House leaders called for an investigation of the insurance company Health Net, Woodland Hills, Calif., for allegedly pressuring senior citizens into enrolling in certain Medicare Advantage plansa violation of recently passed federal laws and regulationsand potentially trying to defraud the Medicaid program.
In letters sent to the HHS secretary and inspector general, as well as Health Net President and Chief Executive Officer Jay Gellert, House Energy and Commerce Committee Chairman John Dingell (D-Mich.) cites the use of automated phoning, or robo-calls, that led seniors to sales agents who provided misleading information regarding the private plans that operate within the Medicare program.
The alleged abuses were reported by the not-for-profit National Senior Citizens Law Center, a legal services group that assists low-income senior citizens.
In its complaint, the NSCLC alleges that sales agents gave incorrect information about plan restrictions, enrollment deadlines and whether or not they would lose Medicare drug benefits or Medicaid benefits if enrolled. Additionally, the sales agents implied that they could enroll the prospective seniors during the outbound call, which Dingell states is expressly prohibited by federal law.
Perhaps more troubling, Dingells letter to federal health officials cites instances where Health Net agents allegedly posed as beneficiaries in order to obtain Medicaid identification numbers.
The CMS imposed a temporary marketing suspension on Health Net earlier this year. And in September, the company agreed to restore coverage to 926 former members in a $25 million agreement with the California Insurance Department after it had allegedly dropped coverage to them when they became sick. Health Net agreed to pay a $3.6 million penalty, $14.2 million in billed medical charges and $7.2 million in waived insurance premiums.
Health Net officials said the company is addressing Dingells concerns and will work to resolve the issues. We immediately began an exhaustive review of these issues the day we received the letter on October 3, 2008, according to e-mailed comments from a company spokesman. We believe we are already far
along in implementing the recommendations cited in the Congressmens press
release. We want to thank the National Senior Citizens Law Center for
bringing these important matters to our attention.
Earlier this year, Congress passed and President Bush signed into law strict marketing rules aimed at protecting seniors from predatory sales practices and fraudulent enrollments in Medicare Advantage. Additionally, the CMS also issued strong marketing guidelines. -- by Matthew DoBias
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