Does this smell as bad to you as it does to me?

[beatuplunchbox]

I had a friend who has been doing MAPD for the last year call me today with questions about how his FMO was dealing with the new CMS regulations.

He told me that they were getting pre-sets from a company who was calling seniors about DME and telling that they would send rep by with a free blood pressure cuff or free diabetic supplies.

They told him when he delivered the supplies he could then discuss MAPD plans because he had developed repor with them while dropping off the supplies and did not need a cooling off period because the supplies were not insurance products.

Here is the kicker: the free supplies are being billed to medicare by the DME company.


I told him to leave it alone because it sounded illegal and if nothing else unethical.

What is your thoughts? (and what should I do about it?)

 

[midwestbroker]

Sounds like a big mess to me. I would not put my insurance license on the line for that.

That is the partial problem with having such strict rules on this...the bad agents or agencies are going to get really creative on finding loopholes that are going to blow up in their face.

 

[DarrylVK]

Sounds like a big mess to me. I would not put my insurance license on the line for that.

That is the partial problem with having such strict rules on this...the bad agents or agencies are going to get really creative on finding loopholes that are going to blow up in their face.

Exactly why I am staying away from selling Medicare Advantage. The FMO I was with is looking for (trouble) Loopholes.

 

[mswebb06]

Darryl, might I take a stab and say you were with Parker?

 

[Frank Stastny]

It smells like Monday's fish to me.

 

[patch36]

Turn them in to CMS. Nip it in the bud before we get even more rules and regulations in over reaction to strategies like this.

 

[midwestbroker]

The thing about delivering DME supplies and then going to a MA presentation is that they did not invite you in to talk about MA plans, so going forth with an appointment would be in violation of CMS marketing rules.

 

[beatuplunchbox]

I told him to look at it from the seniors perspective. How would you feel if someone came to your house with a free gift and then tried switching your health plan?

Probably would constitute high pressure tactics under CMS guidelines too.

I could just see the local news story now...

 

[Frank Stastny]

Probably would constitute high pressure tactics under CMS guidelines too.

I could just see the local news story now...

It constitutes "High Pressure" tactics as far as I'm concerned also. When I was hiring agents if one of them had pulled that they would have had an opportunity to go on their own. Only it would have not been a suggestion.

 

[beatuplunchbox]

I talked to this "recruiter" and he told me that he was approached by the DME company as a way of doing this.

He said many FMOs were going to use this approach. From the way he was explaining things to me, I could almost tell that the DME company is giving him some sort of kickback to do this while he is going to be charging his agents for the appointments as "pre-set appointments". It looks to me like he is trying to make money of his agents three different ways.

I told my friend this and he is going to contract direct with carriers like I have.