Creating an SEP by Purposely using the wrong Enrollment Code...

[RunnerDude]

I know several agents who falsely "create" an SEP by using the "Chronic Condition" enrollment code to enroll a new client "outside of AEP, OEP or some other valid SEP. Knowing the client will not qualify for the chronic condition SEP since they do not actually have a chronic condition like diabetes or cardiac issues, they then write the client on a different MAPD plan since a "valid SEP" is automatically created once the carrier declines the Chronic Condition MAPD enrollment 60 days later. These agents seem to get away with this practice routinely. Is this legal- or is CMS just not catching it?

 

[policywunk]

I know several agents who falsely "create" an SEP by using the "Chronic Condition" enrollment code to enroll a new client "outside of AEP, OEP or some other valid SEP. Knowing the client will not qualify for the chronic condition SEP since they do not actually have a chronic condition like diabetes or cardiac issues, they then write the client on a different MAPD plan since a "valid SEP" is automatically created once the carrier declines the Chronic Condition MAPD enrollment 60 days later. These agents seem to get away with this practice routinely. Is this legal- or is CMS just not catching it?

I don't think CMS has been verifying most SEPs especially for LIS and DE for a while now and agents are getting away with using creative SEPS.It will come back to haunt them if someone doesn't get approved when they were promised they would and they file a complaint. I know of one agent who thinks it's ok to use LIS as long as he completes a LIS application on SSA.gov for them .

 

[LostDollar]

I know several agents who falsely "create" an SEP by using the "Chronic Condition" enrollment code to enroll a new client "outside of AEP, OEP or some other valid SEP. Knowing the client will not qualify for the chronic condition SEP since they do not actually have a chronic condition like diabetes or cardiac issues, they then write the client on a different MAPD plan since a "valid SEP" is automatically created once the carrier declines the Chronic Condition MAPD enrollment 60 days later. These agents seem to get away with this practice routinely. Is this legal- or is CMS just not catching it?

Caveat, I am NOT an insurance agent and I do not have to make daily decisions about whether or not my family eats based on whether or not I sell a policy that day.

From reading posts here, it seems to me that there are spectrums of actions agents can or will take to sell policies. But it seems to me like if an agent can build a solid business following the rules, they would be better served in the long run by doing that rather than breaking the rules to make sales, even if they don't attain the volumes achieved by some other agents.

In short, I think it comes down to an individual's decisions about appropriate ethical behavior.

 

[DonP]

I don't think CMS has been verifying most SEPs especially for LIS and DE for a while now and agents are getting away with using creative SEPS.It will come back to haunt them if someone doesn't get approved when they were promised they would and they file a complaint. I know of one agent who thinks it's ok to use LIS as long as he completes a LIS application on SSA.gov for them .

You’re saying a company will approve a client for lis if they don’t have present lis ? You’re saying a company’s not checking to see if a client legitimally has lis? So you can write a regular middle calls person and use lis sep and if the sept was no used they’ll approve? I know the co’s approve all the sep’s and cms never even double checks

 

[selfgen]

CMS does keep track of LIS SEP’s. If I have a MBI number and a birthdate I can access CMS data which will tell me if and when the Medicare beneficiary last used the LIS SEP. it will show me whIch plan they are on and what the effective date is/was. Very useful tool for me.

 

[RunnerDude]

Getting back to the point…. Agents are illegally creating SEP’s by using the “chronic condition” enrollment option - knowing that the client will not qualify- thus creating an SEP 60 days later. Why is CMS not catching this??

 

[policywunk]

You’re saying a company will approve a client for lis if they don’t have present lis ? You’re saying a company’s not checking to see if a client legitimally has lis? So you can write a regular middle calls person and use lis sep and if the sept was no used they’ll approve? I know the co’s approve all the sep’s and cms never even double checks

I know that agents use LIS when they dont have LIS and it gets approved.- BTW not me.

 

[Chazm]

Getting back to the point…. Agents are illegally creating SEP’s by using the “chronic condition” enrollment option - knowing that the client will not qualify- thus creating an SEP 60 days later. Why is CMS not catching this??

About 8 years ago is when I first heard of this tactic.
Freedom health notified agents and that if anyone was caught doing this would be terminated for cause.
Yes, it will work but companies will track agents who they believe are abusing it.

 

[axeman462]

About 8 years ago is when I first heard of this tactic.
Freedom health notified agents and that if anyone was caught doing this would be terminated for cause.
Yes, it will work but companies will track agents who they believe are abusing it.

yup, I personally never done it. especially these days, when there are never-ending legitimate SEPs. I just never believe that risking an appointment with a carrier is worth it

 

[ValeRosso]

What the hell? Man, I should have thought of that. Even the garbage shady IMO I was with before, I still never heard of doing this.

Im guessing it just doesn't happen nearly enough to have it on CMS radar. Besides, CMS is too concerned about things that literally dont matter, like implementing call recording and new SOA rules.