Castor amendment could curb fraud in Medicare Advantage

09/02/09 Seán Kinane
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The Medicare Advantage program, passed by the Republican Congress and signed by President George W. Bush in 2003, allows private health maintenance organizations to provide care to seniors who opt for the program. But some seniors say they have been tricked to switch from their Medicare plan to Medicare Advantage by dishonest HMOs. Virginia Seaman is a resident at the Acorn Trace Apartments in Tampa. After she was pressured to sign a form outside of a health clinic, Seaman was told by her original insurer that she had unwittingly lost her prescription drug plan.

“‘We understand that you’re dropping us.’ I said, ‘No way, why would I drop you?’ And she said, ‘It has here you have dis-enrolled from us.’ I said, ‘No, no.’ I said, ‘What is this?’ She said, ‘Well, did you sign up for something?’ I said, ‘Oh, yeah.’ … I think it’s terrible that they can do that to people.”

Seaman says she was approached by a representative from the HMO WellCare outside of a clinic on Fowler Avenue who pressured her to sign a form. But, Seaman says, the WellCare agent did not disclose that she would lose her current prescription coverage.

Tampa-area U.S. Representative Kathy Castor spoke with Seaman and other victims at Acorn Trace on Wednesday. Castor is on the House Energy and Commerce Committee, one of the three committees that have passed a version of Congress’s health care reform bill. She successfully attached an amendment to her committee’s version that could help protect seniors from these abusive marketing practices by private HMOs.

Castor says the HMOs have a financial incentive to seek out Medicare recipients and deceive them into signing up for a private Medicare Advantage plan.

In the past, residents at Acorn Trace have been pressured by HMOs to join Medicare Advantage, according to the apartment’s director Barbara Van Matre. Van Matre says the pressure continues, both at the apartment and at nearby social service providers.

The AARP offers some common-sense tips for seniors to avoid scams like being unsuspectingly signed up for Medicare Advantage, according to the manager of state operations at AARP Florida, Jeff Johnson. Johnson says that AARP favors the inclusion of Castor’s amendment as part of Congress’s health care reform package.

In May the National Association of Insurance Commissioners supported Representative Castor’s “efforts to protect seniors from deceptive and fraudulent marketing tactics used to sell Medicare Advantage … insurance.” In July, Florida’s Insurance Commissioner Kevin McCarty wrote a letter to Representative Castor supporting her amendment. Virginia Seaman, the Acorn Trace Apartment resident who was tricked into signing up for Medicare Advantage, hopes it becomes law. “I think it’s a good thing.”

Rep. Kathy Castor


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