Editorial: Oversight woefully lacking

Saturday, Oct. 13, 2007 | 7:12 a.m.

Federal audits show tens of thousands of Medicare patients have fallen prey to deceptive sales practices and claims have been erroneously denied by at least 11 insurance companies under the Bush administration's Medicare drug benefit program.

One of those companies is UnitedHealth, which may not bode well in the eyes of Nevadans who currently receive Medicare benefits through Sierra Health Services' Senior Dimensions program. UnitedHealth is seeking to acquire Sierra Health.

In a story Sunday, The New York Times reported that Medicare has fined the 11 companies more than $770,000 since March for violations that include failing to notify program recipients of benefits changes in a timely manner. In some cases, this delayed patients' access to critically needed medicines.

The Times' review of 91 federal audits also shows that problems with the Medicare drug benefit have included massive claims and complaints backlogs, insurance companies' failures to answer telephone calls from consumers, doctors and druggists, and even improper termination of coverage for people who have HIV and AIDS.

Marketing abuses also were rampant, the Times' analysis shows. Most of these occurred in the Medicare Advantage program, a program created by the former Republican-led Congress in which Medicare recipients get their prescription drugs through private comprehensive health insurance plans subsidized by the federal government.

Not only have federal audits shown that this program costs taxpayers 12 percent more, on average, but auditors also said the program has subjected Medicare beneficiaries to such schemes as marketers telling them that their benefits would be suspended if they did not sign up for the program that the marketer was selling.

Seven companies suspended marketing their Medicare plans in June, the Times reports. But Medicare officials allowed the companies to resume marketing after they had imposed measures to more closely monitor sales agents.

Still, such after-the-fact measures don't provide us with a comfort level that there are adequate oversight and cost controls of the Medicare drug program, a privatized program that has seen its share of problems from its inception.