Prometheus 6

Collectively the companies account for about 90 percent of the 1.3 million Medicare beneficiaries enrolled in private fee-for-service plans, Block said.

Congressional investigators said in hearings last month that some agents seeking to cash in on high commissions have enrolled the mentally incompetent, impersonated Medicare representatives and misrepresented provisions of the plans....

"This isn't really enforcement," said Abby L. Block, director of the agency's Center for Beneficiary Choices. "This is a voluntary agreement. In terms of the conditions we've put forward, they are just what we would consider to be good business management."

Insurers to Halt Medicare Plan Sales
By Christopher Lee
Washington Post Staff Writer
Saturday, June 16, 2007; A07

Seven insurance companies have agreed to stop marketing private Medicare plans temporarily amid complaints that agents used illegal or unethical sales tactics, Medicare officials announced yesterday.

The companies -- United Healthcare, Humana, WellCare, Universal American Financial, Coventry Health Care, Sterling Life Insurance and BlueCross BlueShield of Tennessee -- will not resume marketing Medicare Advantage fee-for-service plans until they meet six basic conditions, although they can still sell policies to consumers who ask for them.

Congressional investigators said in hearings last month that some agents seeking to cash in on high commissions have enrolled the mentally incompetent, impersonated Medicare representatives and misrepresented provisions of the plans.

The requirements include telling beneficiaries that the plans do not guarantee a doctor will accept them as a patient, requiring agents to pass a written test on how the plans work and calling prospective beneficiaries to make sure they understand the plan they are enrolling in. The companies also must help doctors and other providers understand how the plans work and provide the Centers for Medicare and Medicaid Services with lists of all agents and marketing and sales events.

"This isn't really enforcement," said Abby L. Block, director of the agency's Center for Beneficiary Choices. "This is a voluntary agreement. In terms of the conditions we've put forward, they are just what we would consider to be good business management."

Collectively the companies account for about 90 percent of the 1.3 million Medicare beneficiaries enrolled in private fee-for-service plans, Block said. The plans promise extra benefits (and extra profit for insurers) in exchange for reimbursement from the government that is on average 19 percent higher than that for traditional Medicare coverage.

The marketing moratorium does not affect ongoing criminal investigations, Block said.