Thursday, December 01, 2005

Report questions Medicare drug benefit oversight

Report questions Medicare drug benefit oversight

WASHINGTON (Reuters) - Medicare has received thousands of complaints about its temporary drug discount card, according to a congressional report released on Wednesday as the agency grapples with new gripes about the card's replacement program.

The Government Accountability Office said the insurance program for the elderly and disabled received 26,000 complaints and formal grievances about the temporary cards. It took 23 actions against 15 insurers and other card sponsors.

Rep. Henry Waxman of California who requested the GAO report, said the findings call into question how well Medicare will oversee the new permanent drug discount benefit that starts January 1.

"Unless they are corrected, the problems identified by GAO will undermine the new Medicare drug benefit, just as they did the Medicare drug card program," said Waxman, the ranking Democrat on the House of Representatives Government Reform Committee.

Centers for Medicare and Medicaid Services (CMS) Administrator Mark McClellan criticized the report, saying investigators did not take the agency's full enforcement abilities into account and focused "on a snapshot ... rather than the process."

The center also said it has received about 100 complaints about the marketing of the new plans targeted at insurance companies and agents.

"One hundred complaints is a pretty small number when you consider the number of plans, the number of agents out there that are going to be marketing," said agency spokesman Gary Karr. About 40 different plans are offered in most states.

Both the cards and the plans allow private companies to negotiate prices with drug manufacturers and offer discount plans to seniors directly. Medicare is charged with making sure they cover certain types of drugs, and not others, and follow certain marketing rules.

"There are a number of things we can and are very willing to do" if sellers break the law, Karr said. These include monetary penalties or terminating a company's contract to provide a plan.

A second GAO report released on Wednesday found Medicare's efforts to promote the discount cards "did not consistently provide information that was clear, accurate, and accessible."

CMS's McClellan said the agency had learned lessons from the program that would "inform" its planning for next year's benefit.