Certain types of Medicare Advantage plans are coming under close scrutiny by authorities after discovery of abusive hard-sell tactics by private insurers. In April, two Wellcare insurance salesmen were arrested in Columbus for a variety of aggressive and fraudulent sales tactics, including forging the signatures of elderly customers.

Two weeks ago Insurance Commissioner John Oxendine announced the formation of a Medicare Fraud Task Force to review fraudulent Medicare Advantage sales tactics and other program abuses. That came on the heels of the Columbus arrests and an additional arrest in suburban Atlanta relating to a separate series of forgeries and misrepresentations by a salesman to residents of a Suwanee nursing facility.

The abusive activity seems to center on a particular type of Medicare Advantage Plan known as a "private fee for service plan". Nevertheless, the developments in Georgia (and elsewhere in the country) are triggering careful evaluations of all Medicare Advantage Plans.  The US Senate has gotten into the act and has held a series of hearings around the country in a lead-up to what many believe will be new legislation.

Medicare Part A has been the traditional route for medical coverage needed by the elderly and disabled in medical facilities. Part B applies to services provided by physicians and other medical practitioners, home health services, durable medical equipment and other services not covered by Part A. (For a more complete discussion of Medicare read Medicare 101 on the Mason Law website.)

When combined with good Medicare supplemental insurance policies (popularly called Medigap policies) and the new Part D Drug plans, Part A and Part B provide fairly complete coverage. There are gaps, however.

Traditional Medicare, for example will not pay for most dental care, vision care, hearing care and preventive care. On the other hand, many Medicare Advantage plans offer to fill some of those gaps. But at a cost (and often hidden).  For example there may be higher coinsurance amounts or deductibles, or other restrictions on who may provide services.

The newer Medicare Advantage Plans may be patterned after health maintenance organizations, which offer a wide variety of services as long as the member uses participating providers.  Other Advantage plans may be patterned after preferred provider organizations and managed care organizations that offer broader service but hold down costs by preapproving services or placing other restrictions on the medical providers. Most of the abuses do not involve these plans. But do think very carefully before switching to an Advantage Plan; the deal may not be as sweet as it first seemed.

Remember: There are different kinds of Medicare Advantage Plans. The abuses have centered on Medicare Advantage plans known as "private fee for service plans". Under a private fee for service plan, the member is free to use any physician or provider willing to accept a payment from the plan and render service according to conditions set by the Plan. Many people switch to private fee for service plans later to discover that their doctor will not participate in the Plan.

Georgians are getting a new Health Care Advance Directive form. Governor Perdue recently signed into law the Georgia Advance Directive for Health Care Act, which will become effective July 1. Mason Law has begun using the new forms immediately.

The forms are a badly needed improvement over the older forms. The old Health Care Power of Attorney form and the Living Will form will continue to be effective if executed before July 1. Nevertheless, the new forms are better enough that many will want to execute the new form. The new "Georgia Advance Directive for Health Care" form may be downloaded from the Mason Law, PC website.  Go there HERE.

Soon to be 'history' will be the current "Durable Power of Attorney for Health Care" and the "Living Will". Georgia law had treated the two documents separately because two different objectives were being pursued. The power of attorney form allowed an individual to name another person (or persons) to make health care decisions on behalf of the individual if he or she became incapacitated. On the other hand, a living will allowed the same individual to make certain elections with regard to treatment (or withholding treatment) in the event of a number of serious or end-of-life conditions.

The two forms have been combined into an easily understandable form. The directions are understandable and appear on the front of the form. Four parts of the form allow for the selection of an agent (I suggest naming a successor or two), specification of treatment options, free-style description of any important personal considerations, nomination of a future guardian if the need should ever arise, and the ability to limit the effective duration of the power.

The form is flexible enough to allow anyone with strong preferences to state them, yet the design of the form is such that the "default setting" is toward a pro-life orientation. I have been involved in advance directive re-write efforts in North Carolina, and the Georgia effort would avoid many of the political objections raised in North Carolina.

It's a good form that had plenty of input from the legal, medical and academic communities. Hats off to the people who worked very hard on this effort.