House Democrats on Tuesday sharply criticized the CMS for the agencys oversight of its Medicare Advantage program. Federal lawmakers probed problems found in the small-but-growing private fee-for-service plans, sending their strongest signal yet that the program is ripe for payment cuts.
House Ways and Means Health Subcommittee Chairman Pete Stark (D-Calif.) said that while all providers have been put on notice this year, Given what we know about (private fee-for-service) at this time, theyre at the top of my list.
In a snappish exchange, Stark pressed Abby Block, director for the CMS Center for Beneficiary Choices, on whether the agency had any hard evidence that the private plans used higher-dollar reimbursement rates to boost benefitssuch as eyeglasses, hearing aids and dental servicesfor their beneficiaries. According to data cited by Stark, health plans spend about $8.3 billion per year on added benefits for seniors enrolled in such plans.
Block countered that while the agency does not review actual benefits provided by private fee-for-service plans, it nevertheless relies on satisfaction surveys and other beneficiary data that show a high level of satisfaction with the plans. She also said the CMS is largely handcuffed by law in its oversight of the private plans.
(Youre) handing out more than $8 billion to these plans, dont you think it would be a good idea to regulate it? Stark asked.
The Medicare Payment Advisory Commission has said that private fee-for-service plans are paid, on average, 19% more than traditional Medicare, but added that in some instances the number is as high as 50% more.
Meanwhile, the American Medical Association on Tuesday released a survey of physicians in which more than half said patients enrolled in Medicare Advantage HMO or PPO plans were denied coverage of services typically covered in the traditional Medicareand 84% reported patients have had difficulty understanding how the plans work.
The private health plans were supposed to inject competition into the Medicare program, but instead weve ended up with a federal handout to the insurance industry, AMA Chairman Cecil Wilson said in a statement. -- by Matthew DoBias