Dr. Oz says commission churning for MA plan is big issue

[EckoRomeo]

Then what are you specifically saying is against the rules. I'm asking the same question over and over and you are yet to answer it. You never have said what was against the rules, only that he was breaking the rules. If I have missed it, please help me with my reading comprehension and point it out. I must just keep missing it. Please help me ol' knowledgeable guru!

Weird how MedicareWAA understood exactly what I said but you, Todd "the" King, can't seem to. Maybe hes just smarter than you?

 

[Todd King]

Weird how MedicareWAA understood exactly what I said but you, Todd "the" King, can't seem to. Maybe hes just smarter than you?

Well, when you figure out exactly what he's doing against the rules, you let me know. Until then I'll just go with, you're just a whiner and a bullshitter that can't back himself up.

 

[Winters Ins Agcy]

Just for clarification to the audience, which rules is he skirting?

If an agent is door-knocking for FE and shows up wearing an "Ask Me About Medicare" badge and/or shirt, you don't see a compliance issue with that? Does there have to be a written provision or rule that specifically addresses that in order for it to be non-compliant.

As Justice Potter Stewart once famously opined in defining hard-core pornography, "I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description, and perhaps I could never succeed in intelligibly doing so. But I know it when I see it."

 

[EckoRomeo]

Well, when you figure out exactly what he's doing against the rules, you let me know. Until then I'll just go with, you're just a whiner and a bullshitter that can't back himself up.

I'm not the one that needs to figure anything out, Todd. That's you. Another poster has posted and they seem to understand what I am alleging to be against the rules. Only person lost here is you. Wonder why? Probably because this is how you train your agents maybe?

 

[Special Agent]

I wear an ask my about Medicare badge and an ask me about Medicare shirt. They ask me and approach me about Medicare . I don't need 48 scope . It's no different than a call in to a call center . No 48 hrs needed . THEY ALL ASK ME .

When i door knock in the hood i wear my Axe Me About Medicare shirt.lol

 

[EckoRomeo]

When i door knock in the hood i wear my Axe Me About Medicare shirt.lol

You door knock the hood to sell Supplements?

 

[EckoRomeo]

Also, Don claims that he writes 40 MAPD PER MONTH because prospects "approach" him after he's rang their doorbell.

Lol…

When I first started I sat in Walmart with balloons saying "ask me about Medicare" DURING AEP. Never did 40 people per month approach me.

But 40 people a month "approach" Don as he's standing on their door step to ask him about Medicare. When he is just there to sell them some final expense...


lol
lol
lol

 

[MedicareWAA]

Once again, point out to me where he is breaking the rules. It may go against someone's morales, but it is not breaking the rules. Please show me the rule that says he can't wear that badge and I'll be happy to concede and apologize.

(Edited to add something about intent)

My intent here is not to be a jerk. If my comment comes across that way, please know it's not intentional.

Do you sell MA plans? If yes, do you not get and read the codes of conduct for each of the plans? They address this subject, directly or indirectly, depending on the carrier.

Also - and this is a genuine question - do you not receive and read HPMS memos about compliance? Or go to industry compliance events where CMS explains their interpretation of the rules? Or have someone on your staff or in your hierarchy who does these things for you?

As to your question about where to find the rules, start by reading 42 CFR 422 and 423. Look at the last five editions of the MMGs to appreciate how the guidance has evolved, what's stayed consistent, etc. Make sure you understand that CMS sometimes uses terms like "sales appointments" and "calls" more broadly than one might think, and right or wrong, they're the ones who make the rules.

Also go read the annual rule-making materials that pertain to sales and marketing. Pay special attention to the agency's responses to public comments. Those are important because the agency is consistently transparent about what the rules mean … the intent of the rules, which is sometimes overlooked by a strict reading of the words. That's why they give us this insight.

Then go read state insurance laws. In at least a few states, including Maine, you cannot use the techniques Don describes. And virtually every state has insurance and/or consumer protection laws that prohibit misleading marketing practices, which would include marketing the sale of any insurance product as an intentional pretext for soliciting the sale of an unrelated insurance product. Some states restrict this conduct under their unfair trade practices act, deceptive trade practices rule, consumer protection regulations, etc. Sometimes the guidance is promulgated by their commerce department, their AG, or others.

You can go read the Federal Trade Commission Act (start with section 5(a)(1). You can also go search any legal databases for case law pertaining to everything I've just mentioned. The case law will show you that, to the extent the wording of these rules are ambiguous, the courts (often administrative law courts) have given them clarity.

CMS has written and spoken about these sorts of tricks. I don't have the time to find the citations. In a nutshell, it comes down to pretext and circumvention. When you show up at someone's door to discuss life insurance, wearing a button and shirt that shouts "ask me about Medicare", you are showing an intent to solicit a conversation about MA products. A conversation about MA is therefore not incidental.

The intent is further evidenced by the percentage of people who buy a MA plan. When you're selling 40 MA plans to these people, it is clear evidence against incidental MA selling. It is a pattern of conduct that reveals the real intent of the conduct.

In the view of CMS, and most carriers, this is analogous to leaving a brochure on a doorknob, which is prohibited as an unsolicited individual contact. (I'm not saying it's a good rule.)

There used to be agents who would sell a low dollar critical illness or FE product to someone and then claim the person an existing business relationship. They'd cold call the client a few weeks later and pitch an MA appointment, a MA review, etc. CMS clarified that it's prohibited as a circumvention of the MA rules against unsolicited contact. It's not the same thing as calling your existing MA book for a re-review. The existing relationship argument gets you around certain FTC rules, but it does nothing to get around the MMGs.

Here is an example of what is unlikely to attract scrutiny: Don door knocks about FE. He wears his Medicare button. The person asks about Medicare. Don offers to schedule another appointment a couple of days later, collects a scope, and comes back to pitch MA. A legitimate, albeit convoluted and unsavory, loophole.

Also cool: Don walks around the supermarket, minding his own business, dressed in full "Ask Me" paraphernalia. Shoppers walk up and ask him about Medicare, and Don starts a discussion. Totally legit, although a scope may still be implicated. BUT … Not cool: Don walks up to a shopper, uninvited, and just stands right in front of them, waiting for them to ask about Medicare. That's an unsolicited contact, even though Don never says a word.

In the strictest sense, wearing that big button turned your FE door knock into a covert MA door knock, loosely akin to the legal theory of "fruit from a poisoned tree".

If you're still uncertain whether Don's trick is permitted, go ask the compliance departments at each of the top three MA carriers. Describe the practice, factually and in its entirety. Tell me what they say. Or, trust me when I tell you they'll say something along the lines of, or in the spirit of, what I'm saying in this response.

I'm not your compliance person. I'm not your lawyer. So no, I'm not going to give you every regulatory citation and I'm not going to fetch all the case law about this subject.

In summary: Don is using a cute trick and thinking it absolves him of accountability. It does not. It's also a crappy way to sell MAPD, and it gives him no standing to criticize the games call centers play. Different shades of sh?t.

P.S CMS itself doesn't regulate independent insurance agents, per se. They regulate MA plans, and in that context, the agency views any appointed sales agent as a representative of the plan. When I discuss a Humana plan with a client, I am the same thing as a Humana employee in the eyes of CMS. I write this to emphasize that carriers have their own rules, underpinned by their own interpretations of CMS rules, and we're subject to them.

So if you really think Don's conduct is cool, and assuming you're interested in knowing whether you're correct, go ask the carriers. Or save that fool's errand and quit arguing about it.

Don't do it. Do better.

 

[DonP]

You have trouble with reading comprehension?

Your fos dude . I door knock fe leads or Medicare sup leads . Jealous dudes like your are pathetic . I also use appt setters

 

[DonP]

My intent here is not to be a jerk. If my comment comes across that way, please know it's not intentional.

Do you sell MA plans? If yes, do you not get and read the codes of conduct for each of the plans? They address this subject, directly or indirectly, depending on the carrier.

Also - and this is a genuine question - do you not receive and read HPMS memos about compliance? Or go to industry compliance events where CMS explains their interpretation of the rules? Or have someone on your staff or in your hierarchy who does these things for you?

As to your question about where to find the rules, start by reading 42 CFR 422 and 423. Look at the last five editions of the MMGs to appreciate how the guidance has evolved, what's stayed consistent, etc. Make sure you understand that CMS sometimes uses terms like "sales appointments" and "calls" more broadly than one might think, and right or wrong, they're the ones who make the rules.

Also go read the annual rule-making materials that pertain to sales and marketing. Pay special attention to the agency's responses to public comments. Those are important because the agency is consistently transparent about what the rules mean … the intent of the rules, which is sometimes overlooked by a strict reading of the words. That's why they give us this insight.

Then go read state insurance laws. In at least a few states, including Maine, you cannot use the techniques Don describes. And virtually every state has insurance and/or consumer protection laws that prohibit misleading marketing practices, which would include marketing the sale of any insurance product as an intentional pretext for soliciting the sale of an unrelated insurance product. Some states restrict this conduct under their unfair trade practices act, deceptive trade practices rule, consumer protection regulations, etc. Sometimes the guidance is promulgated by their commerce department, their AG, or others.

You can go read the Federal Trade Commission Act (start with section 5(a)(1). You can also go search any legal databases for case law pertaining to everything I've just mentioned. The case law will show you that, to the extent the wording of these rules are ambiguous, the courts (often administrative law courts) have given them clarity.

CMS has written and spoken about these sorts of tricks. I don't have the time to find the citations. In a nutshell, it comes down to pretext and circumvention. When you show up at someone's door to discuss life insurance, wearing a button and shirt that shouts "ask me about Medicare", you are showing an intent to solicit a conversation about MA products. A conversation about MA is therefore not incidental.

In the view of CMS, and most carriers, this is analogous to leaving a brochure on a doorknob, which is prohibited as an unsolicited individual contact. (I'm not saying it's a good rule.)

There used to be agents who would sell a low dollar critical illness or FE product to someone and then claim the person an existing business relationship. They'd cold call the client a few weeks later and pitch an MA appointment, a MA review, etc. CMS clarified that it's prohibited as a circumvention of the MA rules against unsolicited contact. It's not the same thing as calling your existing MA book for a re-review. The existing relationship argument gets you around certain FTC rules, but it does nothing to get around the MMGs.

Here is an example of what is unlikely to attract scrutiny: Don door knocks about FE. He wears his Medicare button. The person asks about Medicare. Don offers to schedule another appointment a couple of days later, collects a scope, and comes back to pitch MA. A legitimate, albeit convoluted and unsavory, loophole.

Also cool: Don walks around the supermarket, minding his own business, dressed in full "Ask Me" paraphernalia. Shoppers walk up and ask him about Medicare, and Don starts a discussion. Totally legit, although a scope may still be implicated. BUT … Not cool: Don walks up to a shopper, uninvited, and just stands right in front of them, waiting for them to ask about Medicare. That's an unsolicited contact, even though Don never says a word.

In the strictest sense, wearing that big button turned your FE door knock into a covert MA door knock, loosely akin to the legal theory of "fruit from a poisoned tree".

If you're still uncertain whether Don's trick is permitted, go ask the compliance departments at each of the top three MA carriers. Describe the practice, factually and in its entirety. Tell me what they say. Or, trust me when I tell you they'll say something along the lines of, or in the spirit of, what I'm saying in this response.

I'm not your compliance person. I'm not your lawyer. So no, I'm not going to give you every regulatory citation and I'm not going to fetch all the case law about this subject.

In summary: Don is using a cute trick and thinking it absolves him of accountability. It does not. It's also a crappy way to sell MAPD, and it gives him no standing to criticize the games call centers play. Different shades of sh?t.

P.S CMS itself doesn't regulate independent insurance agents, per se. They regulate MA plans, and in that context, the agency views any appointed sales agent as a representative of the plan. When I discuss a Humana plan with a client, I am the same thing as a Humana employee in the eyes of CMS. I write this to emphasize that carriers have their own rules, underpinned by their own interpretations of CMS rules, and we're subject to them.

So if you really think Don's conduct is cool, and assuming you're interested in knowing whether you're correct, go ask the carriers. Or save that fool's errand and quit arguing about it.

Don't do it. Do better.

Dude I don't even sell mapd . Hell I'm a liar . Maybe all you people can show me how to sell it