Medicare Advantage: CMS Assists Beneficiaries Affected by Inappropriate Marketing But Has Limited Data on Scope of Issue
DIANE Publishing, 2010 - 48 pages
Questions have been raised about complaints that some Medicare Advantage (MA) org. and their agents inappropriately marketed their health plans to Medicare beneficiaries. Inappropriate marketing may include activities such as providing inaccurate info. about covered benefits and conducting prohibited marketing practices. The Centers for Medicare and Medicaid Services (CMS) is responsible for oversight of MA org. and their plans. This report examined: (1) the extent to which CMS has taken compliance and enforcement actions; (2) how CMS has helped beneficiaries affected by inappropriate marketing and the problems beneficiaries have encountered; and (3) info. CMS has about the extent of inappropriate marketing. Charts and tables.
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2006 through February According to CMS affected by inappropriate agency agent-related Appendix beneficiaries affected beneficiaries experienced beneficiaries who experienced CAP request CAPs accepted civil money penalties CMS data CMS determined CMS officials told CMS regional office CMS required CMS sent CMS took complaint rates complaint tracking module compliance actions compliance and enforcement corrective actions coverage DOI and SHIP election period enforcement actions experienced inappropriate marketing Fee-for-Service Plans inappropriate marketing complaints inappropriate marketing SEP initial notice interviewed officials January June MA beneficiaries MA plan marketing activities marketing and enrollment marketing events marketing requirements Medicare Advantage Medicare Part D Medicare Prescription Drug Medigap NAIC noncompliance and warning notices of noncompliance number of beneficiaries organization’s organizations for inappropriate out-of-pocket costs oversight PFFS plans problems beneficiaries prospective SEP regional office action related to inappropriate requested CAPs require MA organizations retroactive SEP surveillance activities Suspension of marketing track the number warning letters