MA Plan Marketing Fraud is Year-Round for People with Medicare & Medi-Cal

MA Plan Marketing Fraud is Year-Round for People with Medicare & Medi-Cal

While we often warn of Medicare marketing scams each fall during Medicare’s Open Enrollment, Medicare Advantage (MA) marketing scams are a year-round threat for beneficiaries with both Medicare and Medi-Cal. That is because these beneficiaries have a right to switch plans up to once a month throughout the year. Insurance agents know this and some agents take advantage of this right to con beneficiaries into switching plans when they don’t need or want to just so they can make a commission.

One example is a case our California Senior Medicare Patrol (SMP) recently received involving a Spanish-speaking beneficiary who was unknowingly switched into a different plan. In this case, she received a call from a Spanish-speaking agent, we’ll call Mr. G. He claimed to be calling on behalf of her HMO broker, who no longer worked at that plan so he was following up. Mr. G proceeded to share that he could provide her with better benefits than her current plan, benefits that included better doctors and access to a gym. Well, the beneficiary did share that she was not too happy with her current doctor, to which Mr. G replied that they indeed had better doctors and he had already found her one.

When the call ended, Mr. G had given the beneficiary his call back number and the beneficiary understood that he had found a doctor for her if she decided at some point she wanted to switch plans. Yet, it wasn’t until a couple weeks later, when the beneficiary received an enrollment letter from a different HMO plan that she realized she had been changed into a different plan without her authorization.

Concerned, the beneficiary called her original HMO plan and told them she wanted to remain with them. The beneficiary also attempted to contact Mr. G, but was never able to reach him. She then contacted her former HMO broker and determined that yes, he was still indeed employed with her HMO plan. Upon telling him what had happened, he said he actually knew Mr. G, saying they used to work together and that he thinks Mr. G may have taken client information when he left.

The beneficiary then reported this case to our Senior Medicare Patrol (SMP), who now has this case on file and has sent it to the Department of Managed Health Care for further investigation. One of our SMP staff did call Mr. G first to try to get some more information. He introduced himself as Mr. G with Medicare Union. When asked what Medicare Union is and what they do, he stated they sell Medicare Advantage plans and supplement plans and are a Medicare brokerage. When our staff asked him if he was a licensed agent, he replied yes. Yet, when asking him for his CA license number, he hung up.

We share this case as one of many examples of marketing abuse scams that are aimed particularly at beneficiaries with both Medicare and Medi-Cal. If you or a loved one come across such a scam or suspicious situation or agent, please call our California Senior Medicare Patrol at 1-855-613-7080.

Also, please review and share our fraud alert, Beware of Agents Pressuring You to Switch Plans (PDF). It’s also available in Spanish and 5 other languages. See our Fraud Alerts page to download these languages and any other fraud alerts.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.