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PPO Group: Medicare Test Plans Not Real PPOs

By Staff Writer

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NU Online News Service, Oct. 4, 2004, 5:15 p.m. EDT

The American Association of Preferred Provider Organizations, Jeffersonville, Ind., says bad test program design may be at least partly responsible for the weak performance of a group of Medicare test PPOs.[@@]

The U.S. Government Accountability Office reported last week that the test PPOs did little to improve beneficiaries’ benefits or hold down costs.

The results were not surprising, because the Centers for Medicare and Medicaid Services, the agency that runs Medicare, ignored AAPPO’s concerns about the PPO test program, according to a statement by AAPPO President Karen Greenrose.

“The demonstration project offerings were not the same PPO model in which 55% of Americans with health care coverage in the private sector are enrolled,” Greenrose says in the statement.

The GAO report is misleading because it might confuse readers who think that the Medicare test PPOs are like ordinary private-sector PPOs, Greenrose says.