1. Archive

Nelson calls for HMO records

State Insurance Commissioner Bill Nelson has issued subpoenas for seven insurance companies in hopes of learning more about why they pulled Medicare HMO plans out of several Florida counties.

It is the second time during a political campaign that Nelson, who has no regulatory authority in such cases, has tried to dig into the records of Medicare HMOs that withdrew their plans and prescription drug coverage from thousands of Florida residents.

Nelson, who is running for U.S. Senate, asked for records in October of 1998 when he was running for re-election as insurance commissioner. That investigation turned up no wrongdoing.

The subpoenas, which were issued Tuesday and arrived at some of the insurance companies Wednesday, seek proof that the companies are leaving counties because of low reimbursement rates paid by the federal government.

"The companies are claiming the reimbursement levels are too low, so these will be very detailed subpoenas seeking information on whether they are indeed, or if it's something else," said Nelson spokesman Don Pride.

The move comes at a time when thousands of seniors and disabled residents in Florida and across the country are losing access to prescription drug coverage as Medicare HMO companies head to more-profitable counties.

More than 26,000 Florida residents, including 10,000 in Hernando County, will be without a Medicare HMO in their county at the end of the year.

Even though the federal government regulates Medicare plans, the state Department of Insurance issues their licenses to operate in Florida and oversees their financial stability.

For that reason, the companies say, Nelson already should know the information he's seeking.

"We went through the same experience two years ago, and the result after months of investigation was that there was nothing there," said Pam Gadinsky, spokeswoman for Humana, one of the last two companies to pull out of Hernando County, where it lost $654,000 last year and expects to lose $2.2-million this year.

Pride said the last investigation focused on whether the companies had violated antitrust laws in dropping more than 53,000 Florida Medicare customers. This one focuses on finances.

Pride said Nelson consistently has fought against Medicare HMO withdrawals, and that it has nothing to do with the political year. Any information gleaned from this investigation will be passed on to Congress, he said.

In addition to Humana, the other six companies subpoenaed are Aetna U.S. Healthcare Inc., AvMed Health Plan, CIGNA Healthcare of Florida, Physicians Health Care Plans, Preferred Medical Plan and Prudential Health Care.

"We gave them 32 boxes of information," said Valerie Rubin, spokeswoman for AvMed, the other company pulling out of Hernando County. "We had to have a truck haul it up there."

During the company's loss of $60-million statewide in 1998 and 1999, mostly due to Medicare HMO business, Nelson's office worked closely with AvMed to make sure it would stay solvent, she said.

AvMed can afford to stay in business in places like Miami-Dade County because the federal reimbursement rates are higher, she said. Competition prevents them from transferring money to Hernando.

"And it's not fair to jeopardize the programs in Dade County because the federal government is not reimbursing programs for Hernando, Dixie or Levy," she said.