By Thomas Goldsmith
Privately run Medicare Advantage insurers attract more enrollees each year with prominent advertising and enticing perks. But the program, with about 1 million North Carolina enrollees, faces challenges on specifics from federal regulators, the courts and Congress about the profits it makes, its consumer advertising and some of its internal practices.
As federal regulators are taking aim at aspects of Medicare Advantage, such as allegedly fraudulent billing practices, a report from the U.S. Senate Finance Committee is one of the sources that lists complaints calling its marketing misleading. Those problems have been seen in North Carolina, as well as across the country.
“The North Carolina Department of Insurance shared that its Seniors’ Health Insurance Information Program (SHIIP) had received a number of complaints involving dually eligible beneficiaries who had their enrollment changed to a different [Medicare Advantage] plan even though neither the beneficiary, family member, or power of attorney had been engaged in an enrollment discussion with the plan or an agent,” the August 2022 report reads.
(Dually eligible beneficiaries are eligible for Medicaid, the health insurance that covers low-income people, and for Medicare, which is mostly for people older than 65.)
Now, federal regulators are proposing new rules to curb such deceptive practices. Regulators say the rules are necessary to make sure potential Medicare Advantage customers can receive accurate information about the plans and their differences from traditional Medicare.
In addition to restricting the advertising that draws millions of enrollees to Medicare Advantage, the federal Centers of Medicare and Medicaid Services is working with the federal Department of Justice to crack down on billing practices that they contend can unnecessarily increase company profits by billions annually.
Recently announced moves by CMS to improve the accuracy of billing by Medicare Advantage companies won praise late last week in a joint letter from a group of more than three dozen leading figures from public health, public policy, health care and clinical care.
“CMS has taken a strong and appropriate approach to improving the accuracy of payment in the MA Program,” said Dr. Don Berwick, a former administrator of the Centers for Medicare and Medicaid Services who signed the letter.
Additional signers included faculty from Yale, Harvard, Stanford, Southern California, Pennsylvania and New York universities, as well as former officials of CMS, the Center for Medicare and Medicaid Innovation and the Medicare Payment Advisory Commission, known as MedPac,