Editorial: Questionable tactics

Thursday, May 10, 2007 | 7:27 a.m.

Sin ce the late 1990s, insurers have been allowed to administer a private fee-for-service version of traditional Medicare coverage so that Medicare recipients would, ostensibly, have better access to medical services.

One of the reasons for this arrangement, in which the federal government pays private insurers to administer the Medicare Advantage plans, was to ensure services in areas where facilities and doctors were limited or did not accept Medicare coverage.

But according to a story by The New York Times this week, an increasing number of these private insurers are enrolling Medicare patients in plans that the patients don't understand and are even enrolling some people without their knowledge.

Furthermore, in some instances not only are patients often forking over higher co-payments, the federal government is paying, on average, 19 percent more for services administered through these plans than it pays for traditional Medicare services, the Times reports.

While insurance agents in some states have been arrested and accused of defrauding Medicare recipients, the practice likely has flourished because such incidents largely are left up to state insurance commissioners to investigate. But with about 8 million of the nation's 43 million Medicare beneficiaries enrolled in private plans, it is obvious that the potential for fraud is large. State insurance commissions, which often have limited resources and staffs, cannot be expected to be the front line of defense against these fraudulent practices.

The federal government needs to be more involved in pursuing these cases. Medicare is a federally funded program into which all American workers pay and that is intended to benefit all Americans once they are eligible. It is unconscionable that this valuable and necessary program is being co-opted by unscrupulous private insurers who are wasting taxpayers' money and cheating older Americans out of benefits to which they are entitled.