All Medicare Advantage (MA) and Medicare prescription drug plans have been ordered by CMS to immediately discontinue any mailings regarding current health care reform legislation to Medicare beneficiaries, as well as remove any related materials from their website. The order followed CMS' discovery that an insurance company was contacting enrollees, alleging that current health care reform legislation could hurt seniors and disabled individuals causing them to lose important benefits and services as a result of the legislation.
Potentially misleading information. “We are concerned that the materials sent to our beneficiaries may violate Medicare rules by appearing to contain Medicare Advantage and prescription drug benefit information, which must be submitted to CMS for review,” said Jonathan Blum, acting director of CMS’ Center for Drug and Health Plan Choices. “We also are asking that no other plan sponsors are mailing similar materials while we investigate whether a potential violation has occurred.”
“We are concerned that, among other things, the information in the letter is misleading and confusing to beneficiaries, who may believe that it represents official communication about the Medicare Advantage program,” said Blum. Specifically, CMS is investigating whether the company inappropriately used the lists of Medicare enrollees for unauthorized purposes.
GOP response. House Republican Leader John Boehner (R-OH) responded to the memorandum by criticizing actions of the Obama Administration to impose what he referred to as a gag order on critics of the $500 billion in Medicare cuts proposed by the congressional Democrats. He released a statement contending, “It is outrageous that the Obama Administration is trying to keep seniors in the dark about the consequences of congressional Democrats’ costly government-run health care bills.
CMS investigation. CMS is currently investigating the released information because the communications claim to convey legitimate Medicare program information about an individual’s specific benefits or other matters, but instead offer “misleading or confusing opinion and conjecture by the plan about the effect of health care reform legislation on the Medicare Advantage program and other information unrelated to a beneficiary’s specific benefits,” according to CMS. The communications ultimately urge enrollees to contact their congressional representatives to protest the proposals referenced in the letter. These communications are potentially contrary to federal regulations and guidance for the MA and prescription drug programs and other federal law, including the Health Insurance Portability and Accountability Act (HIPAA).
Source: CMS Memorandum, Sept. 21, 2009, Health Care Compliance Reporter, ¶350,121.
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