Stricter rules, 'secret shoppers' greet Medicare sales seasonCarol Gentry
Florida Health News
Published: Thursday, September 25, 2008 at 1:01 p.m.
Last Modified: Thursday, September 25, 2008 at 1:04 p.m.
Insurance agents that enroll Medicare beneficiaries into drug and HMO-style plans are being warned that the rules have changed to protect against marketing abuses and that government agents – "secret shoppers" -- will be watching.
The Centers for Medicare and Medicaid Services is tripling the number of undercover agents it will send to sales events this season, a CMS advisory warns. Last year CMS had 300 secret-shopper events -- many of them in Florida -- and took action on four companies, the agency says.
The new rules, released Sept. 15, apply to the marketing for 2009 enrollment in Medicare drug plans and all-inclusive Medicare Advantage plans, such as HMOs. Plans may begin marketing Oct. 1, with sign-ups allowed beginning Nov. 15.
"It's unfortunate that a few scurrilous salespeople and overzealous regulators are making life more difficult for the rest of us," says The Complete Advisor, a newsletter to agents from North American Life Plans. It urges agents to be "diligent about protecting yourself by staying informed, documenting everything and erring on the side of caution in all of your sales and marketing efforts."
A news release at the CMS Web site explains that the regulations are intended to "protect Medicare beneficiaries from deceptive or high-pressure marketing tactics…"
Another change that CMS is proposing would also have a major effect on agents. It would not allow plans to give agents big up-front commissions each time they enroll a new member, but would require that the payment be structured so that the agent wins if the member stays in the plan. CMS says this is aimed at removing the incentive to switch a beneficiary from one plan to another – a process known as "churning."
Florida has been the site of some of the most flagrant examples of churning and deceptive sales practices to Medicare beneficiaries, as described in press accounts and Congressional hearings.
While most beneficiaries have not been subjected to abuses and are pleased with their drug and Medicare Advantage plans, CMS says in its releases, "we will monitor activities throughout this year's enrollment period to ensure that beneficiaries are protected from aggressive marketing behavior from agents and brokers."
In addition to the change in commissions, the new regulations say:
--No more cold-calling or telemarketing. An agent may not call a Medicare beneficiary unless that person has contacted the agent first, according to an e-mail from Universal American. "Even then, the agent must set up an appointment with the individual before visiting the person's home," it says.
-- No more meals at sales seminars. Light snacks are OK, but it's the end of the Red Lobster sales talks.
-- No cross-selling. When agents are making presentations on one product, such as a drug plan, they may not push other products, such as an HMO. If the beneficiary wants information on the HMO, the agent must schedule another appointment to allow "a 48-hour cooling-off period."
-- No selling materials in certain areas, such as clinic waiting rooms, dialysis centers, pharmacy counters, or educational seminars.
CMS has told plans it will check on their ads in print and broadcasts and review recordings of enrollment calls to make sure companies are complying with the new regulations.
http://www.ocala.com/article/20080925/NEWS/809250296?Title=Stricter_rules___secret_shoppers__greet_Medicare_sales_season
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