Department of Human Services

Senior Medicare Patrol Fraud Alert

Rules for Medicare Advantage Agents

Published: 02-01-2012

According to the Centers for Medicare and Medicaid Services (CMS), there are several things you should be aware of that Medicare Advantage agents and brokers are not allowed to do. Being aware of inappropriate behaviors will help protect not only your medical benefits, but your personal identity as well from untrustworthy people.

 

 If you have experienced any of the behaviors listed below, please call the Missouri SMP (Senior Medicare Patrol) at 1-888-515-6565. The Missouri SMP has trained staff and volunteers who work with CMS and the Missouri Department of Insurance to report complaints of inappropriate behavior and assist beneficiaries in making informed decisions about their healthcare coverage.

The Missouri SMP has also published a guide, "Your Medicare Matters, Protect It" that provides information about Medicare Advantage and the questions you should ask before selecting a plan. You may receive a free copy by calling 1-888-515-6565.

 The Missouri SMP is funded by the U.S. Department of Health and Human Services' Administration on Aging to empower seniors to prevent healthcare fraud and abuse through education and advocacy.

 Agents and brokers:

 ″ MAY NOT state that they are from Medicare or use "Medicare" in a misleading manner.

For example, they can't state that they are endorsed by Medicare, are calling on

behalf of Medicare, or that Medicare asked them to call or see you.

″ MAY NOT solicit door-to-door.

″ MAY NOT send unwanted emails, text messages, or leave voicemails.

″ MAY NOT approach people in common areas such as sidewalks, lobbies, parking lots,

etc.

″ MAY NOT conduct sales activities in healthcare settings such as waiting rooms, exam

rooms, hospital patient rooms, dialysis centers and pharmacy counter areas.

″ MAY NOT place unwanted calls, including calling people with Medicare under the

guise of selling a non-Medicare Advantage or prescription drug plan product and then

turning the conversation to selling a Medicare Advantage plan or prescription drug plan.

″ MAY NOT provide meals to potential enrollees at sales presentations.

″ MAY NOT offer gifts to potential enrollees of more than $15. If a gift is offered, it must be

given to everyone, even if they do not enroll in a plan.

If you have any questions, please contact the Missouri SMP (Senior Medicare Patrol) at 1-888-515-6565.

 

Department of Human Services

City of St. Louis

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