Coordinating Complaint Referrals Central Office and Regional Office Roles

Background Signing Parties –State Department of Insurance (DOI) –CMS (CPC & Regional Offices) All states signed MOU August 2008 –Including the District of Columbia, US Virgin Islands, and Puerto Rico Membership –NAIC Senior Issues Task Force –NAIC Anti-Fraud Task Force 2

MOU Purpose Promote cooperation between CMS & States Sharing of information –Regulatory cooperation and information sharing regarding conduct of companies and persons engaged in MA and PDPs 3

CMS-State Information Sharing Enforcement actions taken by CMS or States against organizations or agents Complaints involving specific agents/brokers Consumer complaints involving plans doing business in their state Potential violations of federal laws or fraud, waste, or abuse with the appropriate federal law enforcement agency 4

Compliance & Enforcement (C&E) MEDIC Transition Since September 29, 2009 CMS utilized C&E MEDIC, Safeguard Services (SGS), LLC to assist with marketing issues Effective September 29, 2010 CMS will discontinue this contract SGS will no longer be responsible for conducting agent/broker investigations 5

C&E MEDIC Transition (con’t) Egregious agent/broker issues will be referred to the State DOIs Benefit Integrity MEDIC, Health Integrity (HI) contractor will continue to fight fraud, waste, and abuse complaints 6

Role of National DOI Liaison To serve as the Central Office contact and coordinate with the Regional Office in facilitating the sharing of information related to marketing misrepresentation cases with State DOIs and internal/external partners 7

Role of Regional Office (RO) Department of Insurance (DOI) Liaison Serve as the point of contact for local DOI contacts Exchange information and resolutions for specific agent/broker complaints Share information about complaints with Medicare Advantage and Prescription Drug Plan CMS account Managers for possible compliance actions Answer policy questions related to CMS marketing guidelines 8

What will change? CMS will strive to make this a seamless transition as possible Should only be a change to where the referrals are sent Continue to send FWA complaints to BI MEDIC Continue to send the same type of complaints that were sent to C&E MEDIC CMS will work to provide resolutions of issues as possible 9

What to refer to RO Types of complaint information: Adjudicated enforcement actions (i.e., cease and desist orders, disciplinary actions, etc.) Use of aggressive marketing tactics by specific agents Misleading advertising and phone calls Offering inducements to enroll Enrollment of beneficiaries without consent 10

What to Include in a Referral Beneficiary name Medicare or Social Security number Name of agent/broker Name of MA of PDP plan Date of incident Location As much specifics of the incident as possible 11

Next Steps Continue to track complaints using SMARTFACTS Fax complaints to RO DOI Liaisons –Complaint will be recorded in CMS HPMS CTM RO DOI Liaisons will ensure casework action is taken and associated follow-up activities –Final disposition will be sent to SMPs to update SMARTFACTS 12

Outreach/Communication CMS will be issuing a memo late September announcing the transition Conduct upcoming Webinar in October and November to review transition activities with SMPs Conduct monthly meetings with SMPs and RO DOI Liaisons to review complaints and address outstanding items 13

CO/RO Contact Information National Central Office DOI Liaison Deanna Greene: Technical Advisor for the Consortium for Medicare Health Plans Operations Paul Collura: Regional Office DOI Liaisons by Regions Attachment A 11