CMS puts a stop to misleading Medicare Advantage sales pitches


After reviewing thousands of complaints about “confusing, misleading, and/or inaccurate” Medicare Advantage advertisements and using “secret shoppers” to document misleading telephone sales pitches, the Centers for Medicare & Medicaid Services (CMS) announced that they set foot on Thursday.

Kathryn A. Coleman, director of the agency’s Medicare Drug and Health Plan contract administration group, said in a three-page letter that CMS is immediately improving its review of marketing materials, which must be submitted under its authority. “File and Use” regulations for Medicare Advantage and Part D drug plans, and “may exercise its authority to prohibit” their use.

Currently, Medicare Advantage marketing materials can go live 5 days after submission, provided the submitting company “certifies that the material meets all applicable standards.”

However, as of January 1, Coleman said that Nope TV ads may be submitted under its “File and Use” authority, which means ads will not run until CMS approves them. MedPage today has reached out to CMS for a response, but did not hear back as of press time.

“They’re trying to find a way to curb misleading advertising,” said John Greene, vice president of congressional affairs for the National Association of Health Underwriters.

Christopher Westfall of Senior Savings Network, which is licensed to sell health plans in 47 states, noted that “we hope that eventually regulators will hold these plans and call centers accountable. We have customers who call us all the time to tell us that they have no idea what they were signed up for, and they were shocked that they weren’t on the original health insurance anymore. Now they were in an Advantage plan, with all sorts of restrictions.

In the letter, Coleman said the agency is “particularly concerned about recent national television advertisements promoting MA [Medicare Advantage] plan benefits and cost savings, which may only be available in limited service areas or to limited groups of enrollees, overstate the benefits available, as well as the use of words and images that may confuse recipients or make them believe that the advertisement is directly from the government.”

CMS is also reviewing recordings of calls from agents and brokers with potential enrollees and continuing its covert marketing event shopping “by reviewing television, print and internet marketing and calling associated phone numbers and/or requesting information via online tools”.

The agency approved a final rule this spring that requires all Medicare Advantage agents, brokers and third-party marketing organizations to record all calls with potential enrollees “in their entirety, including the enrollment process.” In his letter, Coleman said the recording reviews would continue.

“Our Secret Procurement activities found that some agents failed to comply with applicable regulations and exerted undue pressure on recipients, and did not provide accurate or sufficient information to help a recipient make a decision to lit inscription,” she wrote.

Coleman also noted that the agency will take “compliance action against business and material plans that do not comply with CMS requirements.” However, the letter did not specify what form the compliance measures might take.

Additionally, she wrote that “CMS may, at any time, determine that accepted material does not comply with our rules and requires modification and resubmission.”

It will also review “all marketing complaints” received during the annual registration period, which runs from October 15 to December 7, and will focus its “monitoring and review on MA organizations and game sponsors.” D with higher or increasing complaint rates”.

Greene said CMS shared with his organization some of what they found through the secret shopper program, “and some of the stories they told us were just appalling.”

An example of what he considered misleading is any advertisement that tells targeted beneficiaries that they will receive money on their Social Security checks if they enroll in a Medicare Advantage plan.

“This [claim] applies to an extremely limited number of people in certain ZIP codes,” Greene explained. them and burn them,'”, i.e. quickly enrolling a beneficiary in a plan without spending the time to know their needs.

“This is not the kind of behavior independent agents who are not involved in these call centers or these advertisements would do,” he said. “No independent agent spends 20 minutes with a client, a beneficiary. It takes them several hours to go through their medication history. Which pharmacies do they use? Do they use mail order? Their health status? Do they travel? “What’s their financial tolerance? There are all kinds of considerations as to whether they’re recommending a Medicare Advantage plan or a medical supplement.”

In an accompanying FAQ, CMS noted that “agents failed to provide recipient with necessary information or provided inaccurate information to make an informed choice for over 80% of appeals reviewed”, giving examples such as “beneficiaries being told that if their medicine was not on the formulary, the doctor could tell the plan and the plan would just add it; or falsely stating that ‘nothing would change’ when beneficiaries asked if their current health coverage would stay the same.”

Greene said her organization and many consumer groups have “complained for years” about misleading claims and advertisements, like the one featuring Joe Namath.

“But what has changed is that the pandemic has allowed special sign-up periods for people infected with COVID, and that has allowed ads to run year-round. So naturally the complaints escalated. “, said Greene. “It caught the attention of [CMS administrator] Chiquita Brooks-LaSure and her deputies that they had to do something to reduce the complaints.”

He noted that some plans may advertise their “additional benefits” include trips to the doctor, dental coverage, hearing aids and meals on wheels. But after the beneficiary registers, he learns that only a small part of these costs is covered, or that he has to go to certain providers who are not near his home, or that there are co-payments and franchises.

“The plans recognize that this is an issue that they need to be more transparent about,” Greene said. “Sometimes they give you a card and you can use it in any of those buckets you want, but once you spend it, that’s right, it’s gone. And then you’re on the hook for the rest. There’s now a recognition that they need to do a better job of explaining exactly what those benefits are, how far they go, and what they actually cover.”

The CMS letter is part of a sweeping effort by numerous federal agencies to crack down on a myriad of Medicare Advantage plan practices, including delays and denials of care through prior authorization requirements. , and concerns that dozens of plans are fraudulently inflating the severity of their enrollees. diseases to receive billions of extra dollars from the Medicare Trust Fund that were not needed for the care of their patients.

  • Cheryl Clark has been a medical and science journalist for over three decades.


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