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Cloud Call Center Community Featured Article

TMCNet: Medicare Announces Requirements to Protect Beneficiaries From Deceptive Marketing

[September 18, 2008]

Medicare Announces Requirements to Protect Beneficiaries From Deceptive Marketing

(BestWire Services Via Acquire Media NewsEdge) The Centers for Medicare & Medicaid Services released final regulations restricting sales and marketing practices engaged in by private insurers and their agents, citing a need to protect Medicare beneficiaries from "deceptive or high-pressure" marketing tactics.


The regulations, issued by the federal agency that administers Medicare, include prohibitions on telemarketing and other unsolicited sales contacts. The announcement was made in advance of the open enrollment period for Medicare Advantage and Medicare Part D prescription plans, which begins Nov. 15.

They also include expanding the current ban on door-to-door solicitation to cover cross-selling of products that aren't health care-related. Sales appointments with beneficiaries for health care-related products would be limited to areas agreed to in advance. Sales activities at health fairs, community meetings and in waiting rooms would be prohibited. The new rules also prohibit financial incentives to encourage agents and brokers to maximize commissions by inappropriately moving, or churning, beneficiaries from one plan to another each year. Plans must be in compliance with these provisions when they begin their marketing activities on Oct. 1.

"The regulations give insurers bright-line guidance on what types of marketing activities are acceptable and what types are not acceptable," CMS Acting Administrator Kerry Weems said in a statement. "Medicare beneficiaries can be assured that we will monitor marketing activities and move aggressively with enforcement measures or other actions if these rules are violated."

Janet Trautwein, executive vice president and chief executive officer of the National Association of Health Underwriters, said her organization supports a requirement that all individuals selling private Medicare policies be both state-licensed and appointed producers. NAHU has other concerns, however, including what it considers an unclear definition of what a "health insurance product" is, she said in a statement.

"The association also would have preferred CMS to have provided a safe harbor for agents and brokers who are working with existing clients, as well as for clients who ask for specific information about other non-health insurance products during the course of a sales meeting, so that seniors who request such information could receive it in a timely manner," Trautwein said.

The new rules, first proposed in May, would clarify the calculating of fines, or civil monetary penalties, against Medicare Advantage or Part D plans that violate Medicare rules. CMS would have more flexibility in determining penalty amounts and would have clear authority to levy a penalty of up to $25,000 for each enrollee affected, or likely to be affected, by the violation (BestWire, May 9, 2008).

In May 2007, representatives of the Oklahoma, Georgia and Wisconsin insurance departments told the Senate Special Committee on Aging of misleading and possibly fraudulent sales practices by life and health insurers that sponsor Medicare Advantage plans (BestWire, May 16, 2007). CMS officials said they logged 2,700 agent complaints from members enrolled in individual plans between December 2006 and April 2007.

(By Sean P. Carr, senior associate editor, BestWeek: Sean.Carr@ambest.com)

Copyright ? 2008 A.M. Best Company, Inc.

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