Suit Against Medicare, Social Security for Better
Service with Part D Payments is Settled
Goals were to improve processing for Part D premium
withholding, issuing refunds of premium amounts erroneously withheld,
and forwarding withheld premiums
Oct. 23, 2009 A suit filed in 2007 by Medicare
beneficiaries against the Centers for Medicare & Medicaid Services and
the Social Security Administration has been settled. One of the legal
teams that represented the beneficiaries, The Center for Medicare
Advocacy, says the Machado case was brought by beneficiaries who
experienced lengthy delays in having their Part D premiums accurately
withheld, or not withheld, from their Social Security benefits.
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By
Tucker Sutherland, editor & publisher
SeniorJournal.com
At the time the Machado case was filed,
extraordinary numbers of people had problems with erroneous premium
withholdings, especially after they had exercised their right to switch
plans.
"To make matters worse, these individuals usually could not obtain
assistance or answers from their plan, CMS, or SSA, the Medicare
advocacy group said in a prepared statement.
The main goals of the litigation were to shorten
the delays and improve processing for Part D premium withholding,
issuing refunds of premium amounts erroneously withheld, and forwarding
withheld premiums to the appropriate plans.
The efforts made by CMS and SSA to improve premium
withholding mechanisms since the filing of the lawsuit have resulted in
significant reductions in the inordinate delays and errors, as well as
in the volume of complaints.
Due to constraints in data coordination, however,
there is still a 90-day wait for withholding adjustments and refunds to
be processed; in certain rare instances a withholding discrepancy may
require longer than 90 days to resolve.
Also representing the beneficiaries in this case
Machado vs Sebelius - were Alice Bers of Benjamin & Bers and the
National Senior Citizens Law Center.
Another goal of the litigation, the lawyers said,
was to improve CMS' response to these types of complaints.
They point out that under the terms of the
settlement, customer service representatives at 1(800)MEDICARE are now
directed to advise people to call back, or to call their plan, if 90
days elapse after the "triggering date" without resolution of their
problem. (The triggering date is the date the individual last switched
plans or requested a change in withholding.)
If the triggering date is in CMS' system,
representatives are directed to inform the beneficiary of the exact date
when 90 days will have passed.
If the triggering date is not in CMS' system, the
CMS representative must recommend that the beneficiary contact their
plan to ensure that the plan has a record of the relevant transaction
and has taken appropriate steps to process the transaction. CMS will
encourage plans to provide similar information to beneficiaries who
contact them concerning premium withhold issues.
Pursuant to the settlement agreement, CMS has also
formally revised its operating procedures to prioritize and track the
resolution of every Part D premium withholding complaint (older than 90
days) that can be resolved through its Priority Entry Tracking System
(PETS).
Under this system, complaints are assigned to
regional and central caseworkers who analyze and take action on problems
- usually involving data discrepancies at the CMS/SSA level) pursuant to
set guidelines and timelines until they are resolved.
Hopefully, the Machado settlement will help to
reduce or avoid the adverse impact of premium withholding delays by
facilitating improved responses to complaints, more effective data
exchange between enrollees, agencies, and plans, and faster resolution
of premium withholding problems, said the statement by the Center for
Medicare Advocacy.
Advocates should inform clients who are having
issues with Part D premium deductions about what they should expect when
they contact 1-800 MEDICARE. Please notify us if these expectations are
not met.
Oct. 23, 2009 A suit filed in 2007 by Medicare
beneficiaries against the Centers for Medicare & Medicaid Services and
the Social Security Administration has been settled. One of the legal
teams that represented the beneficiaries, The Center for Medicare
Advocacy, says the Machado case was brought by beneficiaries who
experienced lengthy delays in having their Part D premiums accurately
withheld, or not withheld, from their Social Security benefits.
