Feds work to protect Medicare recipients

The Centers for Medicare & Medicaid Services  today released final regulations to protect Medicare beneficiaries from deceptive or high-pressure marketing tactics by private insurance companies and their agents during the upcoming 2009 Medicare Advantage and prescription drug open enrollment period.  

The two regulations issued today include prohibitions on telemarketing and other unsolicited sales contacts.  The new rules also prohibit financial incentives that could 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," said CMS Acting Administrator Kerry Weems.  "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."

Surveillance will include:

 -- Tripling the number of "secret shopper" activities in which a Medicare official poses as a prospective enrollee and monitors sales agents' presentations for inaccurate information and prohibited sales tactics.

-- Reviewing plans' local print and broadcast advertisements.

-- Reviewing recordings of enrollment calls to ensure compliance with the new regulations.

-- Ensuring that health and drug plans detect, report and respond to agent/broker marketing misrepresentation and other issues. 

"The vast majority of beneficiaries are extremely pleased with their prescription drug and Medicare Advantage plans and have not encountered heavy-handed sales tactics," said Weems.  "CMS takes its enforcement role very seriously, however, and we will monitor activities throughout this year's enrollment period to ensure that beneficiaries are protected from aggressive marketing behavior from agents and brokers."