In an effort to quell reports of marketing abuses, HMOs in the Chicago area are taking steps to assure ethical conduct in enrolling Medicaid patients.
Through the Illinois Association of Health Maintenance Organizations, the 10 companies that have contracted with the Illinois Department of Public Aid to provide services to Medicaid patients issued a statement saying they would immediately dismiss sales representatives engaged in "fraud, misrepresentation or coercion" when soliciting Medicaid recipients.
"A policy statement clearly outlining the responsibilities and intentions of HMOs in promoting fair and honest Medicaid marketing practices has been issued by IAHMO and personally endorsed by the chief executive officer of every HMO participating in the Medicaid program," a statement from IAHMO said.
The association released a three-page document outlining policies, ethical standards and a statement of understanding.
One outlined policy for Medicaid marketing said sales representatives must be employees of the health plan and earn no less than 51% of their total compensation from salary. In addition, no more than 49% of their annual compensation can come from commissions.
Critics of HMO marketing strategies for Medicaid patients said the abuses won't stop as long as door-to-door solicitation is allowed.
However, executives said IAHMO's actions will go far in regaining the public's trust in Medicaid HMOs.
There have been 19 complaints of alleged marketing abuse reported to the Illinois Department of Public Aid. Some 185,000 Illinois residents are voluntarily enrolled in Medicaid HMOs.
"Although the reported incidence of unethical practice has been very small, we are absolutely determined to restore confidence in the Medicaid marketing process," said Marshall Rozzi, chief executive officer of United HealthCare of Illinois. United's Chicago HMO has 131,000 enrollees in its Medicaid managed-care plan, which has been cited for alleged marketing abuses.
"We are announcing a zero-tolerance policy toward individuals who fail to meet the standards outlined," said Rozzi, co-chair of IAHMO's Medicaid task force.