Scroll down for a discussion on Medicare Secret Shoppers within the Senior Insurance Forum.
Here's a "Marketing Surveillance Summary Report" from CMS: http://www.cms.hhs.gov/ManagedCareMa...ort_092309.pdf .
Has anyone had any run ins with these secret shoppers? I think there will be ...
Has anyone had any run ins with these secret shoppers? I think there will be even more this season.
I've been secret shopped. I think twice. But, definitely once. They are usually younger people, under 65. The one I had came in with her elderly mother.
I was conducting a seminar in OEP. The younger lady kept asking me about private/individual insurance. I politely explained that this seminar is about Medicare plans; I'm not here to talk about individual plans. To make a long story short, they try to trick you into non-compliance.
I wonder if they even know what is complaint, what can be said or not said. I often restate the CMS regulations, so they know either way. I don't want to be in a situation were I am misunderstood.
It's funny how the secret shoppers try to make you stumble. We definitely need to be on top of our game.
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For the record, I passed.
Last edited by AJAX : 10-24-2009 at 09:02 AM.
Reason: Posts merged
I've been secret shopped. I think twice. But, definitely once. They are usually younger people, under 65. The one I had came in with her elderly mother.
I was conducting a seminar in OEP. The younger lady kept asking me about private/individual insurance. I politely explained that this seminar is about Medicare plans; I'm not here to talk about individual plans. To make a long story short, they try to trick you into non-compliance.
I wonder if they even know what is complaint, what can be said or not said. I often restate the CMS regulations, so they know either way. I don't want to be in a situation were I am misunderstood.
It's funny how the secret shoppers try to make you stumble. We definitely need to be on top of our game.
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For the record, I passed.
I think a sales event we did on Monday was secret shopped. I didn't personally give the talk at the event, but I was there as the licensed agent. As I pulled into the parking lot, a younger guy got out of his car, and I said good morning and went on in to the facility. At the door, I told them who i was and they showed me back to the room where we were doing the presentation, and the guy said that's what he was here for too.
He asked a couple of strange questions, and hung around outside talking on his cell phone. He took one of my cards and told me he'd definitely be "following up" but I haven't heard from him. His car had out of state license plates on it.
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All hard work brings a profit, but mere talk leads only to poverty. The wealth of the wise is their crown, but the folly of fools yields folly.
He asked a couple of strange questions, and hung around outside talking on his cell phone.
What kind of strange questions? Getting intrigued here.
Well, just questions that were not the typical things you'd get at an event. He was definitely not the demographic nor age of all the people at this event, and he didn't seem to know any of the other people. All of the rest of the people there seemed to know each other and seemed to hang around the center together regularly.
The questions were sort of off topic, and if not handled correctly, could trip up the person giving the talk, or let it go off course into some things we probably shouldn't get into.
Methinks you're hiding something 'cause you're not forthright on those questions, see.
Not really, I just don't know for certain if he was a secret shopper or not, I just strongly suspect it at this point. He could have been somebody's son going there to try and learn about plans for a parent, and just had no knowledge of how medicare or MAPD works.
The things he asked could have been innocent (dare I say ignorant) questions with no intent, or they could have been asked to back the person doing the presentation into a corner. It could really go either way.
I'll let you know for sure, becuase if he was indeed a secret shopper, he'll have to file a report with CMS, which will have to be shared with the company, and then I'd find out about it. If and when I do, I'll put some of the more specific notes from it here.
How long do they usually take to notify plans of a secret shopper event?
How long do they usually take to notify plans of a secret shopper event?
I understand that is an ongoing job and why would they notify anybody if they are a SECRET SHOPPER ?
It's all over the place. They usually will only notify the plan if they did something wrong and it can be very difficult to pick out who the secret shopper was unless you were the one giving the presentation. Even at that, they mostly just recruit amateurs who have no idea what's going on which is why I've seen agents get written up for the most bogus things, it really has the feel of a good old fashioned witch hunt. Some of the secret shoppers feel like they're only doing their job if they're "getting dirt" on agents, so they'll make stuff up when it isn't there or try to make an issue out of something that isn't one.
Just great...so maybe now we need to video tape mktg meetings so you can prove you're innocent!
Well in another year many more folks will shake out of this market as Ma's go network and raise premiums while shutting down freebies like nurse hotline/gyms/toiletries and dental.
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Retread!!
Are you now a secret shopper and those were your answers?
Last edited by policy doctor : 10-24-2009 at 01:36 PM.
Reason: Posts merged
If CMS would put 1% of the effort into looking into Medicare fraud from medical suppliers billing Medicare for things never supplied, doctors charging for procedures that were never performed, etc. etc. than checking on agents to see if they're serving light snacks or food, giving away gifts that are more than $15, saying verbatem "if the provider agrees to the terms and condtions, blah blah blah Medicare might not be in so much trouble financially.
Did anyone see the 60 minutes report last night? It was about how rampant Medicare fraud has become. Medicare doesn't have the staff to investigate like they should. They said that 60 billion a year is from Medicare fraud. Maybe they should have the secret shoppers helping them.
If CMS would put 1% of the effort into looking into Medicare fraud from medical suppliers billing Medicare for things never supplied, doctors charging for procedures that were never performed, etc. etc. than checking on agents to see if they're serving light snacks or food, giving away gifts that are more than $15, saying verbatem "if the provider agrees to the terms and condtions, blah blah blah Medicare might not be in so much trouble financially.
Did anyone see the 60 minutes report last night? It was about how rampant Medicare fraud has become. Medicare doesn't have the staff to investigate like they should. They said that 60 billion a year is from Medicare fraud. Maybe they should have the secret shoppers helping them.
Hilarious! Good points.
I wonder if we can find that 60 minutes report on YouTube?
60 Billion is a huge figure; that would fund almost half of the "public option."
I wonder how much fraud private companies experience?
Thanks for posting the 60 minutes....agents, if you haven't watched this episode, you really should. When CMS says they don't have the funds or people to monitor the fraud thats going on with suppliers and doctors ripping off Medicare, think of all the people and funds their putting into secret shoppers. CMS could cut the fraud in half if on each EOMB statement they send out they just wrote CMS is being defrauded 60 billion a year...please do your part in helping us stop this....please look over your statement carefully and make sure these services were provided to you.
My friend's wife is a secret shopper for Sears - has been for over 10 years. Scary stuff when talking to her. She obviously knows other secret shoppers and says a lot are just bitter human beings - their only goal is to "bust" employees and give bad reviews.
I can see the same for CMS shoppers - some bitter senior who hates the insurance industry asking either loaded questions or putting their bias into the reports.
If I was doing a group presentation I'd have my camcorder set up and running.
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Wow! That 60 minutes report was well done. It is crazy how easy it is to commit fraud on Medicare. I don't know what is worse the criminals or the government, who seems to not care enough to follow up or put enough manpower to fight the fraud.
That 60 billion is not the government's, it is ours. Taxpayers are losing the money.
Are you now a secret shopper and those were your answers?
ROTFLOL!!!
FWIW... I had a seminar last Wednesday. The day before, just as I was arriving at an appointment, my cell phone rings. A guy identified himself as a representative from CMS and wanted to know if I was going to have my seminar as scheduled. I told him, definitely! He said he might be there... maybe, maybe not. I think it was a cheap way to try to put me on notice... he didn't show up.
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To be truly independent, an agent should not be dependent on a government bureaucrat for contracts or commissions.
RE: camcorders.. yep..when someone asks questions, have the camera videoing the person. Liars don't like to have their pics taken.
Re: medicare fraud. Had a client tell me this story. His brother was involved in a billing business and uncovered this fact. Doctors had discovered that by unbundling their service rendered, they earned more.
E.G. take knee replacement. Instead of coding the bill as one surgery for knee replacement, which is what they are supposed to do, some got creative and charged one amount for cutting skin, another for sawing bone, still another for sutures,..etc. You get the point. ( Reminds me of these dentists' charges. ) That is how they spiked their reimbursements.
Anyone heard anything about secret shoppers in the home this year?
I got a compliance notice from Humana stating that if you suspect that someone is from CMS, that you DO NOT ASK them if they work for CMS? Anyone have an idea, what would happen if you did? Can you say entrapment!
Medicare Secret Shoppers
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