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

[annon123]

Yes they are. That's why they aren't included in the AHIP, carrier certifications, or insurance license exams.

Just because they aren't in the exams doesn't mean they don't affect insurance. We can't change a lot of those things, but they can affect both agents and customers.

 

[sman]

Vitamin Sea.

I did the same. Headed West until I found where the sun sets into the Sea.

View attachment 17619

But bro, there's a guy on here who will compare commission deposits with you. And there's another guy who will disagree with you regardless of what you post.

 

[myinsurebiz]

Most of the posters complaining about name calling and "style" voted for this guy:



Excuse me if I don't take y'all seriously…

Thankfully - America decided it was time to DRAIN THE SWAMP . . .

 

[WinoBlues]

But bro, there's a guy on here who will compare commission deposits with you. And there's another guy who will disagree with you regardless of what you post.

Ha, for an IPA Honey Blond pint I'd trade the Fs I'd give about someone's deposits or serious arguments about my opinions. And there'd would be change left.

 

[Medicare bro]

Not a fan of his style, but EckoRomeo is correct here. Don is using a cute trick to try and circumvent the MMGs. Don't be surprised if it backfires on you one day. While cute, it is unlikely to stand up to government scrutiny, were it to ever happen in the first place.

Will anyone ever drop the hammer on you? Who knows … probably not. Are you doing the right thing and acting with integrity? Hard no.

If you don't see a problem with your conduct, or at least the reason why others perceive it to be problematic, you're part of the problem.

I agree with Ecko that it's ridiculous to shame call centers about compliance while you're proactively door knocking for FE while wearing a human billboard that solicits a conversation about Medicare - an obvious and intentional pretext for soliciting MA sales. And it's long understood that you can't discuss both products in the same meeting.

Call centers use all sorts of cute tricks to dodge the rules. If you're gonna call them out, make sure you're running your own clean business.

I said what I said.

He's not breaking rules. I asked my FMO compliance person and it's perfectly legal.

 

[Medicare bro]

Yeah... reading comprehension isn't your thing. Where did anyone say wearing a badge is against the rules?

PS
I spoke to you years ago, Todd. You struck me as slimy then so it's no surprise you are slimy now. Glad I didn't choose you as my FMO!

You are calling him slimy?

 

[Medicare bro]

(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.

You don't have time to find the citations; but you have time to write a book on them?

 

[MedicareWAA]

You don't have time to find the citations; but you have time to write a book on them?

Yes. And your upline's compliance people matter very little. Go ask the carriers. I'll wait.

By the way, re-read my "book" and you'll see some citations. Your welcome, Chad.

 

[Medicare bro]

Yes. And your upline's compliance people matter very little. Go ask the carriers. I'll wait.

By the way, re-read my "book" and you'll see some citations. Your welcome, Chad.

Just read 42 CFR and I don't think that means what you think it means. It's talking about patient confidentiality and consent. I will read the others as well.

 

[MedicareWAA]

Just read 42 CFR and I don't think that means what you think it means. It's talking about patient confidentiality and consent. I will read the others as well.

Frankly, I don't care.

As you pointed out already, I spent a lot of time writing a "book". I hoped it would be constructive to the conversation and helpful to other agents. Do with it what you will. It seems to be of little value, and I'm not personally invested in the outcome. Not my monkey, not my circus.

But if you or anyone else reading this does not see a problem with what he described, I'm sorry to have you in our industry, and I wish you no success.