Those overcharged through Medicare might be out of luck

McClatchy NewspapersApril 22, 2009 

WASHINGTON — If you've been overcharged by Medicare's prescription drug program, don't count on getting your money back any time soon, if at all.

And don't count on Medicare to help you, either.

The government-run elderly health care program appears to have washed its hands of any responsibility for mistakes that have cost subscribers and taxpayers several billion dollars.

That was the message contained in Medicare's response this week to a series of questions about problems with the prescription drug program posed earlier this year by Democratic Sen. Claire McCaskill of Missouri.

"I was shocked at this answer because it basically said, 'Tough. We're not worried about them (seniors),' " McCaskill said at a Senate hearing Wednesday.

McCaskill wrote Medicare in January after the inspector general for the Department of Health and Human Services reported that 80 percent of the insurance companies participating in the elderly drug program, known as Medicare Part D, owed Medicare about $4.4 billion for 2006 alone.

Among her questions was how subscribers to Part D who have been overcharged could get reimbursed.

"…the beneficiary knows the premium cost before enrolling in the plan," Medicare replied in a letter to McCaskill on Tuesday. "Furthermore, beneficiaries have access to detailed plan information; therefore if a beneficiary is not satisfied with a plan's premium, the beneficiary may enroll in a less expensive plan for the coming year."

After reading the response aloud at the hearing, where Medicare and Health and Human Services officials testified, McCaskill said, "Are you kidding me? Seriously. Do you think my mother is supposed to go through her plan and figure out somehow that she's been overcharged and all she has to do next year is pick a cheaper plan?"

One of the witnesses at the hearing, Deb Taylor, acting director of Medicare’s office of Financial Management, told McCaskill that she was unable to say how subscribers could get reimbursed.

The Medicare prescription drug benefit is a $60 billion program. Enacted by Congress in 2003, it provides an optional plan that subsidizes the costs of medicine for about 27 million subscribers. They generally pay a monthly premium for coverage.

The Centers for Medicare and Medicaid Services, which supervises the program, contracts with private insurance companies to provide the drug coverage.

The inspector general's report said that the reasons for the overcharges were due to mistakes in the bids that insurance companies submit to Medicare to participate in the drug program.

The bids represent estimates of how much revenue the companies would need monthly to provide the basic drug benefit.

Medicare is supposed to audit those bids to ensure their accuracy, but the agency is behind in the audits.

A quarter of all the bid audits for the years 2006 and 2007, however, had mistakes that led to higher profits for the insurance companies and higher costs for subscribers, according to the inspector general.

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