Medicare Marketing Violations and Enrollment Fraud

Medicare Marketing Violations and Enrollment Fraud

Unlike Original Medicare, Medicare Part C and Part D are administered, marketed, and sold by private insurance companies. The Centers for Medicare & Medicaid Services (CMS) have guidelines for marketing Medicare Part C and Part D insurance that protect beneficiaries from manipulative and deceptive sales and enrollment tactics.

Plan sponsors and their representatives, including agents and brokers, must follow strict guidelines when they wish to market to beneficiaries. A fundamental principle is that marketing cannot be conducted under the guise of education.

Report potential Medicare marketing violations and/or enrollment fraud, errors, or abuse if:

  • You receive an unsolicited phone call from a company you have no prior relationship with
  • You receive an unsolicited email from a company you have not agreed to receive emails from
  • You receive a call or mail from a company after requesting to opt out of receiving such communications
  • A company represents itself as coming from or sent by Medicare, Social Security, or Medicaid
  • You receive information such as leaflets, flyers, door hangers, etc., on your car or at your residence from a company you did not have an appointment with
  • An agent initiates a discussion about other insurance products, such as life insurance annuities, during a visit or meeting about a Part C or Part D Medicare product
  • An agent returns uninvited to your residence after missing an appointment with them earlier
  • You signed up for a plan after being told by a company that certain prescriptions or services were covered, but after reviewing your EOB, you found they were not covered by the plan and you received a bill instead

To learn how to read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB), click here.

Report Suspected Fraud

To report suspected fraud, click here.

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