HMO Consumer Rumors

CONSUMERS UNION (violator enabler)
WILLFUL BLINDNESS RE: FRAUDULENT USE OF CONSUMER REPORTS IN MEDICARE HMO ENROLLMENT

Consumers, Enforce Our Policy (if you can find it)

Consumers Union (Consumer Reports, Jan 2000, p.4) states in "microdot" fine print that:

"Our ratings and reports may not be used in advertising or for any other commercial purpose including any use on the Internet. Report any apparent violation by sending an e-mail to nocomm@consumer.org or by writing to CU, Dept WJW, 101 Truman Ave., Yonkers, NY 10703-1057."

CU Non-Enforcement Enables HMO Fraud

On Tuesday, November 9, 1999 at 3:00 p.m., HMO HARDBALL investigators attended a Kaiser Permanente Medicare HMO enrollment meeting at CoCo’s Restaurant.

The HMO sales representative softened up the old folks with free pie (loaded with bad cholesterol) that her own HMO’s health promotion staff advises patients to avoid. HARDBALL investigators refused to succumb to temptation. It took cast iron willpower and fear of heart disease to resist pecan pie with whipped topping and apple pie a la mode.

The sales pitch lasted for more than an hour, while the usual eye-glazing HMO hype was presented. But, before the sales rep closed in for the metaphorical "kill" by handing out enrollment applications, she referred to her best "talking point:"

"Consumer Reports' survey rated Kaiser Permanente as the best HMO."

HMO HARDBALL Does Consumers Union’s Job

The sales rep had violated CU’s no-commercialization policy, evidently not for the first time. She had intentionally misstated CU report content to defraud consumers to enroll in the Kaiser Permanente Medicare HMO. She was confident that CU would not enforce its policy to prevent this. She was right! CU "enabled" Kaiser Permanente to defraud Medicare enrollees.

However, this time HMO HARDBALL investigators were on the job to stop patient rights violators. They had read Consumer Reports’ HMO survey (August, 1999 issue). They told the group:

  • Kaiser Permanente wasn’t rated the best HMO.
  • Kaiser Permanente’s ratings varied by location.
  • Kaiser Permanente’s HMO in this location didn’t have even one factor rated best.
  • Kaiser Permanente’s HMO in this location had doctors whose ratings were only average in all categories (access, choice and care).

The sales rep’s reply: "I don’t remember word for word."

HMO HARDBALL investigators added that the Consumer Reports to which the sales rep referred did not even apply to Medicare HMOs at all.

Her reply: She did not reply!

HMO HARDBALL’S Advice to Consumers Union

HMO HARDBALL is in agreement with the Medicare Rights Center’s statement that:

"Laws designed to protect people are worthless if no one ensures that the front-line, consumer-service representatives know the rules… These are not small mistakes." (The San Diego Union-Tribune February 2, 2000, p. C1)

It is HMO HARDBALL’s mission to identify and enforce patient rights, but HARDBALL suggests that CU enforce its own no-commercialization policy by taking these steps:

    1. Obtain a written assurance from all HMOs reported on in Consumer Reports that they will not use CU ratings and reports in advertising (oral and written) or for any other commercial purpose.

    2. Replace CU’s "fine print" notation to consumers regarding policy violation and reporting. Consumers shouldn’t be forced to search for and examine "microdots" to learn CU policy.

    3. Report all policy violators by name and address in CU publications in a separate and highly visible section. (e.g., click on HMO HARDBALL website, HMO Violators).

    4. Assess penalties for intentional policy violators.

    5. Standardize report formats and begin each report with a prominent summary section highlighting unsatisfactory findings instead of "burying" them within the text. For example, the HMO sales representative would have had a much more difficult task misrepresenting Consumer Reports findings (8/99). Consumers who read that issue would have known that:
  • "Only 33 percent of those readers [who said they were ill] were completely or very satisfied."
  • Only 5 percent of respondents had used their plan’s formal grievance procedure… Half were not happy with the outcome,
  • and 40 percent said it took more than two months to resolve complaints.
  1. Include a form in every CU publication to make it easier for consumers to report CU policy violations. (e.g., click on HMO HARDBALL Scorecard.)

HARDBALL'S Bottom Line

CU, take responsibility. Don’t depend upon readers to enforce your policies. You know or should know that your no-commercialization policy is violated with impunity at will. CU staff should be out in the trenches to insure that HMOs don’t misuse CU reports to victimize consumers, in this case patients. My HMO Songbook sums it up:

"HMOs do slick talking, when they go out stalking."
The HMO RAP