AEP Compliance

[AngelBand]

Only a few days into this AEP and I've run into clients who have had dealings with agents who are showing up unannounced, showing MAPD plans without a scope, switching to MAPD after a Med Supp presentation without a scope or 48 hours and the best yet, an agent who said he was there to discuss AARP then went on the show a MAPD pan.

I don't have time to be the Medicare police but every company I certified with this year said it was my obligation to notify their Compliance Officer if I found fraud, waste or abuse.

What do you do?

 

[GreenSky]

Only a few days into this AEP and I've run into clients who have had dealings with agents who are showing up unannounced, showing MAPD plans without a scope, switching to MAPD after a Med Supp presentation without a scope or 48 hours and the best yet, an agent who said he was there to discuss AARP then went on the show a MAPD pan.

I don't have time to be the Medicare police but every company I certified with this year said it was my obligation to notify their Compliance Officer if I found fraud, waste or abuse.

What do you do?

I just keep posting about Amerilife.

Rick

 

[AngelBand]

I just keep posting about Amerilife.

Rick

This is why everyone loves you, rick, you get right to the point.

 

[bluediamond]

Turn them in Angel. I have already see quite a few violations in less than a week.

 

[Russ]

Only a few days into this AEP and I've run into clients who have had dealings with agents who are showing up unannounced, showing MAPD plans without a scope, switching to MAPD after a Med Supp presentation without a scope or 48 hours and the best yet, an agent who said he was there to discuss AARP then went on the show a MAPD pan.

I don't have time to be the Medicare police but every company I certified with this year said it was my obligation to notify their Compliance Officer if I found fraud, waste or abuse.

What do you do?

You almost have to be a robot to play by the governments rules.

If everybody was reported, there may not be too many agents left. Then again, that may work to the honest agents benefit.

 

[HAMPnet]

I just make sure I'm following the rules, and if someone else wants to break them, that's their issue. I cannot police them. I only wrote 5 the first week, but they were all solid and sold compliant.

 

[Josh]

Only a few days into this AEP and I've run into clients who have had dealings with agents who are showing up unannounced, showing MAPD plans without a scope, switching to MAPD after a Med Supp presentation without a scope or 48 hours and the best yet, an agent who said he was there to discuss AARP then went on the show a MAPD pan.

I don't have time to be the Medicare police but every company I certified with this year said it was my obligation to notify their Compliance Officer if I found fraud, waste or abuse.

What do you do?

What you're talking about are marketing violations, not fraud, waste, or abuse.

In short:

Fraud: Filing a claim with Medicare when no services were rendered, sharing a Medicare ID with a friend so they can use it to get healthcare, etc.
Waste: Renting a cpap machine and paying for the rental on it when you don't need it or even use it
Abuse: Typically this is more of a provider thing and it involves billing issues such as intentionally double billing and/or adding extra services that aren't medically necessary.

Someone claiming their from Medicare and urging folks to get on a MA plan because it saves the government money and offering $100 cash to anyone that does it along with free meals during the presentation is a field day for a marketing compliance agent/officer, but it has nothing to do the fraud, waste, and abuse referred to in your training. The language you should be looking for is "marketing violations". If your training said it was your responsibility to report any suspected "violations of CMS Medicare marketing violations" or something around that nature, then they're recruiting you for the Medicare police.

 

[AngelBand]

Thanks for the replies, I am still in a quandry though.

Josh, you are correct that it is non compliant marketing- it is still very frustrating.

I agree that CMS rules are not easy to live with and do waste our time, which is $$$, but I don't get why an agent would risk a CMS violation for $200.

rick- I met with a US Navy veteran yesterday. He is 73 years old, lives in low income housing and works part time in his building as security to make ends meet. He has a Humana HMO- 0 premium. An AmeriLife agent wrote him a Heartland Indemnity policy last week- he said he signed the application just to get rid of her because we can practically see Bay Pines Veterans Hospital from his window. Here, the moral violation is far beyond any CMS violation and I didn't even mention this case in my original post.