Marketing Surveillance Christine Reinhard, J.D. Technical Advisor Division of Surveillance, Compliance and Marketing

Objectives Define Marketplace Surveillance Last Year’s Efforts and Results Planned Activities for Upcoming Year

What is Marketplace Surveillance? National program to detect, prevent, and respond to marketing violations and misrepresentation Initially aimed at egregious abuses in the Private Fee-for-Service and other plan areas Expanded to all Medicare Advantage and Part D Prescription Drug plans A broad range of surveillance activities

2011 AEP Efforts Primary Surveillance Activities: Secret Shopping of Public Events Unreported Marketing Events (UME) Targeted Observation (TO)

2011 AEP Results: Secret Shopping Shopped 1,938 public events by 75 Plan Sponsors in 45 States As the season progressed, performance improved (based on average number of deficiencies per event) October = 7.26 December = 3.55 Number of Plan Sponsors with no validated deficiencies increased October = 6 November = 10 December = 22

2011 AEP Results: Secret Shopping Deficiencies discovered: Administrative in nature Failure to include required future availability and LIS language in notices Failure to cancel previously reported event Forced completion of sign-in sheet and contact information Failure to identify products being marketed at the beginning of presentation Failure to verbally explain which prescription drugs are covered

2011 AEP Results: Secret Shopping Compliance Actions Taken by Month: *TALs were sent to Plan Sponsors that were shopped but either did not meet the minimum number of shops, no matter how many deficiencies were found, or had minimal findings. Action Oct Nov Dec Total Technical Assistance Letter* 17 40 45 102 Notice of Non-Compliance 12 4 2 18 Warning Letter with Business Plan 3 1 Ad-hoc Corrective Action Plan 32 46 124

2011 AEP Results: Unreported Marketing Events Reviewed 5,256 unique events by 75 Plan Sponsors 57 Plan Sponsors submitted 100% of the clipped marketing events in HPMS accurately and timely 18 Plan Sponsors had one or more deficiencies

2011 AEP Results: Unreported Marketing Events Compliance actions were based on the entire AEP Compliance Actions Taken by Risk Level: *TALs were sent to Plan Sponsors that were shopped but either did not meet the minimum number of shops, no matter how many deficiencies were found, or had minimal findings. Action Ultra High High Moderate Low Total Technical Assistance Letter* 5 3 4 17 Notice of Non-Compliance 1 18 Percent of Total 27.78% 22.22%

2011 AEP Results: Targeted Observations Conducted 31 TOs on 11 Plan Sponsors Performed 4 TOs not attributed to a particular Plan Sponsor Made referrals to DOIs, FW&A MEDIC, AMs, and Plan Sponsors 2 Agents were terminated by their respective Plan Sponsors

Planned Activities for 2012 AEP Secret Shopping of Public Events Unreported Marketing Events Targeted Observation

2012 AEP: Activities Secret Shopping of Public Events Unreported Marketing Events Surveillance Marketing Allegation Response Team (SMART / fka Targeted Observation) Year-Round Activity SMART Referral Form Marketing Allegation Sources Method of Investigation Compliance Actions Team’s Focus (shifted from strictly Targeted Observations to investigating marketing abuse allegations) Year Round Activity SMART Referral Form (allegation intake form will be used to gather pertinent info for investigation – will be available soon) Marketing Allegation Sources  (DOIs, SHIPs, SMPs, beneficiary advocacy groups, CMS staff/ROs, plan sponsors, surveillance mailbox, electronically) Marketing Allegation Categories (examples:  inappropriate tactics related to sales activities, unsolicited contacts by agents or brokers, marketing websites or any other concerns related to the marketing of a MA/MAPD/PDP products) Method of Investigation (Targeted Observation (using Targeted Observation Tool), refer to AM for action, refer to Secret Shopping or any other action that seems appropriate given the allegation)  Compliance Actions (make recommendations) Ongoing Trend Analysis (identify any trends in the marketplace that will require new approaches for surveillance activities or enhancements to existing processes)

Surveillance Questions? Surveillance Mailbox Surveillance@cms.hhs.gov