DOI Investigation
- Thread starter axeman462
- Start date
Does anyone have a generic letter they have a client sign if a med supp cold call turns into a MAPD sale (done by the book)? One that states the initial phone call was regarding med supps and the client brought up MAPD and wanted to discuss their options.
Would such a letter help in these types of cases?
Would such a letter help in these types of cases?
So some agent is of Medicare age and, because he/she can't sell...decides to make your life difficult because you are working.
Got it.
'Merica.
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And I'm sure nearly 100% of your med supps are from UHC where in your contract says you can't cold call for UHC med supps. You should be fine but hopefully they don't catch wind of it.
Does anyone agree with jbage007 that you should have an attorney in this situation. I ask this question with the two recent California annuity cases in mind.
just do an open record request of the case number and they have to produce the info...... there, now you know the agent that did it... then sick some fed agency on them....
- 1,199
Wow so I guess the DOI/CMS doesn't take complaints from agents on other agents seriously - unless the agent filing the complaint also happens to be a Medicare beneficiary.I imagine since this agent was willing to file a complaint on you to the DOI then this agent also would have been willing to file a complaint to CMS or a carrier if he had the goods on you that you mentioned a specific carrier.Had this agent filed a complaint to a carrier too I think you would have heard from them already because the carriers turn around time for complaints has got to be faster than the DOI.
As long as you are not intentionally fishing for MA prospects off the med supp pier i don't think you have anything to worry about.Again IMHO your best defense in this he said - she said scenario is to document that the majority of your MA sales came from either BRC or IB calls. I would think the DOI ,CMS and the carriers have a benchmark percentage of how many MA enrollments will a med supp only phone script inadvertently generate out of every 10 med supp sales.As long as you are within what they consider a reasonable boundary you should be fine.
just a thought if you can narrow down the window in which this call may have been made you can cross reference your ob list with the Florida agent search to see if you can identify the culprit.Filter a search of all agents in Fl who are licensed with one of must have MA carriers if you are an indy agent i.e. UHC and then scan through alpha list.
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I believe that's what the SOA form was designed for - specifically it's noted where you have to say how the initial contact was made.Doing things strictly by the book you have still have to put OB call for initial contact in a case where a call for med supp prospect led to a f2f MA presentation. Just keep very good notes/documentation in case you ever have to do some splaining on the back end.
- 11,995
The only reason I would hesitate is that an attorney probably doesn't know enough about these things to be helpful. Not to say that they wouldn't be, but it may be a case of the blind leading the completely blind.
"Agent, did you break the law"
"No"
"Ok"
Of course it's much more involved and serious than that, but they're going to need grounds to do anything. Now, if for some reason this does become an issue and an appeal of some sort needs to happen, then absolutely, it's time to get an attorney and start really digging in. Of course I doubt axeman would admit publicly of any wrongdoing, but so far it sounds like they don't have enough rope to hang him. If half his production is supps and he's cold calling for supps, then someone asks about MA, that is not soliciting for MA by phone. It's that simple. If the DOI disagrees, then it's time to start talking to an attorney. I could be completely wrong though, Florida has tons of agents, maybe there are attorneys that already specialize in defending agents against bogus claims of violating marketing rules.
- 10,328
I dont think he is to that point yet. However, I do think that he needs to get his records straight and have a bit of a self defense planned for the next meeting. The idea of calculating the % of MA sales to Sup calls is a great idea in this case I think. I agree that they must have some type of benchmark to judge these things off of.
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Best idea yet... at least for after he gets the investigation out of the way. I wouldnt do it during the investigation. No need to rock the boat at the moment. Revenge is best served cold (for both parties)
- 901
xrac,
Just so you know my perspective, I was a lawyer in my former life - technically still am one, I guess. Trust me - bring your lawyer. It shows you take this seriously.
Let me ask you a question: Would you show up for an IRS meeting without a lawyer?*
Here, your livelihood potentially is at stake. Bring a lawyer. Sit there and be quiet. Let your lawyer do the listening (after asking minimal but probative questions).
You need to find out first and foremost what they are accusing you of. This seems most irregular. Agencies tend to put everything in writing. If nothing else, I would take a lawyer (yes, I would bring a lawyer with me) if for no other reason than to tell them that the only reason you are meeting in person is to find out what their concerns are and get those concerns in writing. Any response on my part always will be in writing. Never try to respond to any inquiry blindsided.
Good luck.
*The asterisk is to acknowledge that a CPA or EA can represent you before the IRS; however, only an attorney can represent you on appeal, so why bother with someone whose representative authority is so limited?
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scagnt83,
By bringing a lawyer the first time, you reduce the possibility of having the issue escalate to the level of needing a lawyer. (You're welcome for the lawyer double-speak.)
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