in June to suspend marketing of the plans amid allegations of illegal and aggressive sales practices, the Tennessean reports (Ward, Tennessean, 9/25).

According to acting CMS Administrator Kerry Weems, an agency review of the four health insurers -- BlueCross BlueShield of Tennessee, UnitedHealth Group, Humana and Sterling Life Insurance -- "found vast improvements to their internal controls and oversight processes consistent with regulations." Three other health insurers that entered the voluntary agreement -- Coventry Health Care, Universal American Financial and WellCare Health Plans -- resumed marketing of the plans last month after a similar review (Wisenberg Brin, Wall Street Journal, 9/25).

CMS spokesperson Jeff Nelligan said that the agency received 2,700 allegations of illegal and aggressive sales practices before the health insurers suspended marketing of the plans. He said, "I think the best way of (describing) it is that the benefits as outlined to the beneficiary under the plans by brokers, by agents were not accurate" (Connolly, Memphis Commercial Appeal, 9/25).

Comments
At a conference sponsored by American's Health Insurance Plans on Monday, Weems said, "Unless the marketing abuses are nipped in the bud, congressional and public sentiment can easily turn against the entire" MA program (Reichard [1], CQ HealthBeat, 9/24).

House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) said that health insurers and CMS have not adequately addressed the allegations of illegal and aggressive sales practices. He said, "These seven plans certainly weren't readmitted based on an open and transparent process that assured Congress or America's seniors that plans' behavior has changed" (Wall Street Journal, 9/25).

Meanwhile, according to Congressional Budget Office Director Peter Orszag, health insurers must provide more evidence that higher reimbursements for MA plans compared with traditional Medicare leads to reduced treatment costs (Edney, CongressDaily, 9/25).

Anemia Rx Coverage Decision
CMS officials on Monday in a letter to physicians and others who support a reversal of a decision to limit Medicare coverage for use of anemia medications said that they will not take such action without additional evidence, Reuters/Boston Globe reports (Reuters/Boston Globe, 9/25). In the letter, CMS Chief Medical Officer Barry Straube wrote, "CMS will reconsider ... when new evidence is presented or arguments are presented that the agency materially misrepresented existing evidence," adding, "In this case, no new medical evidence was presented."

CMS sent the letter to U.S. Oncology, the American Society for Clinical Oncology and the American Society of Hematology (Reichard [2], CQ HealthBeat, 9/24).

House Asks Pelosi To Block Hospital Reimbursement Reduction
Some House Democrats have asked Speaker Nancy Pelosi (D-Calif.) to pass legislation to block a provision in a CMS rule that would reduce Medicare inpatient hospital reimbursements, CQ HealthBeat reports. In a letter to Pelosi sent on Sept. 20, about three dozen House Democrats criticized the "behavioral offset" provision, which addresses the expectation that hospitals will "upcode," or bill Medicare for services reimbursed at higher rates, in response to changes that would link payments with the severity of the illnesses of patients. According to House Democrats, the provision will reduce Medicare inpatient hospital reimbursements by $20.3 billion over five years.

House Democrats asked Pelosi to "consider legislative avenues ... to protect seniors." The new rule takes effect on Oct. 1 (CQ HealthBeat, 9/24).

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