Hours after arbitrator okay's the forced move of NY public employees to Medicare Advantage plan, the feds take steps to restrict MA abuse.

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Days after an arbitrator ruled against New York city’s public employees, including retired public teachers, to forcibly move retirees into a Medicare Advantage plan, the feds are calling for tighter restrictions on the shady practices of the for-profit MA industry.

The head of the NY teachers union, Michael Mulgrew, has turned a deaf ear to member protests. In fact, he has been a co-conspirator in the shift to privatization.

Although not a NY teacher retiree myself, I have been following these developments because I see them as an attempt to privatize Medicare nationally.

Joe Biden has continued a Trump era plan to move all retirees - even without our agreement - to for-profit healthcare by the end of the decade.

Federal health officials are proposing an extensive set of tougher rules governing private Medicare Advantage health plans, in response to wide-scale complaints that too many patients’ medical claims have been wrongly denied and that marketing of the plans is deceptive. (NY Times)

Kaiser Health News reports:

A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013.

As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.

One of the biggest complaints about Medicare Advantage plans (aside from the hard sell marketing) has been the misuse of the power of pre-authorization.

Even when our own doctors and medical teams recommend a procedure or medication, MA plans can deny payment.

The rules would also address the health plans’ use of techniques that require the company to approve certain care before it would be covered. Patients and their doctors complained to Medicare that the private plans were misusing prior authorization processes to deny needed care. The inspector general’s report estimated that tens of thousands of individuals had been denied necessary medical care that should be covered under the program.

The new proposal would require plans to disclose the medical basis for denials and rely more heavily on specialists familiar with a patient’s care to be involved in the decision-making. Medicare has also established tighter time limits for answers on authorizations; patients now often wait up to 14 days. The new rules would also require authorization to cover the full length of a treatment so patients don’t have to continually request identical approvals.

Dr. Meena Seshamani, the director of the Center for Medicare and a deputy administrator at the Center for Medicare and Medicaid Services, said the changes had been influenced by thousands of public comments solicited by the agency and by lawmakers. (NY Times)

The attempt at greater regulation of the for-profit privatized MA industry is a good thing.

My fear is that it is tinkering around the edges.

For-profit health insurance bureaucrats should not have the right to over-rule the medical decisions of our healthcare professionals.

In fact, the idea of a for-profit healthcare industry runs counter to those in need of good health care.

Something that should be obvious to union leaders like Michael Mulgrew.