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GAO Weighs in on Medicare Advantage Mailers

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WASHINGTON BUREAU — The U.S. Government Accountability Office says the Centers for Medicare and Medicaid Services (CMS) followed the rules but took an “unusual” action when it told health carriers to stop mailing Medicare Advantage plan enrollees warnings about pending legislation.

The GAO today released a report developed in response to questions from Republican House members about the decision by CMS to order Humana Inc., Louisville, Ky. (NYSE:HUM), to stop sending Medicare Advantage (MA) plan enrollees warnings about what the proposed program changes might do to their coverage.

CMS also told other large Medicare Advantage carriers to stop communicating with enrollees about pending legislation.

“In general, CMS’s handling of MA communications on pending health reform legislation appeared to adhere to the agency’s policies and procedures,” GAO officials say in the report.

The Sept. 21, 2009, CMS memo instructing all Medicare Advantage organizations to discontinue communications on pending legislation while CMS conducted its investigation “was unusual,” officials say.

Representatives from CMS and Humana were not immediately available for comment.

GAO officials say Medicare Advantage plan and CMS regional staffers “told us they were unaware of CMS ever directing all MA organizations to immediately stop an activity before CMS had determined whether that activity violated federal laws, regulations, or MA program guidance.”

“When asked about this directive, officials from CMS’s central office stated that,

given the degree of potential harm to beneficiaries, the action was appropriate for the circumstances,” GAO officials say.

Republican House members have criticized CMS offficials for ordering Humana to cease mailings to subscribers.

The mailings stated that, if proposed funding cuts became law, “millions of seniors and disabled individuals could lose many of the important benefits and services that make MA health plans so valuable.” Humana also encouraged beneficiaries to contact members of Congress and ask them to protect Medicare Advantage funding.

CMS officials found that 6 of the 189 organizations with Medicare Advantage program contracts in September 2009 had violated enrollee communications rules, GAO officials say.

“These organizations used various means to communicate with about 3 million beneficiaries on pending health reform legislation,” GAO officials say. “The agency concluded that four violated CMS’s Medicare Marketing Guidelines, all six violated CMS’s Data Use Agreement, and three violated the prohibition on using federal funds to lobby members of Congress on pending legislation.”


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