By Jeffrey Young - 11/02/07 07:42 PM EDT
CMS was hit with accusations that the agency was too close to the health insurance industry and politically pressured to promote private Medicare Advantage plans over traditional, government-run Medicare.
In response to these criticisms, acting CMS Administrator Kerry Weems has promised to make oversight of private health plans in Medicare Part D and Medicare Advantage a hallmark of his tenure.
The health plans have been put on notice that CMS will be more active in seeking out signs of marketing abuses rather than relying primarily on incoming complaints, Weems indicated.
“The message is clear: We’re watching,” Weems told The Hill.
Weems assumed the leadership of CMS in September as acting head but has yet to win Senate confirmation. He is on a bus tour of New England this week to answer questions about Medicare at town-hall meetings.
One congressional aide said that CMS’s message has reached Capitol Hill, but lawmakers will be watching to see if the agency comes through.
“I don’t think we know either way,” said an aide to Sen. Max Baucus (D-Mont.), chairman of the Finance Committee. “We’re just not going to know until December [or] January.”
Baucus, one of only two Democrats who helped write the 2003 law creating the Medicare drug benefit, has sharply criticized CMS’s implementation of the program. During Weems’s confirmation hearing in July, he said that he would be watching closely. “This is really important to Sen. Baucus,” his aide said.
Marketing for Medicare Part D and Medicare Advantage plans began on Oct. 1, before which the insurance companies had to clear their marketing plans through CMS. The open-enrollment period for the plans begins on Nov. 15 and runs through Dec. 31.
“We’ve set up an active surveillance network,” Weems said.
CMS will monitor the plans’ advertising, their employees’ and independent brokers’ sales practices, and their other efforts to promote their products to beneficiaries. In addition to working to ensure that beneficiaries are presented with accurate information, CMS will be on the lookout for companies that attempt to steer people seeking Part D plans into the more comprehensive Medicare Advantage plans, which are more profitable.
The health insurance industry says it supports CMS’s plans to ferret out companies using unlawful practices. “We do need to identify the bad actors as soon as possible,” said Mohit Ghose, spokesman for America’s Health Insurance Plans.
One of the new weapons in CMS’s arsenal this year is undercover operations using agency employees. Under the “secret shopper” program, representatives from Medicare anonymously attend promotional meetings between health plans and groups of beneficiaries.
Weems indicated that “secret shoppers” are a key part of their oversight efforts and that top people from the agency are being called on to participate. “The senior staff at CMS is doing this,” he said.
After these meetings, the agents submit audit reports to CMS headquarters detailing whether the plans are providing accurate information to beneficiaries. The agency then follows up with the beneficiaries and with the plans if corrective actions are needed.
In the agency’s limited experience so far, they have uncovered some abuses, Weems said. These incidents have ranged from health plan officials providing “fuzzy” information to being downright “deceptive,” he said.
The Baucus aide noted that cleaning up the marketing practices was only one part of the issue. Making sure beneficiaries are provided with the best information to choose the right Part D plan also is key, and the results will not be known until after enrollment closes.
An attorney who advocates for Medicare beneficiaries and is highly critical of Part D said that the vast array of plans on the market presents challenges to beneficiaries.
“There [are] too many plans to analyze, making it almost impossible to advise beneficiaries,” the Center for Medicare Advocacy’s Vikki Gottlich wrote in an e-mail.
Baucus has repeatedly expressed concern that there are too many Part D plans on the market and that many of them are indistinguishable from each other. “The market is just not consolidating yet. It’s still a very wide-open field,” his aide said.
CMS also has to do a better job reaching out to low-income beneficiaries who are eligible for more generous subsidies, the Baucus aide said. “I have not seen anything that leads me to believe that they have a handle on this,” the aide said, noting Baucus has introduced legislation to make the subsidy more accessible.
Weems said that the agency, using ZIP code data on household income, was targeting this population intensely. “We make sure that we go to low-income neighborhoods,” he said, citing a trip he made Wednesday to a housing center in Springfield, Mass., largely inhabited by low-income Hispanics, as an example.