Officials at the Centers for Medicare and Medicaid Services are proposing changes to the Medicare Part D prescription drug plans and Medicare Advantage plans to strengthen oversight of the programs.
The proposal includes mandatory self-reporting aimed at curbing potential fraud and misconduct by plans. It also includes changes to streamline the process of intermediate sanctions and contract determinations, and it clarifies the process for imposing civil money penalties.
“While the majority of Medicare Advantage and Medicare Prescription Drug Plans that offer important benefits to beneficiaries are conducting themselves professionally, it is important for CMS to be able to take swift action to safeguard beneficiaries from unlawful or questionable business practices,” Leslie Norwalk, acting CMS administrator, said in a statement.
But the Bush administration is falling short in policing the marketing practices of Medicare Advantage plans, said Robert M. Hayes, president of the Medicare Rights Center. He has called on Congress to establish clear safeguards against “abusive and deceptive” marketing practices and to give state governments the power to enforce those standards. He also called for the establishment of minimum benefit standards and standardized benefit packages to allow for better consumer comparison of plans.
Officials at the American Medical Association are also reporting problems with Medicare Advantage plans. An online survey of more than 2,200 AMA member physicians conducted in March found that patients had difficulty understanding how the plans work or have had coverage denials for services that were covered under traditional Medicare plans.
For example, about 84% of physicians with patients in Medicare Advantage managed care plans reported that their patients had difficulty understanding how the plan works, as did about 80% of physicians with patients in Medicare Advantage private fee-for-service plans.