Medicare surveillance teams on the look-out

Medicare surveillance teams are on the lookout for insurance agents who break the rules for marketing and selling Medicare Advantage and Part D plans. While the “surveillance teams” are gearing up for the upcoming annual election period (October 15 – December 7), CMS (Centers for Medicare and Medicaid) just released its report on last year’s activities.

According to the report, the surveillance program sent secret shoppers to over 1,900 plan-sponsored marketing events during last year’s annual election period (which Medicare calls the “open enrollment period”).

The top states for surveillance activities were Florida with 310 “shops” (meaning secret shopper activities); California with 310 “shops”; New York with 142. Arizona came in fourth with 121 secret shopper activities.

The number of secret shopper activities is related to the number of complaints about agents and the companies that operate in these states. As well, Medicare Advantage is very popular in Florida, California, and Arizona, so I suppose we can expect to get special attention from Medicare during the annual election period/open enrollment period.

From the report, it appears that more attention will be spent this year on “targeted observations” outside retail stores, where agents sit at company-sponsored information booths or tables.

I had been thinking I should write about how agents will be all over the place as of October 1st and how I don’t like the idea of seniors sitting in a noisy store, getting a presentation on a Medicare Advantage plan, and signing up on the spot.  I’m surprised Medicare even allows this.

Agents will be manning tables in Walgreens, Frys, Walmart, and other stores from October 1 to December 7. 

Note to Medicare:  How about companies whose agents are sitting by the door of health care clinics that serve low-income seniors? How is that allowed?

The report mentioned two cases last year in which agents were dismissed by their Medicare Advantage company after they were secret shopped.

From the report:

One agent was using “scare tactics” with potential members entering a local retail store. The agent utilized superlatives in describing the plan sponsor’s products, stated that Medicare was going away and told the beneficiaries they needed to sign up for his plan or they would not have any drug coverage next year.

The other agent was marketing door-to-door at a low income housing complex, using scare tactics in an attempt to get dual eligible individuals to enroll.

According to the report, there will be more secret shopping activity this year, even though problems reported decreased significantly from 2009 to 2010. Insurance agents and brokers have been warned over and over again about the rules for presenting Medicare Advantage and Part D. Agents must present the entire summary of benefits for a plan (40 pages). Agents cannot say things like “this is the best plan”.  There is a long list of do’s and don’ts. Unfortunately there are still a few agents out there who don’t just cut corners – they seriously break the rules by going door-to-door in low-income housing complexes, or making cold calls to seniors, or pressuring seniors to make a decision on the spot.

The  infractions listed in the report were focused on group sales meetings, and the numbers of infractions seemed pretty small to me. 32 problems identified out of 1900 secret shops? That seems like overkill on the group sales event side.  All of these events must be reported to Medicare, so agents can expect to have a secret shopper in the audience monitoring every word they utter.

But does Medicare require Medicare Advantage companies to report to CMS that they are setting up tables in health care clinics for the poor, or the lobby of assisted living facilities? If that’s not against the rules, then Medicare is barking up the wrong tree.


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