In addition to CMS efforts, HCSC has developed a producer monitoring program. The program reviews marketing and sales activities with findings recorded in the respective producer’s file.

Tracking
Secret Shopper
Internet Applications
Annual Training and Certification
Corrective Actions

Tracking

• Contract terminations — A Rapid Disenrollment investigation is triggered when over four percent of a producer’s contracts cancel their coverage within 60 days of the effective date.
• Complaints — Any complaint against a producer is logged and investigated. Complaints are acted upon based on the severity of the infraction.
• Sales events — CMS states that health plans must provide a list of all upcoming seminars and sales presentations for the next month to be conducted on behalf of the plan sponsor by internal and external partners, including contracted producers/agencies.

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Secret Shopper
Secret Shoppers interact with producers to help monitor compliance with marketing rules and accuracy of product and network representation. Secret Shopper interactions can occur in person, over the phone, or at seminar events. Among the areas a Shopper could focus on are:

• Accuracy and thoroughness of product and benefit information provided by the producer,
• Use of approved materials, and
• Professionalism

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Internet Applications
As online enrollment increases, monitoring of marketing activities, as well as document retention, will be ongoing focuses. HCSC regularly requests random hard copy samples of online enrollment forms from producers in order to monitor compliance.

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Annual Training and Certification
All producers must be certified to sell Part D and Medicare Advantage products whether they are independent brokers or affiliated with an agency. Agencies are monitored as well to make sure every agent selling Medicare products who is representing that agency is licensed and certified. The producer selling the Blue MedicareRx or Blue Medicare PPO plan must provide his/her name and producer ID number on the Blue MedicareRx or Blue Medicare PPO enrollment form.

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Corrective Actions
The ramifications of violating the rules can be severe. A recent example of corrective action is the $500,000 fine imposed upon a major insurance company by CMS, brought about because the company used unlicensed agents to sell products. 

Penalties for individuals, agencies, and plan sponsors are assessed when necessary, up to and including suspension and termination of sales privileges for the specific product in question. Producers may be reported to the fraud department, their state’s insurance department, and CMS.

Marketing errors that warrant immediate loss of certification and termination include:

• Forgery
• High-pressure sales tactics
• Fraudulent misrepresentation
• Outbound telephone solicitation
• Door-to-door solicitation
• Offering gifts or payments to induce or renew enrollment
• Failure to process termination request in a timely manner
• Using advertising/marketing materials that are not approved by HCSC and/or CMS

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