Managed-Care Enrollment Fraud
Managed-care enrollment fraud has become a growing problem is the United States, affecting thousands of consumers every year. Florida class-action lawyer Joseph Saunders filed a lawsuit in July 2007 in Pinellas County Circuit Court against UnitedHealthcare of Florida, on behalf of his mother and others similarly situated who he says were fraudulently enrolled in the company's Medicare Advantage plans. As a result, plaintiffs were unwittingly duped out of their Medicare. The suit, filed in behalf of Charleen G. Edge, also names United's parent company, UnitedHealth Group of Minnetonka, Minn as a defendant.
Back in April 2006, when Ms. Edge found out she may have been enrolled in a managed-care plan, she sent a letter to United requesting that she be dropped from the plan. Apparently that didn't happen, Ms. Edge claims, and now she's obligated to pay $30,000 in medical bills and other medical expenses.
These onerous medical expenses were incurred when she fell and broke her pelvis, and was taken by ambulance to St. Anthony's Hospital in St. Petersburg, Florida. Subsequent to leaving the hospital, she spent five weeks of rehab at a skilled nursing facility. Both Medicare and United deny responsibility for payment for the hospital, nursing home, ambulance and other bills.
It's still not immediately clear how many others may be in Edge's situation and therefore able to join the class. The lawsuit, which seeks judicial certification as a class action, cites 5,000 members, but Saunders concedes that he only can estimate the number until he accesses United internal documents.
Saunders claims that he is certain there are more people in his mother's predicament because of congressional hearings in May and June 2007 on abusive marketing practices in Medicare Advantage. Advocates and several insurance commissioners testified at the hearings in 2007 that sales agents for numerous plans misled beneficiaries about the coverage to win the generous commissions that Medicare Advantage enrollment bring.
Abby Block, an official from the Centers for Medicare and Medicaid Services, testified at the hearings that the agency had received thousands of complaints from beneficiaries who were enrolled either without their consent or through misleading sales pitches. In late June 2007, the agency wrote new guidelines instructing its regional offices and phone operators to help beneficiaries get out of plans if they make a persuasive case that they were misled.
See Also
- Consumer Fraud