Uncle Sam Wants YOU

Officials at the Centers for Medicare & Medicaid Services are encouraging seniors and other members of the public to become fraud detectives by reporting misleading or deceptive sales tactics to 800-MEDICARE, the agency’s 24-hour information hotline. Suspects include postcards designed to look like they’re from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties.

During just one hourlong Cleveland news program in December, researchers found, viewers were treated to nine Advantage ads.

For the first time, CMS asked insurance and marketing companies this year to submit their Medicare Advantage television ads, to make sure they complied with the expanded rules. Officials reviewed 1,700 commercials from May 1 through Sept. 30 and nixed more than 300 deemed misleading, according to news reports. An additional 192 ads out of 250 from marketing companies were also rejected. The agency would not disclose the total number of TV commercials reviewed and rejected this year or whether ads from other media were scrutinized.

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Even though she died two years ago, my wife has been getting almost daily ads in the mail for Medicare advantage plans. Add in all the TV advertising, and it’s clear to me that these plans must be very lucrative for the insurance companies to pay for all that advertising.

Since the premiums are the same for Medicare and Medicare advantage, that profit has to come from some combination of lower payments to doctors and denied claims. Neither of those bode well for quality of care.

—Peter

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And it affects everyone…not just the folk who’ve elected to roll with the MA marketing “come ons”. Whether it’s at primary care or specialty level, the more MA beneficiaries there are in a patient demographic, the greater the burden has to be shared by the rest.

Wouldn’t be so bad if there was plenty of wiggle room but reimbursement levels across the board are being tightened unrealistically.