Medicare Watch

Medicare Rights Center Testifies Before Congress on Problems with Medicare Secondary Payer

The Medicare Rights Center’s federal policy director, Ilene Stein, testified this week before the Energy and Commerce Committee’s Subcommittee on Oversight and Investigations about problems people with Medicare face under the current Medicare Secondary Payer program. The policy allows Medicare to recoup payments for a patient’s health care when another entity is responsible for paying for such treatments, such as when a patient is in a car accident and the auto insurance should pay for health services to treat injuries related to the accident. Ms. Stein’s testimony supports the premise that Medicare should not pay when another party is responsible for payment, but also highlights the various flaws in the system, including delays in seeking repayment, the lack of a statute of limitations in which Medicare may seek repayment, and the failure of Medicare to differentiate between care stemming from the original incident and unrelated treatments.

Medicare Rights Center often receives calls on its helpline from consumers who receive letters from Medicare demanding repayment for coverage provided for services that are unrelated to past accidents, and that should thus be covered by Medicare. In some cases, Medicare will prospectively refuse payment for all services if a secondary payer case is improperly closed, even when these services do not relate to treatment for an injury for which another party is responsible for payment. To address these shortcomings, Medicare Rights proposes a statute of limitations on Medicare’s right to seek recovery, as well as increased scrutiny of Medicare claims to ensure that the recovery attempt applies only to care related to claims against a separate payer.

Also testifying before the committee were Deborah Taylor, the director of financial management at the Centers for Medicare & Medicaid Services (CMS), who spoke about the current operation and oversight of the Medicare Secondary Payer system, and James Cosgrove, director of health care at the Government Accountability Office (GAO), who spoke about ongoing studies of the failures and successes of Medicare Secondary Payer policies. The panel on which Ms. Stein testified included representatives from the business, insurance and legal sectors, all of whom cited multiple, overlapping defects in the program.

Read Ms. Stein’s testimony on the impact of the Medicare Secondary Payer policy on people with Medicare.

Read more about the collective effort by the Medicare Rights Center, the Center for Medicare Advocacy and other organizations to improve the law.

Senate Committee on Finance Holds Hearing on the Future of Medicare

Bruce Vladeck, Ph.D., chair of the Medicare Rights Center Board of Directors, testified today before the Senate Committee on Finance about the relationship between Medicare and the federal deficit. Dr. Vladeck is a former administrator of the Health Care Financing Administration (HCFA), now known as the Centers for Medicare & Medicaid Services (CMS). At a hearing titled “Health Care Entitlements: The Road Forward,” he argued that the deficit is a problem not of Medicare specifically, but of rising health care costs overall, and pointed out that the ebb and flow of the economy has a large impact on Medicare’s financial outlook in a given year. Dr. Vladeck also discussed the harmful effects that proposals that shift extra costs to people with Medicare would have on the population, noting that those with Medicare already face significant out-of-pocket costs. To avoid the need for such measures, he proposed several solutions, including increasing revenues, investing in health care delivery system reforms, and reducing what Medicare pays for certain medical services and products, such as prescription drugs. 

An array of proposals are under discussion that would save the government money by shifting costs to consumers. The most prominent is the voucher proposal included in the House budget, which would provide a capped payment to Medicare consumers to purchase insurance on the private market. The Congressional Budget Office (CBO) has estimated that such proposals would double what people with Medicare pay out of pocket. Other proposals include increasing Medicare consumers’ share of premiums, reducing coverage provided by Medigap supplemental insurance, and adding cost-sharing for services, such as home health, for which no cost-sharing existed before. Medicare Rights opposes such proposals, which would cause many people with Medicare, especially the half who have household incomes below $22,000 per year, to avoid going to the doctor and to forgo necessary medical care.

Read Dr. Vladeck’s testimony.

Read Medicare Rights Center President Joe Baker’s statement on Medicare redesign proposals.

Read the Medicare Rights fact sheet “Painting a Grim Picture: Deficit-Reduction Proposals that Hurt People with Medicare.”

Medicare Reminder

If you have Medicare and you file for workers’ compensation, workers’ compensation pays primary (first) for all medical and prescription drug bills (claims) that are determined to be related to your injury.

If workers’ compensation doesn’t make a decision about paying your health care bills within 120 days, Medicare may make conditional payments for your bills. A conditional payment is when Medicare pays in place of workers’ compensation. Once the workers’ compensation claim is settled or a final decision or award is reached, Medicare must be paid back.

If workers’ compensation denies a claim for a Medicare-covered service, Medicare should pay for the health care claim.

Learn more about Medicare and workers’ compensation at
www.medicareinteractive.org.

Spotlight

The Centers for Medicare & Medicaid Services (CMS) has launched a national campaign to raise awareness and encourage use of Medicare-covered preventive services, including the new Annual Wellness Visit and screenings such as mammograms, colonoscopies and bone mass measurements.

Though such services can save lives and prevent chronic medical conditions, they historically have been underutilized. Less than 40 percent of adults age 65 and older make use of recommended preventive care services, according to the Centers for Disease Control and Prevention.

Read more about CMS’s campaign.

Read Medicare Rights Center President Joe Baker’s statement on the importance of preventive care.

Learn more about Medicare-covered preventive services.