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CMS May Hire Medicare Advantage Mystery Shoppers

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The Centers for Medicare and Medicaid Services (CMS) is looking into the possibility of hiring a contractor to help it monitor newspapers, websites and public events to detect misleading Medicare plan marketing practices.

CMS officials have posted a “Marketplace and Surveillance Support Services and Data Reporting” sources sought notice on the Federal Business Opportunities website.

In the notice, which was posted Dec. 22, officials note that they are not putting out a Medicare mystery shopperformal request for proposals.

Instead, officials say, they are looking into the availability of vendors that can help them look for possible Medicare Advantage plan and Medicare Part D prescription drug plan marketing problems.

Insurers are making widespread use of agents and brokers to sell the private Medicare products, and some of the products, “have engaged in practices that cause CMS considerable concern,” officials say.

CMS says marketplace and surveillance activities

could include:

  • Secret shopping of public marketing events.
  • Targeted observations of public marketing events as directed by the CMS Surveillance team.
  • Ad Hoc activities to possibly include:
    • Review of third party marketing sites.
    • Year-round monitoring of agent marketing practices to dual eligible beneficiaries.
    • Monitoring of [prescription drug plan] marketing tactics.
    • Data analysis and reporting.
  • Review of newspapers and other paper and electronic communications to identify unreported marketing events.
  • Monitoring of organizations that non-renew or reduce the service area of their [Medicare Advantage] or [prescription drug plan] contracts.
  • Review of social networking sites.
  • Assessment of [Medicare Advantage] and [prescription drug plan] practices as they impact vulnerable populations, including, but not limited to individuals who are non-English speaking, or physically and/or mentally challenged, or low/limited income or low education.

Contractor staffers may have to attend scheduled or unscheduled marketing events, complete a public marketing and sales events secret shopping script and scoring tool, and review print and social media for noncompliance with CMS guidelines, officials say.

CMS wants contractors with staffers that have experience with non-English speaking populations, including consumers who speak Spanish, Russian, Chinese, Korean and Armenian.


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