**GAO-10-953R**                      Published: Sep 20, 2010. Publicly Released: Oct 13, 2010.                  

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## Highlights

In August and September 2009, Humana--a large private health insurer--sent a letter to the approximately 930,000 beneficiaries enrolled in its Medicare Advantage (MA) plans, advising that leading health reform proposals could adversely affect MA beneficiaries. Signed by Humana's Chief Medical Officer, the letter stated that if proposed funding cuts became law, "millions of seniors and disabled individuals could lose many of the important benefits and services that make MA health plans so valuable," and encouraged beneficiaries to contact their members of Congress and ask them to protect MA funding. Once the Centers for Medicare & Medicaid Services (CMS) learned about the mailing, the agency directed Humana on September 18, 2009, and all other MA organizations on September 21, 2009, to immediately stop all communications to beneficiaries about the potential impact of health reform legislation while CMS investigated whether such communications violated federal laws, regulations, or MA program guidance. CMS issued clarifying guidance to all MA organizations on October 16, 2009, and took compliance action against some organizations, closing its investigation. CMS is responsible for overseeing communications between MA organizations and beneficiaries enrolled in their plans. Because MA organizations are Medicare contractors, communications to beneficiaries must comply with various requirements, including marketing guidelines and restrictions on the use of beneficiary information obtained from CMS databases. CMS requires that MA organizations submit marketing materials--defined as materials targeted to beneficiaries that, among other things, provide information on plan benefits--to the agency for review and may impose penalties for distributing marketing material inappropriately. This report responds to your request that we review CMS's actions in response to MA plan communications to beneficiaries about pending health reform legislation. We examined: 1. how CMS learned that Humana sent a mailing to beneficiaries on the impact of pending health reform legislation in 2009; 2. the concerns CMS officials cited regarding the Humana material and the reasons they gave for suspending all MA plan communications about pending health reform legislation; 3. how CMS learned whether any other MA organizations had communicated with enrolled beneficiaries about pending health reform legislation; 4. what criteria CMS used to evaluate whether MA communications on pending health reform legislation violated any laws, regulations, or agency guidance; 5. what CMS found in its investigation into MA communications on pending health reform legislation; 6. what specific actions CMS took after it investigated MA communications; and 7. the extent to which CMS's actions were in accordance with agency policies and procedures, and consistent across MA organizations.

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## Topics

Health Care

Agency proceedingsBeneficiariesCommunicationDocumentationFederal fundsFederal lawFederal legislationGovernment information disseminationHealth care planningHealth care reformMarketingMedicareProgram managementCompliancePolicies and proceduresReimbursements