DOI Investigation

[axeman462]

got a letter from FL DOI saying that I am being investigated yesterday. Called them this morning, and have an appt set up for next week. When I asked what it was in reference to she said "Without going into specifics over the phone, it has to do with your marketing practices. You do Medicare right?" I said "yes" and tried to dig a little further.
She mentioned call logs and if I had any notes from phone calls. I do not really keep any notes or logs (except for little notes on my google calender so I know who to call back). I am thinking it may be a DNC allegation or maybe someone who thought I was marketing MAPD over the phone?

If it is a DNC violation or MAPD mis-marketing how serious of a violation are we looking at? This would be my first DOI violation/allegation, am I looking at a slap on the wrist, or a major fine? I already asked her if I am looking at losing my license, and she said "I would strongly doubt that you would lose your license."

 

[somarco]

It would be nice if they gave you a time frame. At least then you could narrow it down vs bringing in reams of paper or other notes.

I can be anything, or nothing. I would be surprised if it was over a DNC or CMS violation. Probably someone didn't like something you said.

I had a guy threaten to report me to the DOI a few years ago over a pre-screen for U65 health insurance. I told him what I was going to do (share his medical history, age and desired plan) with underwriters but also told him the carrier would not know who he was.

A few days later when I emailed him the results (possible rate up or rider, etc) he got pi$$ed and claimed I had violated his HIPAA rights. He said he was going to report me to the DOI and get my license pulled. Even sent me a copy of the letter he supposedly sent to the DOI.

I never heard anything from them.

I wouldn't sweat it if you are playing by the rules.

 

[Jerard]

Some people have nothing else to do with their lives than complain about something.

 

[Josh]

First, that sucks. It's nice they told you that they highly doubt you'd lose your license. I doubt they'd care about anything with the DNC, but if you've been selling MA to folks you cold called they could be concerned with that being done by the book.

The first thing they're going to do is investigate before any fine and/or other disciplinary action is taken. If you've been doing things right you should have nothing to worry about. Even if you haven't been playing by all the rules, worry it's interest paid on debt not yet accrued. You're innocent until proven guilty and it's entirely possible that this is going to end up being nothing more than a scare.

 

[djs]

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

 

[VolAgent]

While I wouldn't be antagonistic, you should expect anything you say or provide will be used against you.

I wouldn't bring anything more than requested. I'd try to find out exactly what they are investigating and then only produce documents related exactly to that. If you show up with the kitchen sink and it is a person who is out to get agents, they'll find something.

Again, I go out of my way to be pleasant and nice, but this isn't confession. I'd be asking as many if not more questions than the investigator.

 

[vic120]

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

Its amazing how anything I do in my own life
I and no one else is responsible to know the facts
I was told this or that by rep is never acceptable

only did you read the documents its all right there, that's it and that's that

but when selling insurance
It does not matter how many documents say it how many documents they have on it or if its in big bold red letters

the agent said or did not say or some how just implied
or even just telepathically made me think this or that

that's it hang the agent this innocent person was brutally taken advantage of

 

[GreenSky]

I think they'll stop short of lethal injection.

Remember, anyone can accuse. The DOI must investigate. It would be a real stretch to think you actually did anything wrong.

Rick

 

[bobson]

Its amazing how anything I do in my own life
I and no one else is responsible to know the facts
I was told this or that by rep is never acceptable

only did you read the documents its all right that's it and that's that

but when selling insurance
It does not matter how many documents say it how many documents they have on it or if its in big bold red letters

the agent said or did not say or some how just implied
or even just telepathically made me think this or that

that's it hang the agent this innocent person was brutally taken advantage of

Did anyone else try to read that as a poem?

 

[axeman462]

Did anyone else try to read that as a poem?

LOL you took the words right out of my mouth