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CMS Posts Reams of Data on Private Plan Violations

By John Reichard, CQ HealthBeat Editor

October 5, 2007—Acting Centers for Medicare and Medicaid Services (CMS) Administrator Kerry Weems made good this week on his promise to publicly post the names of private plans in Medicare that violate agency rules governing marketing, drug coverage, appeals, and other aspects of plan operations.

By posting hundreds of pages of information on rules violations by dozens of plans, the data fulfills a "transparency" pledge made by Weems when he first took over at CMS to be more open about the agency's dealings with the health care industry.

But consumer representatives complain the information posted by CMS requires too much computer power and patience with both downloading and poring through legalese in the massive files to be of practical value to seniors trying to pick a prescription drug or private health plan in Medicare.

The information posted by CMS on its Web site is presented in the form of "corrective action plans" telling a total of 39 companies what actions they must take to comply with agency regulations. The companies include some of the biggest names in Medicare's private plan market, ranging from United HealthGroup to Humana to Michigan Blue Cross-Blue Shield.

Violations include managed care companies breaking rules to prevent misleading marketing practices, to ensure beneficiaries access to prescription drugs and to establish grievance and appeals procedures, among other areas, according to the corrective action plans. Many of the violations appear to have been identified by going through the written materials of companies and finding gaps in their policies and procedures governing those areas of plan operations.

However, the information is not arranged in a way that is consumer friendly, consumer advocates say. "To say it's now "public" is not exactly meaningful," said Deane Beebe, a spokeswoman for the Medicare Rights Center, a consumer advocacy group. "It's not accessible or understandable."

Beneficiaries may not have computers that allow them to easily open the files—presuming they know such information exists in the first place, she said. While a CMS report about a nursing home's violations may be placed in the lobby of the facility for all to see, in many cases seniors in the managed care or drug-only plans affected by the violations, or those interested in enrolling, may not know about the corrective actions posted on the CMS Web site.

To guide consumers in their selection of a plan, Beebe said the information should be incorporated in the CMS Web-based "Medicare Plan Finder" that helps beneficiaries compare plans, and in report cards that the agency plans to issue later this year on Medicare prescription drug plans and health plans in the Medicare Advantage program.

"It's CMS' job to monitor and report problems with the private health and drug plans," Beebe said. “But unless consumers know there is information available on the plans' failings and what, if anything, is being done to address these problems, consumers will continue to be harmed by plan violations.”

Weems said recently there are no immediate plans to incorporate the information in the corrective action plans into the Plan Finder.

A CMS spokesman had no immediate comment on whether the information would affect ratings on the plan report cards to be issued by CMS later this year. "The Web site posting of this substantial amount of information is a work in progress and indeed, we welcome comments and suggestions that would make the corrective action plans more user friendly."

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