Physical Therapist with MA/Supp agent side gig: Conflict?

[fun2drum]

I've got a friend who's an independent physical therapist, and he recently asked me if it's possible for someone like him to compliantly get Medicare licensed and have a completely separate side profession as an agent.

My immediate reaction was "Oh heck no! That's a conflict of interest.", but my search results on that scenario have been vague at best. He gets all of his patients by doctor referral only, so there wouldn't be any opportunity for his PT practice to gain financially from his Medicare plan business. He would be in direct contact with Medicare beneficiaries in his practice but if he didn't provide plan materials or discuss Medicare plans with his patients then it appears to me he would be in compliance. Some MA carriers are even operating medical clinics across the country, so that's all making me wonder.

My question, as stupid as it feels to ask it: If he were to keep everything completely separate under different LLC companies which he owns, and ran both businesses compliantly, then do you think there is any way he could legally do this?

 

[David Taylor Jr]

I know if he contracts with Humana it is a potential conflict of interest because they list side businesses that take away the necessary time for MA sales/meetings/etc.

 

[somarco]

Some MA carriers are even operating medical clinics across the country,

Carriers can get away with a lot more sheet than you or I can. It's not fair, but just because they do it doesn't mean you can.

I know if he contracts with Humana it is a potential conflict of interest because they list side businesses that take away the necessary time for MA sales/meetings/etc.

I assume you are referring to a HO employee or captive, not an indedpendent agent.

 

[David Taylor Jr]

I assume you are referring to a HO employee or captive, not an indedpendent agent.

Actually, I am an independent agent with them and it says it in my packet of materials as well.

 

[somarco]

Actually, I am an independent agent with them and it says it in my packet of materials as well.

One, I am surprised anyone reads the contracting materials with any carrier.

Two, your comment makes it SEEM as if you are exclusive to them. I have been contracted with Humana for years. Never noticed that clause. Have contracts with other carriers (and they know it). Likewise have written business with other carriers.

I used to write a fair amount of U65 health insurance with them . . . before Obamacare. Also have written life insurance, dental and Medigap.

 

[fun2drum]

I should clarify that he's talking about being an independent agent, not captive or career with a carrier.

 

[David Taylor Jr]

One, I am surprised anyone reads the contracting materials with any carrier.

I'm surprised there are people that don't

Two, your comment makes it SEEM as if you are exclusive to them. I have been contracted with Humana for years. Never noticed that clause. Have contracts with other carriers (and they know it). Likewise have written business with other carriers.

I'm definitely not exclusive. But yeah, the clause is definitely there.

 

[somarco]

I'm surprised there are people that don't


I'm definitely not exclusive. But yeah, the clause is definitely there.

I would like to know how/if they enforce it since INDEPENDENT agents are 1099 contractors.

Guess I will keep on writing business that is right for my clients with carriers that understand I am not exclusive and never will be.

 

[fun2drum]

I've known plenty of agents who've had side gigs with no problem. Some teach, some are actors, musicians, and whatever. The bigger picture of my question has more to do with a medical professional with a side gig selling Medicare plans. How is that looked at by the powers that be?

 

[somarco]

Ask the carrier(s).

I would think the bigger question is, how does the PT licensing board feel about it?

CMS is another potential problem. Their marketing rules make it seem like if you use a public restroom in a medical office building and accidentally drop your business card or a flyer, you can go to CMS jail.