Managed Healthcare Executive - October 2008 - (Page 7)

NEWS ANALYSIS OIG’s recommendations for improving the oversight process. At the same time, Congress’ Government Accountability O ce (GAO) issued a report criticizing a lack of auOIG faults insurers’ sales materials diting by CMS to ensure that PDPs are doing all they should to prevent fraud. while CMS tightens marketing rules Medicare plans are supposed to establish training programs to inform employJILL WECHSLER | W A S H I N G T O N B U R E A U C H I E F ees of correct procedures for preventing and detecting fraud. While insurers WASHINGTON, D.C. — Many of period that begins November 15. generally have developed written polithe brochures and ads issued by health CMS’s nal rule is no surprise to cies and standards of conduct and have plans to promote Medicare drug bene ts Medicare plan sponsors, as most of appointed requisite compliance o cers, to seniors fail to meet standards, and the the speci cs were proposed last May employee training and internal moniCenters for Medicare and Medicaid Ser- and then included in the Medicare toring is less widespread. GAO further vices (CMS) has fallen short in monitoring reform bill approved by Congress in notes that CMS is not conducting reguthe program, say federal investigators. July. Legislators and regulators will be lar on-site audits of PDP anti-fraud efA separate government audit also keeping a close watch on forts, admittedly because criticizes CMS and insurers for lax how well insurers adhere of budget cuts on auditing e orts in preventing Medicare fraud. to the sti er sales policies, programs. CMS seeks to stem the criticism by particularly in light of a These reports support tightening up the rules governing recent report from Congress and state marketing of Medicare Advantage the HHS O ce of o cials who would plans and stand-alone prescription the Inspector Genlike to see greater drug plans (PDPs) as insurers head eral (OIG) which state involvement into the 2009 open enrollment sea- found that nearly in overseeing PDP per enrollee son. Evidence of continued sales abus- 85% of marketing marketing and other Fine faced by insurance es will provide added ammunition materials issued by activities. State infor those members of Congress who prescription drug surance regulators sales reps for violating would like CMS to take over the Part plans (PDPs) in CMS marketing regulations monitor sales agents D drug bene t and to reduce the role 2007 did not fully and representatives Medioimages/Photodisc/Getty Images involved in Medicare of private plans in providing health- meet CMS guidecare to seniors. lines. The OIG also pointed the nger plan marketing and have taken enforceThe marketing regulations published at CMS for providing poor models ment actions. by CMS September 15 aim to protect for insurers’ marketing materials and Last month, Humana agreed to pay Medicare bene ciaries from “deceptive or then failing to monitor resulting doc- $750,000 to Wisconsin insurance o high-pressure marketing tactics” by insur- uments in a timely fashion. cials to settle allegations about violations ance companies and their agents, accordSenate Finance Committee Chair- by company agents selling MA plans and ing to CMS Acting Administrator Kerry man Max Baucus (D-Mont.) blasted this PDPs. Current law limits state oversight Weems. Sales reps can’t o er free meals “near-total failure by CMS” to regulate of Medicare plan sponsors and states’ abilduring sales pitches or make unsolicited how insurers market plans to seniors as ity to address bene ciary complaints. sales calls to seniors, for example. “unconscionable” and promised to moniThe July Medicare legislation stopped Companies that violate the rules face tor how CMS was correcting these prob- short of enhancing state regulators’ insti nes, starting at $25,000 for each en- lems. CMS o cials pointed out that many volvement in Medicare marketing, but rollee a ected by illegal marketing tactics. of the cited problems characterized the Congress plans to revisit it. Continued The policies went into e ect last month program’s initial years and that the agency complaints will provide reason for revising and will apply to the fall open enrollment already was implementing many of the the MA and PDP programs. MHE Stiff policies applied to Part D marketing $25,000 OCTOBER 2008 7

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Managed Healthcare Executive - October 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Healthcare Reform Trends in 2009 Cost Control Strategies Predicted Premium Increase Top Challenges in 2009 IT System Integration Technology Innovation Disease Management Health Management Pharmacy Best Practices Technology Desktop Resource Ad/Edit Index Managed Care Outlook Statement of Ownership

Managed Healthcare Executive - October 2008

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