Medicare marketing, claims handling problems abound

Misbehavior and administrative problems are surprisingly common within Medicare contractors, according to a new review of federal audits by The New York Times. In particular, plans are having problems in marketing the Medicare Advantage product appropriately and in responding to consumer challenges related to quality of care issues.

CMS has been cracking down on violations by Medicare plan operators of late, and has handed out $770,000 in fines to 11 companies since March. Violators have included big names like UnitedHealth, Humana and WellPoint.

UnitedHealth, for example, was accused of failing to supervise marketing representatives and improperly denying claims without giving proper explanations to beneficiaries. Humana has failed to keep up with complaints about marketing and has not handled claims denials appropriately, the agency says. And WellPoint's UniCare subsidiary had a backlog of about 354,000 claims and took nearly 16 minutes to answer provider phone calls.

To find out more about the investigation:
- read this article from The New York Times

Related Article:
Medicare Part D marketing not going well. Report

Read more on: Medicare l CMS

Post a comment