The CMS this week will wrap up its request for information on cases where healthcare providers steer eligible patients away from Medicaid and Medicare and into private plans, often on the Affordable Care Act marketplaces, in order to receive higher payment rates. Medicare, for example, tends to pay roughly 80% of what private insurers would pay for the same service.
This summer, UnitedHealth Group sued American Renal Associates, a dialysis treatment chain for getting bigger payments from UnitedHealth through this practice.
“Some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients' needs,” acting CMS Administrator Andy Slavitt said in a statement. “These actions can limit benefits for those who need them, potentially result in greater costs to patients, and ultimately increase the cost of marketplace coverage for everyone.”
The agency is concerned the practice can result in beneficiaries experiencing a loss in coverage and coordination of care. In its request for information, the CMS also asked for feedback on potential disciplinary action. One idea involves civil monetary penalties.
A week before the deadline, the CMS had received more than 600 comments.
Most of the comments posted at that time came from patients who were concerned about getting financial assistance from not-for-profits under the ACA. The agency is looking into which third-party entities should be allowed to make payment of premiums on behalf of beneficiaries.