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Medicare Advantage Sales Changes Sought

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A flurry of actions designed to curb alleged abusive marketing of Medicare Advantage plans by the insurance industry were announced by the industry and the Centers for Medicare and Medicaid on May 21 in advance of a hearing the following day on the issue by the House Ways and Means Committee.

The changes will also extend to marketing of programs provided under Medicare’s prescription drug program, Part D, the agency said.

The actions by the CMS and the industry were prompted by recent stories in The New York Times and intensive questioning by Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, of CMS officials following publication of the stories.

Specifically, CMS said it is proposing new regulations designed to strengthen oversight of insurance industry marketing of Medicare Advantage plans through a requirement for mandatory self-reporting.

CMS also said its proposed regulations are designed to streamline the process relating to intermediate sanctions and contract determinations (including non-renewals) and to better clarify the process for imposing civil money penalties.

For its part, the Association of Health Insurance Plans, which represents more than 80% of the providers of Medicare Advantage plans, disclosed in a letter to the leadership of the Ways and Means panel that its board has recently released a new set of principles designed to “strengthen existing consumer protections” its members must follow in marketing the plans.

In addition, AHIP said in letters to the chairman and ranking minority members of the Ways and Means panel’s Health Subcommittee, it has sent a letter to CMS recommending specific actions that “we are urging CMS and the National Association of Insurance Commissioners to take on this issue, including requiring health plans to report all broker/agent relationships in the marketing of their products.”

The letter to Reps. Pete Stark, D-Calif., and Dave Camp, R-Mich., said: “As an industry, we maintain a strict zero tolerance policy when it comes to inappropriate sales and marketing practices by agents, brokers, or plan marketing staff.

“We believe it is imperative that seniors have complete and accurate information to make informed decisions to meet their individual health care needs,” AHIP added.

In remarks prepared for the hearing, Janet Trautwein, executive vice president and CEO of the National Association of Health Underwriters, Arlington, Va., said the trade group is “extremely concerned about ethical sales practices concerning all Medicare-related insurance products, including Medicare Advantage plans.”

“NAHU is well aware of some recent publicity depicting a few “bad apples” in our industry who have been behaving in what appears to be an unethical manner,” she said. However, she cautioned, “it is important to note the vast majority of health insurance producers work very hard every day to find quality and appropriate health coverage at the best possible price for millions of employers, individuals and families.”

In disclosing its plan to strengthen its rules regarding market oversight, acting CMS administrator Leslie Norwalk said the proposed rule will be published with a 60-day comment period. She also said she expects a final rule to be published this year.

“There should be no uncertainty–complete compliance with Medicare rules is essential to the integrity of the program,” Norwalk said. “We want to have every enforcement tool available to ensure that Medicare beneficiaries are protected.”


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