CMS Audit Raises Concerns About Humana's Marketing Of Medicare Advantage Plans

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 05 Oct 2007 - 11:00 PST

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A CMS audit of Humana, one of the nation's largest Medicare insurers, raises concerns that the company has not done enough to curb misleading sales practices to the elderly and people with disabilities, AP/Long Island Newsday reports. Humana provides coverage to about 4.6 million Medicare beneficiaries, with about 3.5 million enrolled in prescription drug plans and about 1.1 million enrolled in Medicare Advantage plans.

In one audit, conducted in July, Medicare officials wrote that the company was having a difficult time keeping up with the number of complaints it received and investigating each one, as the company said it would. Many complaints have come from beneficiaries who thought they were enrolling in drug coverage but instead were enrolling in comprehensive MA plans. Federal officials had received so many complaints about the practice that seven large insurers agreed to stop marketing certain MA plans while changes were being made to clarify marketing. CMS recently said the companies could resume marketing the plans after complying with the agency's guidelines for participation.

In addition, Medicare officials said many of the complaints indicated that beneficiaries received incorrect information from Humana sales representatives. The audit also found that Humana does not take appropriate disciplinary action against agents who receive large numbers of policy cancellations.

Heidi Margulis, senior vice president of government relations at Humana, said several of the concerns cited by the audits have been addressed. She added, "It's CMS' opinion that we are in compliance. They are the people who lifted the moratorium." The audit is one of about 90 "corrective action plans" CMS has issued and posted on its Web site. Acting CMS Administrator Kerry Weems said that making the audits public is part of an initiative to increase transparency in Medicare (Freking, AP/Long Island Newsday, 10/3).

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