Agency Tells Humana To Stop Its Portrayal Of Health Reform
• By ARTHUR D. POSTAL
Published 9/21/2009
NU Online News Service, Sept. 21, 357 p.m. EDT
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WASHINGTON—The Centers for Medicare and Medicaid Services is demanding that Humana stop telling subscribers that current health care reform legislation could cause them to lose benefits and services provided through the Medicare Advantage program.
The letter was sent Friday under the signature of Teresa DeCaro, acting director of CMS’ Medicare Drug and Health Plan Contract Administration Group, to Gail Miller, Human’s vice president of strategic and product development.
In response, Tom Noland, a spokesman for Humana in Louisville, said, “Humana is cooperating with CMS on resolving this issue.”
The letter stating subscribers could lose “important benefits and services” was presumably sent because the various health care reform proposals would cut Medicare Advantage payments in order to help pay the cost of adding approximately 94 percent of uninsured Americans to the rolls.
Various proposals in House bills would cut the Medicare Advantage program by $175 billion over 10 years, while the bill introduced by Sen. Baucus would reduce the program’s expenditures by $123 billion over 10 years, according to a Congressional Budget Office estimate released last Wednesday.
The letter was sent at the request of Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, who issued a statement this morning alleging that the letters makes false claims about provisions regarding Medicare Advantage contained in Sen. Baucus’ proposed “America’s Healthy Future Act.”
Markup of the legislation language introduced last Wednesday by Sen. Baucus will begin tomorrow by the Senate Finance Committee.
According to the CMS letter, Humana has been contacting enrollees in one or more of its Medicare Advantage plans through a letter whose envelope states it contains “important information about your Medicare Advantage plan—open today!”
The CMS letter says that besides saying enrollees could lose their access to Medicare Advantage plans, the letter “makes several other claims about the legislation and how it will be detrimental to enrollees, ultimately urging them “to contact congressional representatives to protest actions referenced in the letter.”
In asking Humana to cease sending such letters, Ms. DeCaro of CMS said the agency is concerned that, “among other things, this information is misleading and confusing to beneficiaries, represents information to beneficiaries as official communications about the Medicare Advantage program, and is potentially contrary to federal regulations and guidance for the Medicare Advantage and Part D programs under Medicare and other federal laws, including HIPAA.”
“As we continue our research into this issue, we are instructing you to end immediately all such mailings to beneficiaries and to remove any related materials directed to Medicare enrollees from your Web site,” the CMS letter said.
In disclosing that he had asked CMS to “condemn” insurance industry “scare tactics,” Sen. Baucus said the health reform legislation he introduced “will include significant improvements to the Medicare program that will benefit seniors.”
He said it is “wholly unacceptable for insurance companies to mislead seniors regarding any subject—particularly on a subject as important to them, and to the nation, as health care reform.”
He said the health care reform bill he released last week “strengthens Medicare and does not cut benefits covered under the Medicare program—and seniors need to know that.”
He added, “From lower prescription drug costs to free preventive care to better treatment for chronic conditions, seniors have so much to gain from health reform and I’m not going to let insurance company profits stand in the way of improving Medicare for seniors.”
He alleged that “false claims” in the Humana letter to beneficiaries include the threat of seniors losing benefits in the Medicare Advantage program.
In fact, Sen. Baucus said, his legislation does not include cuts to Medicare benefits and would, instead, “improve the value of Medicare Advantage by reforming payments so that they appropriately reimburse insurers for their costs and promote plans that offer high quality, efficient health care for seniors.”
He also noted that the independent Medicare Payment Advisory Commission (MedPAC) has found that even after the cost of delivering benefits, of marketing and of profits, Medicare Advantage plans are paid 14 percent more, on average, than traditional Medicare. |
