HMO WOES

November 1998
		On January 1, almost half a million elderly and disabled Americans will lose their health coverage when several managed care plans no longer cover Medicare patients. What is the fate of Medicare? What options do people have? Experts answer your questions.

How do I know if I will lose medical coverage? Is the pullout legal? Why is healthcare so expensive? Can people just go back to Medicare? Why don't we raise rates? Does the medical industry charge too much? How can HMO's work with the government?

Charlie Young of Helena, MT, asks: Until the medical industry becomes honest with their billing procedures and accept that they over charge patients, and routinely charge for services not done, we are going to have this expensive mess. Tricia Neuman responds: Few would disagree with your concerns about fraudulent billing practices, excess charges, and other activities known as "fraud and abuse". You might be interested to know that Medicare has put in place a number of new measure to crack down on these activities at least as they pertain to services billed to Medicare, known as Operation Restore Trust. For example, Medicare has established a hotline for beneficiaries to report abuse (1-800-HHS-TIPs) and offers rewards to those whose tips lead to a recovery of funds. The movement toward managed care for Medicare and private payers helps to address billing problems, because people covered by these plans are not billed directly for the services they receive. Diane Archer responds: No one has ever shown that if fraud were eliminated we would end the high cost of health care. Yes, it would save some money. But, good health care is very expensive-especially for seniors and people with disabilities-and much of the high cost turns on the fact that research and development of new technologies and drugs is expensive, medical school is expensive, rent is expensive and everyone--doctors, HMO administrators, businesses, etc. -- wants to make a big salary. Karen Ignagni responds: Eliminating waste and fraud is important to achieving a better health care system. However, even if we eliminated every last penny, we'd still need to work hard to control increasing costs and improve the quality of care. Click to continue...