These enrollees were also not informed that the Medicare Advantage Plans such as Secure Horizons and Complete Care provide limited or no skilled nursing home care, while US Medicare covers 100% of such care for 20 days. The companies also failed to inform clients that the United plans have significant co-payments and significantly more limited availability of physicians who will accept their plan than will accept medicare.
The suit also states that United Healthcare's marketing practices fraudulently imply by names such as CompleteCare and SecureHorizons that the United insurance policies provide equal or complete care when in fact they provide far less care that the Medicare coverage that they replace.
"Last year my mother signed up for the new Part D Medicare programâ"the drug supplementâ"and the insurance company tricked her into signing up for Medicare Advantage (which is privatized Medicare), says lawyer Joseph Saunders. "This case isn't just about the case with her, but the pervasive fraud that goes in the Medicare system and that is why we filed the class action.
Saunders explains that seniors don't realize they are dis-enrolling themselves from Medicare to be in a private HMO PPO and the United Health Care defense is that they are immune from our state consumer laws because they are privatized Medicare and the federal regulations preempt state law.
Saunders filed briefs with the federal court on this preemption issue and United Health Care agreed to pay all of his mother's bills (over $30,000) and make sure she had coverage.
However, Saunders is unlikely to get the class certified. "I expected that the court would rule we were preempted by the federal regulations so we sent the information to Pete Starks of the US Congress--that is where the remedy has to beâ"Congress has to fix this issue," he says. "I don't think a class action is the vehicle that will successfully resolve this issue.
"The case is settled-I believe it was dismissed by the judge yesterday and we are hoping that Congress will address this issueâ"they have been having hearings since last June. We are hoping that Congress will address fraud in the Medicare Advantage programs."