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HHS Investigates Medicare Providers' Massive Misinformation Campaign

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Today, the U.S. Health and Human Services Department took its first steps toward cracking down on misinformation disseminated by Medicare providers.

During the recent health care reform hullabaloo, "Keep Government Out of Medicare" became a rallying call for some and a joke for others. As it became clear that tens of thousands of senior citizens across the country held irrational beliefs about the government's role in their health care, we asked, where is all the misinformation coming from? The answer: Medicare Advantage providers have been deliberately misinforming Medicare recipients about health insurance reform.

Last week, I reported that Las Vegas members of Humana Medicare plans had received a mass mailing from Humana (see the complete mailer and envelope) claiming that Congress and the President are considering proposals to cut "important benefits and services" of Medicare. That mailer actually went out to Humana plan members nationwide. Today, the Health and Human Services's (HHS) Centers for Medicare and Medicaid Services (CMS) sent a letter to Humana demanding that Humana cease "immediately all such mailings to Medicare plan members and to remove any related materials directed to Medicare enrollees from your website."

The letter from CMS to Humana says:

CMS has learned that Humana has been contacting enrollees in one or more of its plans and alleging that current health care reform legislation affecting Medicare could hurt "millions of seniors and disabled individuals [who] could lose many of the important benefits and services that make Medicare advantage health plans so valuable." The message makes several other claims about the legislation and how it will be detrimental to enrollees, ultimately urging enrollees to contact their congressional representatives to protest the actions referenced in the letter (see attachment).

According to a source with inside knowledge of the way CMS regulates
marketing guidelines, Medicare providers are only allowed to
communicate with plan members about the benefits they have now, not
about possible changes to benefits. They are also not allowed to use
plan-related communications to lobby for policies or legislation.

CMS voiced concern that the Humana mailer is misrepresented as information about plan members' coverage and benefits. CMS contends the mailer "is potentially contrary to federal regulations and guidance for the MA
and Part D programs and other federal law, including HIPAA." And CMS instructed Humana "to end immediately all such mailings to Medicare plan members and to remove any
related materials directed to Medicare enrollees from your website."

An official memorandum was sent late Monday afternoon from CMS to "All Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Organizations, Cost Based Organizations and Demonstration Plans" saying:

CMS has recently learned that some Medicare Advantage (MA) organizations have contacted enrollees alleging that current health care reform legislation affecting Medicare could hurt seniors and disabled individuals who could lose important benefits and services as a result of the legislation. The communications make several other claims about the legislation and how it will be detrimental to enrollees, ultimately urging enrollees to contact their congressional representatives to protest the proposals referenced in the letter.


Our priority is ensuring that accurate and clear information about the MA program is available to our beneficiaries. Thus, we are concerned about the recent mailings as they claim to convey legitimate Medicare program information about an individual's specific benefits or other plan information but instead offer misleading and/or confusing opinion and conjecture by the plan about the effect of health care reform legislation on the MA program and other information unrelated to a beneficiary's specific benefits.

In a public statement, CMS says it is also investigating whether Humana inappropriately used the lists of Medicare enrollees for unauthorized purposes. "We are concerned that the materials Humana sent to our beneficiaries may violate Medicare rules by appearing to contain Medicare Advantage and prescription drug benefit information, which must be submitted to CMS for review," said Jonathan Blum, acting director of CMS' Center for Drug and Health Plan Choices. "We also are asking that no other plan sponsors mail similar materials while we investigate whether a potential violation has occurred."

Blum went on to say, "We are concerned that, among other things, the information in the letter is misleading and confusing to beneficiaries, who may believe that it represents official communication about the Medicare Advantage program."

But Medicare Marketing Guidelines,
which govern provider-to-member mass communications for Medicare
Advantage Plans, Medicare Advantage Prescription Plans, Prescription
Drug Plans, and 1876 Cost Plans, do not specifically include political communications -- a point of contention with Medicare watchdog groups. Over the last few years, several organizations have repeatedly asked CMS to specifically include political communications in the guidelines (see their written comments on the current iteration of the guidelines). I asked CMS to clarify its position on political communications from providers to plan members but have not yet received a response.

David Lipschutz, a staff attorney for the California Health Advocates (CHA) has been a long-time critic of the way Medicare providers communicate with Medicare plan members about political matters. "While recent examples are more blatant than in the past", says Lipschutz, "over the last few years the insurance industry has tried to convince Medicare private plan enrollees to join 'grassroots' organizations that are designed to protest any cuts to Medicare Advantage plan payments, sometimes using misleading and/or inaccurate rhetoric. We hope that this broader practice is also prohibited."

Paul Precht, the Director of Policy and Communications at Medicare Rights Center, says insurance providers "scare vulnerable folks into thinking they'll go without the health care they need. That can generate calls." According to Precht, because political communications are not covered in the Medicare Marketing Guidelines, the consumers are mostly unprotected.

Precht says he has also seen specific Medicare plan members targeted with horrifying letters from their providers saying the drug they depend upon to breath may be cut off. In reality, Precht says, the government was just reducing "ridiculous profit margins," not cutting
the service. "We've seen these organizations cutting benefits while raising rates," Precht adds. "With reform, more money goes to benefits."

This past spring, American Health Insurance Plans (AHIP), an industry trade group, hired the Dewey Square Group, a national political marketing and consulting firm, to astroturf for them. The Dewey Group drafted and submitted letters to the editor on behalf of senior citizens who were not unaware that their names were being used to advocate for or against health insurance programs. They did not know their names would appear on any letters to the editor.

The Eagle Tribune, who received the letters, says:

Usually, such letters come from people who simply click a "Take Action" button on a political Web site, which results in a form letter being sent to their local newspaper... But those people are at least aware that a letter will be sent in their names. The Medicare Advantage campaign is unusual in that the "letter writers" said they weren't aware they were participating in political advocacy at all.

Lipschutz and his colleagues were disappointed that CMS did not alter the Medicare Marketing Guidelines in the most recent iteration. "Providers should not be allowed to solicit members to participate in something that is clearly in the pecuniary interest of the provider. They are preying upon people's fears," Lipschutz said. "Industry-funded astroturfers routinely say they have tens of thousands of members, but they've tricked unsuspecting members into checking a box or clicking a link."

The American Association for Retired Persons (AARP) has also weighed in on the misinformation being distributed to older Americans, stating, "The opponents of reform will stop at nothing to derail the process and protect their own vested interests, even if it means misleading older Americans."

AARP Spokesperson Jordan McNerney says, "I think in recent weeks we've seen that the scare tactics do work in a lot of cases. It's a lot easier to scare people than it is to educate them and get the facts to them." And a recent AARP Bulletin says, "Even some Medicare beneficiaries say they're worried about a 'government takeover' of Medicare."

Last week, we asked Huffington Post readers to email us if they or their relatives have received similar communications from their health insurance companies. Lots of HuffPost readers from across the country wrote in to say they received the same mailer from Humana, and a few even said they received it at their doctor's office. Liz Scott told us, "The same mailer came to me in Folsom, Louisiana. Most of my elderly neighbors already believe in Obama Death Panels, so this will only add to their hysteria."

Prentiss Goodroad said, "I also received that letter in Washington state. My disabled husband is a Humana Part D participant only - NOT their Advantage plan. I was outraged! This is a blatant attempt to preserve their profits."

Sharon Peterson received an email from Health Alliance maligning health insurance reform proposals, saying, "Coverage for preventative care, extra attention for members with
chronic conditions and low out-of-pocket expenses could all disappear." They went even further on the astroturf website that they referred Medicare plan members to, saying that proposed legislation could actually take away plan members' Medicare Advantage coverage.

"Some of these people are isolated and lonely, and they get these frightening mailers that say, 'Come be our partner'," Lipschultz points out. "It's unconsionable."

UPDATE: I was able to speak with the organizer at Dewey Square Group who actually worked on the letters-to-the-editors campaign that the Eagle Tribune alleges generated illegitimate letters. According to the organizer, the letters were generated through a multi-step process (which we discussed at length) that should have ensured the legitimacy of each letter. The controversy arose, she says, because organizers and the Eagle Tribune referred to the health plans using terminology inconsistent with what the participants and organizers normally used (for example, Medicare Advantage versus the actual plan name), which was confusing to the letter writers. Having spoken with quite a few Medicare Advantage recipients about the political letters they've received from their providers, what she said actually makes quite a bit of sense to me.

Have you or someone you know been contacted by your insurance company
with scare tactics against health insurance reform? Huffington Post
would like to hear from you. Email us your stories at submissions+scaretactics@huffingtonpost.com - Be sure to include the name of the sender and, if possible, include a picture of the mailer you received.

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