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

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

3. 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

4. 2011 AEP Efforts Primary Surveillance Activities:
Secret Shopping of Public Events
Unreported Marketing Events (UME)
Targeted Observation (TO)

5. 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

6. 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

7. 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

8. 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

9. 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%

10. 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

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

12. 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)

13. Surveillance Questions?
Surveillance Mailbox