Home Health & Hospice Week

Rogue managed care agents misguide beneficiaries, say feds.

A federal effort to monitor and improve the marketing of Medicare's private fee-for-service Medicare Advantage plans should help home health agencies steer clear of denied claims for PFFS beneficiaries.

Seven large health insurers have volunteered to temporarily stop marketing their Medicare Advantage PFFS plans, according to the Centers for Medicare & Medicaid Services.

The seven insurance companies are United Healthcare, Humana, WellCare, Universal American Financial, CoventryHealth Care, Sterling Life Insurance and BlueCross BlueShield of Tennessee.

The marketing hiatus comes amid allegations of misleading and aggressive sales practices by what CMS called "rogue agents" employed by the insurers. The questionable marketing practices in turn led to patients who are poorly informed about their enrollment status and Medicare benefits.

The marketing halt likely will decrease the number of PFFS beneficiaries, which could be good for home health agencies' pocketbooks. "The bottom line is that agencies are having trouble getting paid for these patients," says Elizabeth Hogue, an attorney in Burtonsville, MD.