Wisconsin Senior Medicare Patrol

“Beneficiaries who think they may have been wrongfully enrolled in a plan or those who see other potentially suspicious activity can call the SMP program for help.”

The Medicare Open Enrollment Period, which runs October 15 to December 7 each year, is the time when Medicare beneficiaries can join, switch, or drop a plan.

“There are a lot of rules on what insurance agents can and cannot do. Sometimes they break the rules – like cold calling or approaching beneficiaries with whom they have no prior relationship. They’ll come knock on doors or approach people in hallways. They’ll also disguise marketing events – with the purpose of signing people up for their plans – as educational events,” said Ingrid Kundinger, Wisconsin Senior Medicare Patrol Project Manager.

According to the Medicare Communications and Marketing Guidelines, other violations include agents representing themselves as if they’re from Medicare when they’re really not, agents signing beneficiaries up for plans that are supposed to cover specific prescriptions when the plans really don’t, agents requiring attendees at marketing events to provide contact information as a prerequisite for attending, or agents leaving information such as leaflets, flyers, door hangers, etc., on a beneficiary’s car or residence when they did not have an appointment with that Medicare beneficiary.

Agents are allowed to call beneficiaries who have expressly given advanced permission, make unsolicited contact with potential enrollees using conventional mail and other print media (e.g., advertisements) and by email provided it contains an opt-out function, and conduct marketing/sales activities in common areas of health care settings.

“Beneficiaries who think they may have been wrongfully enrolled in a plan or those who see other potentially suspicious activity can call the SMP program for help,” said Kundinger. “Anyone who has questions, concerns, or complaints about potential fraud and abuse issues is invited to call our toll free and confidential helpline at (888) 818-2611, she said. “We also have excellent information on our website (http://www.smpwi.org) or our Facebook or LinkedIn pages.”

The Senior Medicare Patrol mission is to empower and assist Medicare beneficiaries, their families, and caregivers on how to prevent, detect, and report health care fraud, abuse, and errors through outreach, counseling, and education. The Wisconsin Senior Medicare Patrol program covers 72 counties and 11 federally recognized tribes with educational messages and outreach. The program engages and supports an active team, statewide, to help in mission delivery.

The Wisconsin Senior Medicare Patrol program is housed at the Greater Wisconsin Agency on Aging Resources (GWAAR).