Audits reveals problems with Medicare drug plans

Audits of the drug plans offered through Medicare have revealed that "Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers. (Source: "Medicare Audits Show Problems in Private Plans" NY Times, OCt. 7, 2007.) "Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits. The companies include three of the largest participants in the Medicare market, UnitedHealth,  Humana and WellPoint." Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, was quoted as saying, “The start-up period is over. I am simply not going to tolerate marketing abuses.”

The audits which uncovered the problems were conducted by the Department of Health and Human Services. Compliance problems occurred most often in the plans with regards to marketing, especially in the fast-growing Medicare Advantage product, which provides a full range of benefits including coverage of doctor’s visits and hospital care. Other problems included the "handling of appeals and grievances related to the quality of care."