Medicare Advantage: Enrollment fraud investigated in Tucson
by Denise Early on Jan. 05, 2012, under HealthAccording to a press release from Medicare today:
The Centers for Medicare & Medicaid Services (CMS) is investigating an alleged fraudulent scheme to enroll about 900 Arizona Medicare beneficiaries in different Medicare Advantage health plans without their consent.
Under the scheme, Medicare beneficiaries enrolled in Medicare Advantage health plans sponsored by Health Net and two other companies were switched without their consent to Medicare Advantage plans sponsored by United HealthCare. Most, if not all, of the switches are alleged to have been made by the same sales agent. Agents typically receive commissions of about $200 for every new member they enroll in a Medicare Advantage plan. Most of the affected beneficiaries were enrolled with Health Net during 2011, although some were members of Humana and CareMore plans.
CMS advises Medicare beneficiaries who suspect they may have been switched without their permission to call 1-800-MEDICARE (1-800-633-4227) and report their concerns. All affected beneficiaries will be re-enrolled in the plan of their choice with no interruption in medical coverage.
Word on the street is that an independent agent, who previously worked for Health Net, allegedly enrolled 900 current and former clients in the AARP Medicare Complete Medicare Advantage plan. Allegedly, this agent was able to make these 900 enrollments online using a UnitedHealthcare website. The website allows Medicare beneficiaries to fill out an application online and put in their insurance agent’s id number so the agent gets credit for the enrollment. But this is only supposed to be done after a meeting with the agent to review the details of the plan, including drug coverage.
I have heard from one insurance broker who got calls from several clients asking why they had received an id card from the AARP Medicare Complete plan when they had no desire to change from Health Net. The broker contacted Health Net and was told there was an ongoing investigation.
It looks like they didn’t have to look very far to find a hot trail of 900 online enrollments, each with one agent’s id number (allegedly).
One has to wonder how a person in their right mind could think they would get away with changing 900 people to another Medicare Advantage plan without their consent!! Insurance agents and brokers are required to take annual training classes during which they are warned about the seriousness of Medicare fraud and the penalties involved, which include $25,000 fines for each incident as well as jail time.
Medicare already hates insurance agents and thinks they are all out to take advantage of seniors. Certainly there are some bad apples among insurance agents/brokers, but most are ethical and very helpful to their clients. This is one rotten apple (allegedly) who could spoil the Medicare barrel for everyone.
UPDATE as of January 10: I have heard through the grapevine that United noticed the high enrollment numbers by one independent agent. United supposedly confronted the independent agent who denied any wrongdoing. When the high numbers continued, United stopped commission payments and alerted Medicare about the problem. But because the enrollments were done electronically/on-line, they went right to Medicare, and United couldn’t stop them.
I also got a call yesterday from KVOA channel 4, and it looks like they are starting their own investigation into this news story. Apparently, a person who was a victim of this plan change fraud called KVOA around Christmas to ask that a news story been done about this incident. KVOA now has the time to investigate this, so we may see this story get some air time soon.
UNITEDHEALTHCARE has asked that I include the following statement in this post:
Immediately upon being alerted to this third party agent’s conduct, we notified the appropriate authorities, investigated the matter and then terminated the agent. Such conduct is not acceptable. As importantly, all affected beneficiaries will be re-enrolled in the plan of their choice with no interruption in their medical coverage and we apologize for any inconvenience that may have occurred. Any Medicare beneficiary who suspects they may have been switched without their permission should call 1-800-MEDICARE (1-800-633-4227) and report their concerns.
Thank you.
Matt BurnsSpokesman for UnitedHealthcare’s Medicare business
