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AIS's Health Business Daily
Featured Story November 14, 2008 Health Net Faces Scrutiny Over Allegedly Improper Sales Tactics Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed care programs. By Judy Packer-Tursman, Editor, (tursman@comcast.net) A House panel that held a hearing on "predatory marketing practices" by Medicare Advantage plans back in June 2007 thinks that there already may be instances of it in the 2009 MA and Part D marketing season that began Oct. 1. Reps. John Dingell (D-Mich.), chairman of the House Energy and Commerce Committee, and Bart Stupak (D- Mich.), chairman of the panel's subcommittee on oversight and investigations, announced Oct. 14 an investigation into a complaint submitted to CMS Oct. 1 by the National Senior Citizens Law Center (NSCLC). It alleges that some agents for Health Net, Inc. engaged in fraudulent marketing of MA plans in California, and asks CMS to investigate the marketing activities of Health Net and its agents and reprimand the company if violations are found. Health Net issued a statement that it began "an exhaustive review" of the issues on Oct. 2, the day it got the complaint, and is "already far along" in implementing recommended actions. Specifically, the NSCLC's complaint cites the use of unsolicited outbound "robo-calls" (i.e., automated telemarketing calls with a prerecorded message) in the San Francisco Bay area giving allegedly inaccurate information about a Health Net MA Special Needs Plan (SNP), including network restrictions. The complaint also cites reports of agents allegedly targeting low-income Spanish-speaking beneficiaries in Kern County and misrepresenting MA products to them. "We heard from CMS and Health Net within 24 hours of sending our complaint," Kevin Prindiville, a staff attorney in NSCLC's Oakland office, told MAN Oct. 31. He said NSCLC has had conversations with Health Net and CMS's central and regional offices. "They said they'll get back to us when the investigation is complete." Health Net spokeswoman Amy Sheyer told MAN Nov. 3 that Health Net "takes the improper marketing allegations initially raised in the [NSCLC] letter very seriously. We are investigating the facts and are taking immediate and appropriate measures to address them." According to Sheyer, Health Net has taken the following actions: Suspended the sales and marketing activity of the brokerage agency and producers involved in the telemarketing activity in northern California, pending the results of Health Net's investigation. Held conference calls with NSCLC and CMS, while continuing to work closely with CMS on responding to issues and taking appropriate actions. Taken the initiative
to call every member enrolled in September into a Health Net MA plan,
including SNPs, by the broker agency and producers involved. "Through
these calls, we will determine the member's level of satisfaction with
their plan, any areas of concern or confusion, and give them the option
to disenroll if they so choose," Sheyer says. |
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