Medicare Audits Show Problems in Private Plans
By ROBERT PEAR
Published: October 7, 2007
http://www.nytimes.com/2007/10/07/us/07medicare.html?th&emc=thWASHINGTON, Oct. 6 — Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.
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The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint.
The audits document and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications. In July, Medicare terminated its contract with a private plan in Florida after finding that it posed an “imminent and serious threat” to its 11,000 members.
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For years, Democrats have complained about efforts to “privatize Medicare,” and they are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients.
But federal officials point with pride to their efforts to police the Medicare market, and they say that competition among private plans has been a boon to beneficiaries, offering more choices at lower cost than anyone expected.