Medicare Companies Use Sick Marketing Practices, Federal Audit Finds

A federal audit of Medicare coverage by brand-name insurance companies found a pattern of wrongly denied claims and deceptive marketing practices, NYT reports. In some cases, salesmen would show up at elderly folk’s doors and say the President sent them, or that they’re from Medicare. In others, telemarketers call and say they’re from Medicare and the person will lose their benefits if they don’t enroll in the telemarketer’s plan. Our country’s healthcare system is on life support and we’re not sure what will fix it. Perhaps an appetite for more oversight, audits and fines for misbehaving companies would do the trick.

Medicare Audits Show Problems in Private Plans [NYT via Consumer World Blog]

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  1. IRSistherootofallevil says:

    I’d be suspicious of anyone who claims the president sent them. I’d demand ID and then refuse entry. The government itself is a broken system, what we need is more lawsuits.

  2. JKinNYC says:

    @IRSistherootofallevil: But you’re not 80 and you weren’t born before your house had a TV. The elderly are exceptionally vulnerable to this.

  3. IRSistherootofallevil says:

    Well they need to live with more skepticism. The world has gotten a lot more fucked up since they were 25.

  4. IRSistherootofallevil says:

    I’m sorry, that came out like I’m blaming the victims. What we need is more lawsuits. Lawsuits for something with the word “predatory” in them.

  5. bohemian says:

    I looked into the medicare options last year. A friend became eligible so the subject came up.

    Your options are the basic coverage run by the gubmint or one of the private company medicare programs that cover more but might also cost a bit.

    Why are these people allowed to do this kind of thing in a government program?

    Probably the same reason the CEO of Sallymae is one of the highest paid in the country and profits off of the student loan sector were outpacing any other investment last year.

    Our government needs a really good cleaning.

  6. Lordstrom says:

    What we need is to dismantle medicare and create an open marketplace across state lines. That way there is competition and accountability. It’s time to fire the government.

  7. polyeaster says:

    I work for a Medicare contractor, and I do occasionally talk to people. In my experience, the folks who call claiming that beneficiaries will lose their benefits are normally just scammers, not actual Medicare plans. I normally advise people that they should call 1-800-MEDICARE to verify plan veracity, not to let people who they don’t know into their homes. Unfortunately, a number of people still let people into their homes, sign all kinds of paperwork they don’t understand, and later contact Medicare to see if that was a good idea. There may be some deceptive marketing practices out there, but IMO, at a certain point we just have to educate seniors about this the same way we educate children not to get in strangers’ cars, or talk to people they don’t know.

  8. vanillabean says:

    My gram goes to a senior center and there’s all kinds of counseling about phishing and scams such as this. It’s all well and good but the thing is that when your brain starts to go you can really get screwed.

  9. dregina says:

    The problem with having marketplace competition for healthcare is that the way that the publicly owned providers make money is by spending as little money as possible on their clients. I’m all for “firing the government” in a lot of areas, but I see healthcare as being akin to the police, or the fire department – the profit motive shouldn’t be applied to life or death needs.

  10. polyeaster says:

    Yeah…unfortunately that’s correct. That’s why I plan to stay in my parents’ lives actively when they begin to fail, to try and avoid some of that.

  11. Hambriq says:

    Our country’s healthcare system is on life support and we’re not sure what will fix it. Perhaps an appetite for more oversight, audits and fines for misbehaving companies would do the trick.

    I don’t really think that is going to help. The practices described in this article are reprehensible, but they aren’t really contributing to the bigger problem. Fining shady insurance companies like this is admirable from an ethical standpoint, but let’s not kid ourselves. It’s not going to make health care any less expensive. Because after you strip away all the politicizing of the issue, it comes down to this: Quality health care is expensive.

    That’s what it boils down to. And you can blame a lot of people.

    Look at the irresponsible consumers who expect to get unnecessary medicines and procedures for free. After all, does anyone actually NEED Flonase or Zyrtec to survive? And that’s to say nothing about the people abusing prescription pain medicines.

    But what about the profit-mongering pharmaceutical companies? It’s pretty unethical of them to repackage existing drugs in a slightly altered form and selling them for more than 10 times the price.

    And then there’s the hospitals, who price-gouge because they have a captive audience, and the patients don’t even know how much their procedures cost (or how necessary they are) until four weeks later when they get stuck with the bill.

    Or how about the insurance companies; greedy money-changers who overcharge healthy people and underpay sick people?

    Who should we blame? Who should we scapegoat? The fact is, everyone’s at fault, and you can’t blame one specific party.

    For every irresponsible consumer, there’s one who’s getting dicked over by his insurance company, or one who has a disease completely out of their own control. From the profit-mongering pharmaceutical company come the lifeblood of our health-care industry: research, development, and progress. From the inefficient, price-gouging hospitals come what we expect: quality emergency care when we need it most. And those evil insurance companies ultimately are our salvation: paying the massive health care bills that we could never even dream of affording on our own.

    The biggest problem here is that we’re looking too hard for a quick and easy fix. If you go for the quick and easy, you can cut costs, but you’re going to be sacrificing something. The real answer doesn’t lie in sweeping, radical reforms to the system. It lies in taking the existing system, streamlining it, and shaving away the wasted money.

    Every day, I waste hours of my time sending faxes, filing papers, calling doctors and insurance company representatives, all to ensure that people get the health care that they were paying for in the first place. For every fax I send, someone else is getting paid to read, input, and file it away. For every phone call I make, someone is getting paid to answer it. And 99% of it is waste. Money we don’t need to be spending.

    I can count hundreds, literally hundreds of steps you could take to streamline the prescription filling process; all the way from visiting the doctor to your insurance company being billed to you picking up your prescriptions at the pharmacy. And I represent just one tiny facet of the health care industry as a whole. I can only imagine how much money can be saved in the medical side of things.

    The answer doesn’t involve radically reinventing our health care system. It involves taking our current system and making it better, separating the wheat from the chaff.

    …Okay, so I didn’t intend to hop up on my soap box and give my Health Care Sermon. It just sorta came out. That’s what happens when I don’t work until two in the afternoon.

  12. Trai_Dep says:

    @lorddave: hey, genius, the telemarketing con-men WERE private sector guys. Sheesh, try seeing past your dogma for an instant…

  13. tcabeen says:

    I work for a medicare provider and am close friends with the enrollment manager. The company I work for doesn’t engage in any such practices to the best of my knowledge, but since the Part D (prescription) changes, we have actually had customers disenrolled to tiny Part D-Only plans (Walgreen’s, for one) thinking that it would only be supplemental coverage.

    Usually, they’re able to switch back without interrupted service, but it’s a huge inconvenience. Sometimes, due to “Open Enrollment” restrictions, they are unable to return for a number of months, though. This is a big problem caused by unscrupulous plans preying on naive customers in a Very complicated market.

  14. TMurphy says:

    The other night I saw a comedy troupe perform, in one of their acts they had a woman acting as an old lady trying to sign up for the army. When the army recruiter tried to suggest she might not be mentally fit anymore, she replied that she figured out her healthcare plan all on her own, so she must be capable of doing anything. You know we’ve got problems when that can be a rather true statement.

  15. Lordstrom says:

    @trai_dep: Yeah? And? That doesn’t change anything I said, tard.

  16. magus_melchior says:

    @lorddave: Repeating an oft-used talking point and rebutting with an ad hominem does not an argument make.