Editorial: HMOs are misleading on Medicare

Wednesday, April 14, 1999 | 11:53 a.m.

A growing number of Americans are turning to HMOs for their Medicare benefits, but a recent government report shows that these HMOs often are giving the patients misleading and sometimes flat-out wrong information. The General Accounting Office reviewed the materials distributed by 16 HMOs and discovered "significant errors and omissions." The investigative arm of Congress noted that these brochures frequently are the only source of information for Medicare beneficiaries.

Some HMOs inform female patients that they must get a referral from a primary care physician before they get a mammogram, but federal rules are clear that no such referral is needed. HMOs sometimes also understate how much they are supposed to pay for prescription drugs -- one HMO informed its members it would pay only $600 when in fact it was supposed to cover $1,200 a year. In addition to giving out inaccurate information, HMOs also are frequently guilty of omitting some information, such as failing to tell Medicare patients that they can appeal decisions by their HMOs.

While blame definitely should be borne by the HMOs, the federal government also shouldn't escape its share of responsibility. The Department of Health and Human Services, after all, is required to approve these materials before they go to patients. The GAO found that Health and Human Services' lack of detailed standards to evaluate the brochures for content and terminology allows materials with wrong information to slip through the cracks. Even on those occasions when government officials were notified of the errors, the auditors discovered that the mistakes don't always get corrected.

As the New York Times noted in a story Tuesday about the GAO report, HMOs cover 7 million people who are either elderly or disabled. While this amounts to just 18 percent of all Medicare beneficiaries, the number has almost doubled in the past three years, providing even more reason for the federal government to ensure that HMO patients receiving Medicare benefits get accurate information.

Medicare patients don't have the time to research all the laws and regulations dealing with Medicare HMOs; the beneficiaries assume that since the government has given its imprimatur on the HMO publications that everything they read is true. If the government is going to turn over the responsibility to a third party for government-entitled care, then it should ensure that basic oversight is performed so that patients don't get shorted on the medical care they are supposed to receive. The Clinton administration should make sure that Health and Human Services puts in place better fact-checking procedures to ensure that the HMOs aren't allowed to distribute misleading information.