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NATIONAL CENTER FOR POLICY ANALYSIS
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Medicare Oversight System
Failing Its Responsibilities

Daily Policy Digest

Health Issues

Monday, August 13, 2001

The system which is supposed to oversee how well Medicare and Medicaid deliver their services and investigate patients' complaints is ineffective, concludes a study conducted by the Office of Inspector General for the Department of Health and Human Services.

 The criticism was aimed at the Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration. Complaints investigated ranged from minor problems and unhappiness with rude practitioners to serious medical care issues.
  • The organization referred just six medical practitioners for punishment in the last five years -- despite receiving thousands of complaints.
  • Quality problems were identified in at least 13 percent of complaints filed.
  • Those on Medicare often don't know the system exists -- and even if they do and try to lodge a complaint, they have difficulty getting through by telephone.
  • Under federal law, details of the results of investigations are not released to patients unless the doctor or other care providers agree -- which they do in only 21 percent of the cases where a quality problem is confirmed.
Source: Julie Appleby, "Medicare Oversight Found to Be Ailing," USA Today, August 13, 2001; based on "The Medicare Beneficiary Complaint Process: A Rusty Safety Valve," OEI-01-00-00060, August 2001, Office of the Inspector General, Health and Human Services.

For Inspector General's report
http://www.hhs.gov/oig/oei/reports/a535.pdf

 For more on Medicare Waste, Fraud and Abuse
http://www.ncpa.org/pi/health/hedex3c.html
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Copyright © 2001 National Center for Policy Analysis - All rights reserved.