Is this Really a CMS Violation?

[insuranceconceptscindy]

So then what happens? Will this affect your ability to sell Healthspring next year? Forever? Will you receive an enormous fine? Are you going to CMS jail? Or a slap on the wrist?
It seems like the most unfounded of allegations get hit the hardest. In all our training, it doesn't seem consistent either. From my understanding, the carrier decides the punishment. Healthspring seems like a bunch of bozos, just not sell them next year. Make it an "I quit" rather than "you're fired".
This kind of crap makes zero sense to me.

 

[SirLurkAlot]

Thanks for all the responses. To address a couple of posts above:

I went through corrective training, a discussion with the sales manager and had to sign and return a remediation form. It appears that no further action will be taken against me since I did the above things, according to the letter and discussion with the sales manager. Again, the sales manager even said it is obvious what occurred. I have been a solid agent writing good business for them so I would think that they wouldn't turn a simple wrong digit into anything bigger than they already have.

This thread wasn't started to bash Healthspring (there's enough of that on this board already), but to see if I have any re-course. The two main people, including the sales manager, I deal with in the organization are friendly, positive and have provided me good service the few times I've had questions. They just appear to carry no weight.

I carry every MAPD in my area and in a few counties Healthspring is a strong product. My sales angle is, I don't care which plan you go with, I am an independent agent that represents ALL the MAPD plans in your county and many different supplement plans, so let's determine what's best for you and I will be your agent for life. So, it would suck a little to lose any plan.

BTW, I am moving to the Naples, FL area in the next month or so if anyone wants to train a Medicare guy on selling life. I want to keep my Medicare season open to return to my established area so thinking I want to give Life a try unless someone has a better suggestion for a seasoned Medicare agent.

 

[G.Gordon]

Many a fool agent has thought such a small issue was not career altering... until it was.

When you're getting ready for AEP 2016, it will be too late to tidy this thing up.

Good luck in your new area.

 

[SirLurkAlot]

G. Gordon, you speak my fear. I PM'd you.

Another frustrating side note, I pulled the email requesting my response to the original allegation and I provided EVERYTHING they asked including proof of sending the application within the required 48 hour time frame and names and numbers of her family that was at the appointment. Here's the original email:

Hello [AGENT],

You recently sent HealthSpring an application on [MEMBER] which was dated 11/12/2014 but received on 11/23/2014. Since it is a Healthspring violation for an application to be received more than 3 days after the signature date, please provide faxed confirmation indicating that the application was submitted timely. Please respond to this email as soon as possible so our Compliance Department can be notified. If you feel this email is an error or you have proof of sending the application within the required 48 hour timeframe, please fax the confirmation page to my attention at XXX ASAP. Thank you for your prompt attention to this matter.

If anyone has any suggestions on how to appeal this, please PM me or share on forum.

 

[G.Gordon]

Keep hammering them. You have some loaded desk compliance moron. Get over their head. Keep DEMANDING someone else that can look at this reasonably.

Stay on it. Make this a full time job until it is fixed.

 

[wehotex]

First, I have been in the business 15+ years and have NEVER had any complaints or violations alleged against me because I am diligent about being thorough and ALWAYS put client interests first.

I am very upset at what has transpired and can't believe it is a CMS violation so I am seeking other opinions.

I faxed a Healthspring MAPD application taken on 11/22/14 and it was received by the company on 11/23. On 12/2, I received a notice of a timeliness violation stating that I committed a violation because the application was "received more than 3 days after signature date."

I immediately looked into the situation and determined I had inadvertently written 11/12 instead of 11/22 in the agent area of the application for the date the application was received. Both the Scope & application dates signed by the client were 11/22/14- I had just mis-wrote my date.

I responded to Healthspring on 12/3 with the following:

"In response to the accompanying email, I attest that the application for (MEMBER) was executed on November 22, 2014 as indicated by her signature date on both the application and Scope of Appointment, which was required due to a request to discuss Healthspring. I inadvertently listed 11-12-14 in the receipt date in the agent section but all other dates reflect the correct 11-22-14 date which would make the application submission timely.

(MEMBER) is a long time client of mine and our meetings are always on Saturdays so her children can attend. Two of her children in attendance were XXX (Phone #) and XXX (Phone #) that will also attest to the 11-22-14 meeting date.

I have included a copy of the allegation email & copies of my calendar pages.

Please let me know if you have any questions or need anything additional.

Thanks!"

Today, I received notice that it is indeed a violation, now on my record, I have to do something, submit remediation forms, etc. Interestingly, the letter acts like the sales manager, who signed the letter, had discussed this with me but she hasn't. I got the original violation, responded and assumed "No problem" until today. Awww, the old ASSUMED.

So, Ye' Old Wise Ones of the forum, is this truly a CMS violation? Do I have any re-course to get this reversedremovedetc.

Thanks in advance!

That's the way that Healthspring operates. ;(. I stopped writing them this past AEP for a multitude of reasons. But you just touched on one of them. They have their idiotic Telescope process. Of course, it's not open late on the cut-off date. Gawd forbid they work past 5. When, I tried to get by with a paper scope with notes that their Telescope was closed, it generated an inquiry. I had to write yet another explanation. They treat my area and the agents like crap. As a result, they had a whopping 5 apps this AEP and lost a little over 600 members in my area, and still losing. HAHAHAHA.

 

[midwestbroker]

I work closely with our compliance officer and I thought I would add some insight.

Healthspring is required to report this to CMS, even though it was a simple and easily corrected error. CMS requires all kinds of documentation on what the violation was, why it happened, what the corrective measure is and the outcome of the corrective measures. If Healthspring (or any other carrier) does not report this and CMS finds out, then the flood gates open and CMS is digging through all their records and can fine them or even halt their ability to accept applications until the matter is cleared up.

This should not affect you in any way in the future provided you have no other violations.

CMS violations are like driving violations. Having a headlight out is a simple infraction that is easily corrected. Not a big deal, but you can still get a ticket. Driving 140mph through a school zone is a far worse infraction and can result in hefty fines and loss of your driver's license.

 

[SirLurkAlot]

Thanks Midwestbroker! I needed to hear that. Honestly, this has caused me a lot of stress the last 24 hours and that's tough on this old heart. I am working with my upline to see what can be done but they are telling me essentially what you said. Hopefully, this won't effect my 2016 contracting.

 

[John Galt]

Good Lord, I will never ever never get involved with MAPD or any program similar, what a complete cluster of morons. Its too government controlled as well, I am not a govt. employee so you will never get a chance to treat me like one.

 

[WCMason]

I feel sorry for the poor agent who starts off the new year by writing an app for them, forgets and puts 2014 instead of 2015 on the received date. Sending in an application a year after you receive it has got to incur a horrible penalty.