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Medicare Fraud Spotlight

Fraud

Marketing Rules for Medicare Advantage Plans

There are specific marketing guidelines that Medicare Advantage plans and agents selling these plans must follow.  These guidelines are set by Medicare.  People selling these plans are not allowed to:

  • Ask for your personal information (like your Medicare, Social Security number, bank account, or credit card number) over the phone unless it is needed to verify membership, determine enrolment eligibility, or process an enrollment request. Plans don’t need personal information to give a quote.
  • Show up at your home uninvited.
  • Call you unless you are already a member of the plan.
  • Ask you for payment over the phone or online. The plan must send you a bill.
  • Sell you a non-health related product, like an annuity or life insurance policy, during a sales pitch for a Medicare Advantage plan or drug plan.
  • Communicate incorrect information about their plan or tell you about other plan options you had not agreed to discuss
  • Offer you cash (or gifts worth more than $15) to join their plan or give you free meals during a sales pitch.
  • Talk to you about their plan in areas where you get health care like an exam room, hospital patient room, or at a pharmacy counter
  • Market plans or enroll you drug an educational event like a health fair or conference

Last month, we heard from a beneficiary who had dialed a phone number from a TV commercial he saw advertising Medicare Advantage (MA) plans. When he dialed the phone number, a representative asked him for his Medicare number and asked him where he lives.

The representative convinced the beneficiary to enroll in an MA plan, despite knowing that the plan was not available to beneficiaries in his county. The following week, the beneficiary discovered that his prescriptions were not covered by his new policy, and he was required to pay out-of-pocket. Thankfully, he called SHIIP/SMP and we were able to help him file a marketing misrepresentation complaint, and get him reinstated into his former Medicare plan.

SHIIP/SMP can help you prevent, detect, and report suspected Medicare fraud, errors, and abuse. If you think you have experienced a marketing violation or enrollment fraud, call us at 1-800-351-4664.