Unnamed healthcare providers may be steering patients towards Obamacare instead of Medicare and Medicaid, according to a release from the Centres for Medicare and Medicaid Services (CMS).
CMS, the government organisation in charge of Medicare and Medicaid, solicited public comment on Thursday for instances in which healthcare providers, such as doctors and treatment centres, misled people towards policies on the public exchanges set up by the Affordable Care Act.
“The request for information and letters to providers focus on situations where patients may be steered away from Medicare or Medicaid benefits, which can among other concerns, result in beneficiaries experiencing a disruption in the continuity and coordination of their care as a result of changes to their network of providers,” said a release from CMS.
Healthcare providers typically earn more from the Obamacare plans than Medicare and Medicaid, thus it is more profitable to direct patients towards the former.
“We are concerned about reports that some organisations may be engaging in enrollment activities that put their profit margins ahead of their patients’ needs,” said Andy Slavitt, the acting administrator of CMS, in the release.
One of the largest issues with the exchanges is that healthier people have not been signing up for Obamacare plans, leaving the pool of people paying into the system older and sicker. This in turn drains the overall funds and makes it unprofitable for many insurers.
While the CMS solicitation does not name particular providers, it is likely that the regulator heard of such activities before asking for public comment. The CMS also said they are thinking about possible enforcement action against providers undertaking the practice.
“In particular, CMS is looking at authorities to impose civil monetary penalties on health care providers when their actions result in late enrollment penalties for Medicare eligible individuals who are steered to an individual market plan and, as a result, are delayed in enrolling in Medicare,” said the release.
This news comes in the same week that Aetna, one of the nation’s largest insurers, announced that they will pull out of 70% of the counties in which they offer Obamacare plans due to a $200 million loss on the exchange business in the second quarter.