Horror Stories Could Cost MA, CMS Official Warns

The price for continued horror stories of marketing abuses in the Medicare Advantage program is that public sentiment “could easily turn” against the program, a top official of the Centers for Medicare and Medicaid warned health insurance industry officials Monday.

Kerry Weems, CMS acting administrator, made his comments at the annual Medicare & Medicaid conferences sponsored by America’s Health Insurance Plans, Washington.

At the same time, Weems lauded the industry for its help in launching the Medicare Advantage and Part D prescription drug programs under Medicare.

He “especially” noted “our partnership” to establish the Medicare Part D Prescription Drug Program and the Medicare Advantage program, calling them two truly landmark benefits that have “immeasurably advanced CMS’s efforts to transform our programs from passive bill-payers to actively purchasing quality and value.”

But he added, “The old saying that ‘a few bad apples spoil the whole bunch’ is particularly apt with regard to marketing abuses.”

“CMS is not the only government entity that will be stepping up oversight [of the program],” he said.

“The Congress is watching,” he added. “… unless these marketing abuses are nipped in the bud, Congressional and public sentiment could easily turn against the entire MA program.”

Weems announced at the meeting that the “voluntary” suspensions of seven programs for alleged marketing abuses for MA programs has been lifted.

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

CMS will continue oversight of all plans, and take appropriate action if warranted.