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Gloria D. Parker Associate Regional Administrator CMS Atlanta Helaine Fingold Director

CMS Contract Year 2011 Marketing Surveillance 2.0 Senior Medicare Patrol Webinar December 15, 2010. Gloria D. Parker Associate Regional Administrator CMS Atlanta Helaine Fingold Director Division of Surveillance, Compliance & Marketing. Contract Year 2011 Surveillance Activities.

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Gloria D. Parker Associate Regional Administrator CMS Atlanta Helaine Fingold Director

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  1. CMS Contract Year 2011 Marketing Surveillance 2.0Senior Medicare Patrol WebinarDecember 15, 2010 Gloria D. Parker Associate Regional Administrator CMS Atlanta Helaine Fingold Director Division of Surveillance, Compliance & Marketing

  2. Contract Year 2011 Surveillance Activities • Secret Shopping of Marketing Events • Clipping of Unreported Marketing Events • Non Renewal/Service Area Reduction Oversight • Regional Office Led Initiatives • New Activities: • Social Media and Agent Blogs • Targeted Observations

  3. Stronger and Smarter • All Parent Organizations assigned a risk status (low, medium, high) • More Risk = More surveillance activities • Plan performance starts from where they were last year • Deficiencies based on a weighted scale • Compliance actions are based on an objective analysis of performance = consistent and equitable actions

  4. New Surveillance Activities Monitoring Social Media and Agent Blogs • Per the Marketing Guidelines – CMS will monitor the use of social media by plan sponsors and contracted agents and brokers • If necessary, additional guidance will be issued

  5. New Surveillance Activities Targeted Observations • Response to direct feedback of marketing abuses by State Health Insurance Programs, Departments of Insurance, Senior Medicare Patrols, and other partners – these are “live leads” • Resources allocated to observe and corroborate violations

  6. How You Can Help • Targeted Observations Process • Increasing use of “on the ground” resources • Continued information sharing with Regional Office points of contact • Dedicated email: Surveillance@cms.hhs.gov

  7. CMS/State Key Initiatives • Issued joint CMS/State letter October 2009 to facility directors to educate and protect dually eligible beneficiaries from predatory practices of agents/brokers • Residents of Mentally Retarded and Developmentally Disabled (MRDD) facilities • Independent Care for the Mentally Retarded (ICFMR) facilities • Low income senior housing developments • 2011 – Expand on 2009 efforts by conducting market research to identify organizations that support vulnerable populations • Next Steps: Working to identify additional at-risk populations and geographical areas to provide educational outreach and improve beneficiary protection

  8. Questions?

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