HMOs mislead elderly in lobbying bid, government says

Groups accused of effort to pressure Congress


WASHINGTON -- Medicare officials have accused health maintenance organizations of sending false information to their elderly subscribers in an effort to mobilize them to pressure Congress.

In response, federal officials have begun demanding that HMOs submit newsletters and other documents to the government for review before sending them to Medicare beneficiaries.

In this way, the government says, it will be able to "correct any misstatements or misleading information."

Federal officials said they could also impose civil fines and other penalties on HMOs that send misinformation to beneficiaries.

The health plans insist that they are exercising their right to communicate with their members on important public issues, including recent cuts in Medicare benefits.

But federal investigators say they have found evidence that HMOs billed Medicare for some of their lobbying expenses.

Federal regulations generally prohibit government contractors from using federal money for lobbying intended to influence Congress.

HMOs say that some lobbying expenses might have been included with other administrative costs in the past, and they insist that the practice was not forbidden by the Medicare law.

A new study by the Health Care Financing Administration, which runs Medicare, says HMOs have disseminated "false and/or misleading information" that blames the agency for rising health care costs, increased premiums and reductions in benefits.

One HMO, run by Highmark Inc., a Blue Cross and Blue Shield plan in Pennsylvania, told members that the Clinton administration was cutting $11 billion from Medicare "without approval from Congress." It urged Medicare beneficiaries to send letters of protest to Congress and the administration.

In an interview, Dr. Robert A. Berenson, a senior Medicare official in charge of the managed-care program, said, "We are very concerned about health plans that have been misleading beneficiaries and misrepresenting facts."

Berenson acknowledged that restrictions on the free-speech rights of HMOs could run afoul of the First Amendment.

But in a recent memorandum to the head of the Medicare agency, Berenson said restrictions were necessary because patients would otherwise receive inaccurate information, and the agency would be "unfairly blamed for benefit cuts or premium increases."

Medicare officials considered issuing a regulation that would flatly prohibit HMOs from using their members' names and addresses for lobbying or political purposes.

But, Berenson said, lawyers at the Department of Health and Human Services have "serious concerns about the statutory basis for such a regulation," fearing that it could be challenged as "an unconstitutional restriction on speech."

Rather than ban such communications, federal officials said, they will examine them in advance to correct any inaccuracies.

"The threat of public criticism" by the government will probably be effective in getting HMOs to revise their communications with beneficiaries, Berenson said in his memo. "In extreme situations," he said, the government can correct the misinformation by writing directly to patients.

Medicare provides health care to 39 million people who are elderly or disabled.

More than 6 million of them, about 16 percent of all beneficiaries, are in health maintenance organizations.

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