DOI Investigation

[axeman462]

If they were investigating Medicare Advantage marketing tactics, wouldn't CMS be the entity that contacts him rather than the DOI?

I did have a cms complaint earlier this year (section A). Do you think its possible this could be related? Ie: both departments are overlapping?

 

[yogooglethis]

I did have a cms complaint earlier this year (section A). Do you think its possible this could be related? Ie: both departments are overlapping?

I am not sure without looking it up what a section A is but if it's concerning marketing as far as compliant initial contact with MA prospect then yes it definitely can be related because the MA carriers can and sometimes do contact the DOI If it is then I assume you have the consumers name that filed the complaint and that will probably help you be ready to defend yourself to the DOI with the call log from your phone company showing an IB call for this consumer if they have proof the initial contact for this consumer from you was a OB call then I would go in assuming the worst that DOI has subpenaed consumers call log from phone company and then be ready to show that very few of your tour total MA sales originate from OB calls to prove you are not systematically doing a bait and switch when you sell the occasional MA when cold calling for med supp .Then this will be more of a he said she said case.

 

[DHK]

You're innocent until proven guilty and it's entirely possible that this is going to end up being nothing more than a scare.

Let's rephrase that line: You are innocent, until you are publicized with any alleged acts.

Just ask Glenn Neasham. He was convicted... and then had it reversed. He was painted with the brush of guilt well before his conviction, even on this very forum.

Whenever there is a profession where trust is required and implied, you are going to be presumed guilty by the court of public opinion, until you prove your innocence.


Just make sure you don't end up having your name in a press release from your state's DOI as a 'pending case'.

 

[Josh]

Let's rephrase that line: You are innocent, until you are publicized with any alleged acts.

Outside of him posting here under a screen name, I'm unaware of anyone publicly posting anything about him? There also seemed to be some genuine concern about him losing his license (ability to make money) and for that to happen they would have to do more than publicly criticize him.

 

[DHK]

Josh,

You are completely correct in this case. And just because there is an investigation, doesn't mean anything... so far.

And I realize that I may be COMPLETELY blowing this out of proportion... but we know of one agent who was ARRESTED following a DOI investigation... brought to trial... CONVICTED... and later had that conviction OVERTURNED... who is having a very hard time trying to rebuild his business and (dare I say) his good name in his community.

"In an interview, all you have is trust. Once that's gone, you have nothing."

Our reputation, integrity, honesty is all we have in a selling situation. If that is sullied through the "court of public opinion"... it can spoil your business, even if you do get to keep your license.

----------

Who is looking out for the agent or advisor today?

Companies? Company compliance people first look out after their firm's interests, then the customer. The agent is a distant 3rd.

E&O? Not if it's dealing with a fraud or other criminal issue.

The best defense is to keep clients happy, follow all the rules the best you can, and document everything the best you can..

http://www.insurance-forums.net/forum/annuities-forum/lawsuit-protection-best-practices-t66214.html

 

[yogooglethis]

If they were investigating Medicare Advantage marketing tactics, wouldn't CMS be the entity that contacts him rather than the DOI?

Usually it starts and finishes with the carrier whether the complaint originated from consumer calling Medicare or carrier to complain.CMS made the carriers responsible for policing part C/D but CMS will come down on carriers if they are found not to be enforcing the rules.If you remember in any compliance portion of certifications for MA they make a point to let us agents know that certain violations can have consequences with CMS, DOI, and law enforcement including fines up to 10,000.00 ,5 years in prison,blah,blah blah.

I know an agent who had a client that went ballistic and called every agency to complain. The client filed a complaint against him to Humana and the DOI at the same time so he had to juggle the complaint from to angles.In this particular case Humana closed the case as unfounded but according to this agent a very zealous Florida DOI investigator wanted take it further. I have also heard of cases where after the complaint is filed to the carrier the carrier may decide to report it to the DOI during or after their internal investigation.

I think it's rare that a MA complaint would originate with the DOI but it could happen if for example the consumer thinks an agent was cold calling for MA plans in general but the agent didn't name a particular MA carrier so obviously in this case the complaint can't be made directly to a MA carrier but they could lodge a complaint to the DOI and the DOI will run with it if they think the complaint has merit.

 

[xrac]

I had something similar happen to me once, big investigation because someone complained to the DOI that they had a $300 bill that they didn't want to pay. Turns out, they were trying to claim I placed insurance that they didn't want, ignoring the fact that it was in force for over a year with them making payments and I had signed copies of them requesting the policy. People do silly things. Ultimately, the whole thing was dismissed and nothing happened. I think to this day, they still owe the $300. That said, be a bit careful. I strongly urge you to not bring any information with you to the appointment. Have them explain specifically what they are looking for and then provide only what they need. Basically, don't open doors that aren't open already. The fact that you are concerned about this and don't seem to know what its about tells me that you probably didn't do anything seriously wrong. You may have done something inadvertently, but not blatantly. The fact they said they doubt you'll lose your license to me implies that they are going through some processes and aren't overly concerned about it. Don't take it lightly, but this just sounds like a process issue. Most likely, someone thought they were going to be covered for something that they weren't covered for and YOU promised coverage. When the claim was denied, they filed a complaint with the DOI stating that you said everything was covered..... you know the story..... People hear what they want to hear. Dan

Good advice. Listen to Dan on this.

 

[axeman462]

so I had my meeting with the doi today. kind of hard to tell how it went. The complaint was for allegedly cold calling for Medicare Advantage.
It is basically the customers word against mine. I feel it could easily go either way.

 

[Guest]

This is exactly why I do not call on supps or any other products, the customer can throw you under the bus so quick !!
Hope it all works out for you.

 

[djs]

Hmm, just curious, what was their proof? What triggered it?
Or is it just an allegation and they are fishing?