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Medicare News
Seven Medicare Advantage Plans Given Green Light to
Resume Marketing
CMS says they passed ‘comprehensive marketing
review’
 Sept. 25, 2007 – Seven of the Medicare Advantage
Private-Fee-For-Service plans that suspended their marketing to senior
citizens after complaints of excessively aggressive marketing are back
in business. The Centers for Medicare & Medicaid Services (CMS)
announced yesterday that after being found compliant with Medicare
requirements through a “comprehensive marketing review,” they may resume
marketing.
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The approvals allow the sponsors, as well as all
other Medicare Advantage organizations, to market to newly eligible
Medicare beneficiaries through October 1, 2007. The plans may also
market to those beneficiaries with special enrollment periods, said the
CMS news release.
The United Health Group, Blue Cross Blue Shield of
Tennessee, Humana Inc., and Sterling Life Insurance Co. represent four
of the seven sponsors that voluntarily suspended marketing PFFS plans
earlier this year that are now approved.
CMS completed a similar review of and approved PFFS-plan
marketing by the three other sponsors, Coventry Health Care Inc.,
Universal American Financial Corp., and WellCare Health Plans Inc., in
August.
“Overseeing the marketing activities of Medicare
Advantage plans to ensure beneficiaries have access to the health care
services they need, and are not discriminated against in any way is one
of my top priorities,” said CMS Acting Administrator Kerry Weems.
“CMS conducted a comprehensive review of these
seven sponsors and found vast improvements to their internal controls
and oversight processes consistent with regulations and guidance for
Medicare private-fee-for-service plans. But we’re not stopping there.
Medicare’s procedures to continuously monitor all plans marketing,
including the activities of their agents and brokers, are now in
place.”
Any plan that is found to be in violation of CMS
requirements can be subject to a full range of available penalties,
which can include suspension of marketing and/or enrollment, suspension
of payment for new enrollees, civil-monetary penalties, and termination
from the Medicare program.
“The suspensions of the plan sponsors’ PFFS market
activities were lifted only after CMS verified that each organization
had the systems and management controls in place to meet all of the
conditions specified in the 2008 Call Letter and the May 25, 2007
guidance issued by CMS,” the agency said in a news release.
When marketing begins for the 2008 benefit year on
October 1, 2007, all PFFS plans will be subject to the same standards,
which include the following:
All brokers and agents selling the product must
pass a written exam to demonstrate an understanding of Medicare PFFS
policies and the products being marketed;
● Plans must telephone beneficiaries requesting
enrollment in a PFFS plan to confirm that they understand the terms and
conditions of the plan;
● A provider outreach and education program must
be in place to ensure that providers are aware of PFFS plans and their
payment provisions and are encouraged by the plans to provide services
to PFFS enrollees;
● Plans must include specific disclaimer language
in key enrollee materials to ensure beneficiaries understand the unique
aspects of PFFS;
● Lists of planned marketing and sales events
sponsored by the plan’s brokers and agents must be provided to CMS so
that CMS can monitor these events.
“Sponsors selling private-fee-for-service plan
products will be actively monitored through 1-800-Medicare, our Regional
Office casework system and improved oversight systems,” added Weems.
“In addition, we have forged new partnerships with
State Insurance Commissioners and others to give us an even larger
surveillance net to help monitor this program.”
CMS has more than a dozen new oversight
activities underway. Some of these activities include:
Creation of a dedicated monitoring team and a
comprehensive rapid response plan;
● Enrollment verifications of new PFFS plan
enrollees by CMS to ensure the enrollees were not subject to
inappropriate marketing activities and understand the characteristics of
a PFFS plan;
● Increased “secret shopping” at PFFS marketing
events;
● Random audits of PFFS agent training and test
files;
● Thorough reviews of PFFS enrollment packages to
verify all required disclaimers are included;
● Coordination with state insurance departments
to share information about agent and broker complaints and license
suspensions.
CMS has also developed an outreach plan to educate
beneficiaries, advocacy organizations, and other interested parties
about the marketing guidelines.
“The best practice is prevention. We believe the
new requirements and compliance plans build a system that is designed to
prevent marketing violations,” Weems concluded.
For additional information on
Private-Fee-For-Service (PFFS) click on the zip downloads issued on May
25, 2007:
www.cms.hhs.gov/PrivateFeeforServicePlans/Downloads/PFFS_Files2.zip
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