Oklahoma Insurance Commissioner Finds Widespread Misconduct In Selling of Medicare Advantage Plans

Early this morning I had my most recent post on the Medicare Advantage plans, noting “The plans engage in misleading sales tactics to get seniors to sign up without realizing what they are doing.” Later in the morning I had two different patients come into the office who told of getting signed up for Medicare Advantage plans, thinking they just signing up for a prescription drug program. As I noted earlier, the Medicare Advantage plans are a form of corporate welfare in which the Bush administration has repaid the insurance industry for their contributions by providing massive subsidies to care for Medicare patients beyond what it takes to care for the patients in the government run program.

This afternoon I found that the Oklahoma insurance commissioner is looking into misconduct by Humana in the selling of the Medicare Advantage plans, citing widespread misconduct. Replicating the same story I am frequently hearing from patients, the story reports that “some agents had enrolled Medicare recipients in Humana products that ‘they did not understand and did not want.'” The report sounded quite familiar:

Oklahoma investigators found that some people who wanted to buy just drug coverage from Humana were instead enrolled in “an unwanted plan,” a comprehensive Medicare Advantage plan. The investigators’ report said it appeared that some agents had used “bait-and-switch tactics to secure the initial invitation” into the homes of Medicare beneficiaries, The Times reported.

In its report, the Oklahoma Insurance Department also found that Humana gave agents a strong incentive to sell Medicare Advantage plans, typically paying a commission of $250 for each sale, five times as much as the commission for selling a prescription drug plan, and the company did not maintain a complete record of complaints from Medicare beneficiaries, as required under Oklahoma law.

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3 Comments

  1. 1
    Heather says:

    Dear Ron, Visitors:

    Sorry, but the whole Medicare/Medicaid coverage is corrupt and becoming more and more usless especially Medicaid which every month deletes more services and medicine in its program only to leave poor people suffering with inadequate helthcare. With to many warped republican neocon seats in congress and a heartless moron president in the White House these programs eroded to the point of being valueless.

    I favor National Healthcare, we as a nation spend the most on Healthcare yet receive the least. If we ever get a stronger majority in congress and win over the White House I hope The National Health Insurance Bill (HR 676) can pass, at the very least it can improve on the current system that exists today.

    Medicaid and Medicare should have been combined years ago but its only this bigotry toward the poor in this country that prevents it, this discriminatory policy of the elderly and the poor is plain stupid. In any event thats how I feel
    Sincerely
    Heather™

  2. 2
    MAP employee says:

    I work for a Medicare Advantage Plan and shady sales tactics are just the tip of the iceberg.  You cannot possibly know the level of corruption that goes on where I work.  Did you know that the subsidies they get depends on the dx codes of the patients and the level of high-risk.  Those with certain diagnosis get more subsidies, therefore the plan I work for has hired a group of doctors that are going out to over 13,000 members homes to “reevaluate” their health risk (“after all, some of these people might not even know that they have CHF or Diabetes”) This is from a direct quote from our CEO yesterday.   And the DME fraud..don’t even get me started.  It is blatent  and I do not know who to report this to.  I contacted the OIG but they blew me off like this is so widespread that they are overwhelmed.  I’ve never heard of plans sending doctors out to patient’s homes to have them diagnosed.  This is horrible.

  3. 3
    Ron Chusid says:

    I haven’t seen them go out to anyone’s home but they do regularly request copies of the charts to search out additional diagnoses so they can bring in more money from Medicare.

    Actually I don’t blame them for that. Medical claims only include four items and might not include everything in one’s history which would make them sicker, and entitle the Medicare Advantage plan to more money.

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