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GAO Critical of Medicare HMO Data

November 01, 1996|ROBERT A. ROSENBLATT | TIMES STAFF WRITER

WASHINGTON — Medicare does a poor job of giving its beneficiaries in the Los Angeles area accurate comparative information about various health maintenance organizations, the General Accounting Office said Thursday.

About 30% of the Medicare beneficiaries in California are members of HMOs, and people often seek information from Medicare about which plans offer the best services and benefits.

Sen. William S. Cohen (R-Maine), chairman of the Senate Committee on Aging, and the committee's ranking Democrat, Sen. David Pryor of Arkansas, asked for an inquiry into Medicare HMOs' marketing and enrollment.

The GAO, the investigative arm of Congress, focused on the hottest HMO markets, those in Los Angeles and Miami, two areas where HMO membership is far above the national average of 10% for all Medicare beneficiaries.

"Unlike leading private and public health-care purchasing organizations, Medicare does not provide its beneficiaries with comparative information about available HMOs," the GAO said in a highly critical report.

Comparative information would be particularly useful in Southern California, where Medicare beneficiaries are besieged with ads and solicitations to enroll in HMOs.

HMOs are attractive to many people because they offer benefits not included in Medicare, and enrollees also are freed from paying the 20% co-payments required under Medicare for doctors' services.

. The study found wide variations in dropout rates in the L.A. marketing area--Los Angeles, Orange, Ventura, San Bernardino, Riverside and San Diego counties. Among major marketers, the 1995 rates for enrollees who dropped out of their plans included PacifiCare (9%), FHP (13%), Kaiser (4%), Aetna (12%), Health Net (10%) and CareAmerica (18%). The U.S. rate was 12% for Medicare HMOs.

For some HMOs, the GAO said, the dropout rates "raise questions about whether the HMO's business emphasis was on providing health care or on marketing to new enrollees . . ."

The government defended its policies. A Health Care Financing Administration official said, "We are proud of our record of offering more choice to Medicare beneficiaries."

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