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June 15, 2007 at 05:51 PM
Several health carriers have agreed to take a break from selling new private Medicare fee-for-service coverage.
The Centers for Medicare and Medicaid Services already has responded to consumer group criticisms of marketing of plans in its newly expanded private Medicare FFS program by setting new systems and management controls requirements that will take effect Oct. 1.
Now the CMS says 7 carriers have agreed voluntarily to suspend marketing altogether while implementing the safeguards required by CMS and other safeguards.
The 7 carriers are units of Aon Corp., Chicago; Blue Cross and Blue Shield of Tennessee, Chattanooga, Tenn.; Coventry Health Care Inc., Bethesda, Md.; Humana Inc., Louisville, Ky.; UnitedHealth Group Inc., Minnetonka, Minn.; Universal American Financial Corp., Rye Brook, N.Y.; and WellCare Health Plans Inc., Tampa, Fla.
The suspensions will be lifted when CMS certifies that plans have the systems and management controls in place to meet the Oct. 1 conditions, CMS officials say.
“This voluntary agreement demonstrates that CMS and the plans are stepping up to ensure that deceptive marketing practices end immediately, and that beneficiaries understand what they are purchasing,” Leslie Norwalk, acting CMS administrator, says in a statement.
The private FFS program, which relies on private insurers to provide Medicare plans which permit members to see any willing provider, now has about 1.3 million members, Norwalk says.
The CMS has received 2,700 complaints about agents selling private FFS plans between December 2006 and April 2007, Norwalk says.
Companies that violate the “voluntary agreement” to suspend marketing “will be subject to a full range of available penalties, which can include suspension of enrollment, suspension of payment for new enrollees, civil-monetary penalties, and termination of the plan’s involvement in the Medicare program,” officials say.
The full range of updated conditions will be in effect for all sponsors of private FFS plans beginning Oct. 1, and violations of those conditions will be subject to the same types of penalties, officials say.
The CMS is requiring of private FFS plan sellers that:
- All materials, including advertisements, enrollment materials, and materials used at sales presentations by employees or contracted representatives of a health insurance company must include CMS model disclaimer language.
- All representatives selling the product to beneficiaries must pass a written test.
- The carrier must reach out to providers to ensure that they have reasonable access to the plan’s provider payment information.
