The Centers for Medicare and Medicaid Services (CMS) announced in mid-June that in response to concerns about marketing practices, seven healthcare sponsors have signed an agreement to suspend voluntarily the marketing of private fee-for-service (PFFS) plans. This suspension will be lifted only when CMS certifies that the plan has the systems and management controls in place to meet all the conditions specified by CMS. The signatories include United Healthcare, Humana, Wellcare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross/Blue Shield of Tennessee.
“While we note that most health insurance agents are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors that need to be removed from the system for good,” said Leslie V. Norwalk, acting administrator of CMS. “This voluntary agreement demonstrates that CMS and the plans are stepping up to ensure that deceptive marketing practices end immediately, and that beneficiaries understand what they are purchasing.”
CMS had logged 2,700 agent complaints between December 2006 and April 2007. Although the complaints represent less than one half of one percent of the 1.3 million members enrolled in individual PFFS plans, “we can always do better,” said Norwalk.
Plans signing the agreement will be actively monitored to ensure they do not engage in marketing while the voluntary suspension is in place. To have the suspension lifted, the plans must meet several provisions, including passing a written test that demonstrates their thorough familiarity with both the Medicare program and the product they are selling, and putting in place a provider outreach and education program to ensure that providers have reasonable access to the plan terms and conditions of payment.
