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Beware, again, of Medicare calls

Despite complaints and vigilance, sales pitches still cross the line.

By KRIS HUNDLEY, Times Staff Writer
Published December 6, 2007

Continuing Medicare coverage

When a Medicare Advantage salesman showed up uninvited on Patricia Kelty's doorstep recently, the St. Petersburg woman was shocked.

Yes, she had attended his free seminar at a Red Lobster a week earlier to learn about Optimum HealthCare's HMO plans for seniors.

But no way had she agreed to set up an appointment with the sales agent, John Hudgins. And no way was she letting him in her door.

"He said he was in the neighborhood," said Kelty, 68, a licensed insurance agent for more than 20 years who is familiar with Medicare marketing regulations. "But that's strictly against the rules."

No kidding. To protect seniors from pushy salesmen, the Centers for Medicare and Medicaid Services strictly prohibit sales calls from Medicare Advantage sales agents without an appointment.

"I feel sorry for people who might think they have to let him in," said Kelty. "They'd get brow-beaten into signing up."

This wasn't supposed to be happening as much anymore. Following a deluge of consumer complaints last spring, Medicare increased its oversight of insurers' marketing tactics. In the past, beneficiaries complained they had been promised their plans would be accepted by all doctors and hospitals, only to discover after enrolling that was not the case.

And independent agents in Georgia were so eager for commissions from Tampa's WellCare Health Plans that they put eight dead people on the company's Medicare Advantage plans.

CMS responded to the violations by requiring additional training of sales agents and more monitoring of presentations by the insurers. The federal agency also instituted its own "secret shopper" program, using private contractors to surreptitiously audit sales presentations.

A Medicare spokeswoman said it's too early to tell how effective the program has been, and no data is available on consumer complaints for the current open enrollment period, which began Nov. 15. But last month, Medicare's acting chief, Kerry Weems, was monitoring a presentation at a Virginia diner when he was busted by the insurance agent after asking too many probing questions.

"It's a serious effort," Weems said of CMS's secret shopper program. "It's not a game of gotcha and it's not a publicity stunt."

Caution advised

In the case of Kelty's complaint in St. Petersburg, Dan Polen, chief executive of Optimum HealthCare in Spring Hill, agreed that salesmen's cold calls, by phone or in person, are not allowed and said he would investigate. Polen said seniors should take their time evaluating plans. "Be careful you don't get roped into one of these things," he said.

Optimum is a relatively new player in the Medicare Advantage market, entering its second year of business with fewer than 1,000 members. In 2008, it is marketing three plans in Hillsborough, Hernando, Pasco and Pinellas counties.

Optimum uses both in-house and contracted sales agents, who are paid several hundred dollars in commission for each new enrollee. Hudgins is an independent agent with AmeriLife Group of Clearwater. Neither Hudgins nor his supervisor returned calls seeking comment.

About 8-million Medicare beneficiaries have enrolled in the private insurance plans, which offer more generous coverage than traditional Medicare.

In the Tampa Bay area, 56 Medicare Advantage plans are being offered for 2008. With the annual enrollment period ending Dec. 31, insurers are competing aggressively for business with free lunch seminars like Optimum's occurring daily.

Kelty said she tried to lodge a complaint against Optimum's sales agent with the state, but was referred to Medicare. A woman who answered Medicare's consumer hotline told her to call the state.

"I'm sorry I started this damn thing," she said. "I don't complain about people trying to make a living, but this has just gotten disastrous."

Information from news services was used in this report. Kris Hundley can be reached at


Q&A : Medicare

What marketing tactics are against Medicare's rules?

Medicare Advantage sales agents cannot place cold phone calls to potential clients or show up unannounced or uninvited at their homes.

If you attend a Medicare Advantage seminar, do you have to agree to an in-home appointment?


Where do I report a possible marketing violation?

Call Medicare at 1-800-633-4227.


[Last modified December 6, 2007, 02:53:21]

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