News in brief - Nov. 2, 2009

HHS launches new efforts against medical fraud, identity theft

The Dept. of Health and Human Services on Oct. 15 released a new tip sheet aimed at helping Medicare beneficiaries deter and detect medical identity theft, as well as health care fraud.

The move is part of a joint effort by HHS and the Dept. of Justice to root out health care fraud. HHS Secretary Kathleen Sebelius said in a statement that fighting health care fraud is one of President Obama's top priorities and that preventing medical identity theft is an important part of that crackdown.

The tip sheet warns seniors to be wary of offers for free medical services or supplies and to check their explanation of benefits statements and Medicare summary notices regularly. More information is available online (www.stopmedicarefraud.gov).

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Employer health coverage continues to drop

The percentage of nonelderly Americans with employer-sponsored health insurance declined for the eighth straight year -- reaching 61.9% in 2008 compared with 62.9% in 2007, according to a new report.

Such coverage has decreased by 6.4 percentage points since 2000, or about 5 million people, according to the Economic Policy Institute, a think tank focusing on issues affecting low- and middle-income workers. The calculations are based on the March 2009 update of the U.S. Census Bureau's Current Population Survey.

New Mexico has the lowest employer coverage rate at 57.5%, followed by Texas at 61.9% and Alaska at 63.6%. Massachusetts and Hawaii top the list at 80.7% and 80.6%, respectively. The largest declines in employer-sponsored coverage for the nonelderly occurred in Michigan, Tennessee, Missouri, South Carolina and North Carolina. Each state experienced decreases of at least eight percentage points since 2000. No state had a statistically significant coverage increase since 2000.

The report can be accessed online (www.epi.org/publications/entry/bp247).

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Settlement reached in Part D lawsuit

The Center for Medicare Advocacy announced on Oct. 23 that a settlement had been reached in Machado v. Sebelius, a lawsuit against two government agencies charging that premium withholding delays had an adverse impact on Medicare drug plan beneficiaries.

The Machado case was brought against the Centers for Medicare & Medicaid Services and the Social Security Administration by beneficiaries who experienced lengthy delays in having their Part D premiums withheld accurately, or in some cases not withheld, from their Social Security benefits. At the time the case was filed in 2007, a large number of people reported problems with erroneous premium withholdings, especially after switching drug plans, according to the Medicare advocacy center. Efforts made by CMS and SSA to improve withholding mechanisms since the lawsuit filing resulted in significant reductions in delays and errors.

Under the settlement, CMS customer service representatives are directed to advise people to call them back, or to call their Part D plan, if a withholding discrepancy is not addressed within 90 days. The representatives also are directed to inform beneficiaries of the date when they requested a change in withholding, if that date is in the CMS system. The agency has revised its operating procedures to prioritize and track the resolution of Part D premium withholding complaints through a special system.

The print version of this content appeared in the Nov 9, 2009 issue of American Medical News.

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