Dr. Mehmet Oz — President Donald Trump's nominee to be the administrator of the Centers for Medicare and Medicaid Services — is famous for being a strong supporter of the Medicare Advantage plan program and plans that try to actively manage and improve the patients' care.
But Oz is not happy with everything about Medicare plan sales arrangements.
The Medicare plan sales topic came up at a Senate Finance Committee hearing on the Oz nomination Friday, when Sen. Ron Wyden, D-Ore., talked about his concerns about high-pressure Medicare plan sales practices.
Wyden, who started the Oregon chapter of the Gray Panthers and was the director of the Oregon Legal Services Center for the Elderly, recalled that he used to help older people with shoddy Medicare supplement insurance policies written before the current federal Medicare policy rules took effect.
"What do you think the biggest abuses are right now?" Wyden asked Oz.
"There's brokers that get involved in churning policies," Oz said. "They get you to switch from policy to policy ... Some brokers do a great job; some don't. We probably have too many."
Oz suggested that CMS could reduce churning risk by letting participants stay enrolled in the same plan for multiple years, to reduce the amount of program revenue going to brokers.
"I think there are ways for us to ensure that the marketing process works better for the folks involved," Oz said. Oz said he also supports finding ways to encourage Medicare Advantage plan issuers to reimburse some of the money used to encourage consumers to enroll in the plans, "to ensure that Medicare Advantage does not cost more than fee-for-service Medicare."
What it means: The Trump administration may not necessarily be gentler on Medicare Advantage plan issuers than the administration of former President Joe Biden was.
The backdrop: CMS is an arm of the U.S. Department of Health and Human Services that oversees Medicaid and federal rules that affect private health insurance as well as Medicare.
The Medicare Advantage program gives private insurers a chance to sell private plans that fill in some of the many gaps in traditional Medicare coverage.
Oz is a cardiothoracic surgeon and former Columbia University medical school professor who is best known for being a medical TV talk show host.
In connection with his efforts to work with Medicare Advantage plan marketing programs, he has a New Jersey accident and health insurance producer's license.
He has not kept up with his continuing education requirements, but the producer's license will be in effect until June 30.
Oz and Sen. Warren: Sen. Elizabeth Warren, D-Mass., asked Oz about reports that some Medicare Advantage plan issuers try to "upcode," or make Medicare Advantage plan enrollees look sicker than they are, to qualify for higher risk-adjustment support payments.
Oz said he agrees with Warren about the importance of fighting upcoding.
Upcoding "doesn't just help the scoundrels who are stealing from the vulnerable,' Oz said. "It's actually hurting the people trying to take care of those vulnerable populations."
Oz said he hasn't been inside CMS yet and can't confirm specific reports about companies engaging in upcoding.
"But, if confirmed, this will be one of the topics that is relatively enjoyable to go after, because I think we have bipartisan support," he said.
Dr. Mehmet Oz testified Friday at a Senate Finance Committee hearing on his nomination to be the CMS administrator. Credit: Senate Finance Committee
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