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CMS Official Warns Against Medicare Horror Stories

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A few bad apples could hurt the entire Medicare Advantage program.

Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services, delivered that message here Monday at a Medicare and Medicaid conference organized by America’s Health Insurance Plans, Washington.

Private insurers have been partners in successful CMS efforts to launch the Medicare Advantage program and the Medicare Part D prescription drug program, Weems said.

But “CMS is not the only government entity that will be stepping up oversight” of the Medicare Advantage program in the wake of reports of marketing problems, Weems said.

“The Congress is watching,” Weems affirmed. “Unless these marketing abuses are nipped in the bud, congressional and public sentiment could easily turn against the entire Medicare Advantage program.”

CMS officials are glad that they were able to let the 7 Medicare Advantage carriers that voluntarily suspended sales in June resume selling coverage, Weems said.

“I’m pleased to let you know that, after a rigorous review of the 7 organizations, CMS has determined they now meet the multiple requirements for beneficiary protection,” Weems said.

But CMS is continuing to watch Medicare Advantage plans closely, and it recently imposed fines on 2 plans in connection with allegations of marketing abuses, Weems said.

“I want to be clear,” Weems said. “Despite the fact that we believe civil monetary penalties were necessary, they represent a failure for all of us. … The reality is, we should have prevented the abuses, and we will need to fix them together.”

Weems also talked about CMS plans for the 2008 open enrollment season, which will start in October.

CMS marketers will be making special efforts to reach out to low-income seniors, who may qualify for extra subsidies, Weems said.