CMS Audit Raises Concerns About Humana's Marketing Of Medicare Advantage Plans

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A CMS audit of Humana,one of the nation's largest Medicare insurers, raises concerns that thecompany has not done enough to curb misleading sales practices to theelderly and people with disabilities, AP/Long Island Newsdayreports. Humana provides coverage to about 4.6 million Medicarebeneficiaries, with about 3.5 million enrolled in prescription drugplans and about 1.1 million enrolled in Medicare Advantage plans.

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Inone audit, conducted in July, Medicare officials wrote that the companywas having a difficult time keeping up with the number of complaints itreceived and investigating each one, as the company said it would. Manycomplaints have come from beneficiaries who thought they were enrollingin drug coverage but instead were enrolling in comprehensive MA plans.Federal officials had received so many complaints about the practicethat seven large insurers agreed to stop marketing certain MA plans while changes were being made to clarify marketing. CMS recently said the companies could resume marketing the plans after complying with the agency's guidelines for participation.

Inaddition, Medicare officials said many of the complaints indicated thatbeneficiaries received incorrect information from Humana salesrepresentatives. The audit also found that Humana does not takeappropriate disciplinary action against agents who receive largenumbers of policy cancellations.

Heidi Margulis, senior vicepresident of government relations at Humana, said several of theconcerns cited by the audits have been addressed. She added, "It's CMS'opinion that we are in compliance. They are the people who lifted themoratorium." The audit is one of about 90 "corrective action plans" CMShas issued and posted on its Web site. Acting CMS Administrator KerryWeems said that making the audits public is part of an initiative toincrease transparency in Medicare (Freking, AP/Long Island Newsday, 10/3).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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