Reports that some medical providers are seeking more financial gain by helping patients get private insurance over Medicare or Medicaid have caught the Obama administration's attention.
The Centers for Medicare and Medicaid Services has asked providers and others for information about concerns that third parties are helping patients pay premiums for private plans, which reimburse greater amounts than government health plans.
"It is improper to influence people away from Medicare or Medicaid coverage for the purpose of financial gain," said CMS Deputy Administrator Shantanu Agrawal. "Our goal is to protect patients from being unduly influenced in their decisions about their health insurance options, and to protect the integrity of all the programs we oversee."
Several lawsuits have been filed by insurers protesting that medical providers are "patient dumping" by paying their premiums for private insurance to secure bigger payments, especially for services performed for the sickest patients.
Last month, Blue Shield of California filed a lawsuit claiming that California's CenCal Health engaged in such a scheme.
Besides seeking information about "patient dumping" concerns, CMS said it also is considering some regulatory changes to block medical providers from improperly steering patients toward private plans, including those on the Obamacare exchanges.
The changes could include limits on premium payments by health providers, revising Medicare or Medicaid provider enrollment rules or penalizing individuals failing to provide correct information about consumers enrolling in a plan. The agency also said authorities should fine providers when they cause Medicare-eligible people to delay enrolling in Medicare because they have been steered toward a private plan.
"We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients' needs," said CMS Acting Administrator Andy Slavitt. "These actions can limit benefits for those who need them, potentially result in greater costs to patients, and ultimately increase the cost of marketplace coverage for everyone."