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Medicare Advantage Sales Scams on the Rise in CA

Cheryl Clark, for HealthLeaders Media, October 13, 2011

As Medicare Advantage open enrollment season begins Saturday, state managed care officials in California on Wednesday issued a stern public warning about an increase in unscrupulous and illegal sales tactics some agents are using to pitch plans.

"Deceptive marketing of Medicare Advantage products to senior citizens and others eligible for Medicare or Medi-Cal (Medicaid in California) is a relatively new phenomenon in California and in the nation," Brent A. Barnhart, director of state Department of Managed Health Care said during a news conference.

"These plans can be very beneficial for consumers, but unfortunately, they have also given opportunity for those who would take advantage of the elderly, or vulnerable consumers, by misrepresenting benefits, terms, conditions and co-payments."

Barnhart invited one victim, Brenda Hoot of Manteca, to the briefing to tell her story. 

Hoot was contacted last year by someone who convinced her to switch from her existing plan to a similar one that had lower premium, no deductible, and co-pays merely $10 to $15. She repeatedly called the agent to check whether she had understand the policy correctly. Yes, she was reassured repeatedly. It really was that good.

But after her husband was hospitalized to receive a stent, they started to get the bills and provider demands for $500 per service. Now credit agencies are asking her to pay up nearly $15,000 in medical bills and doctors they see want them to pay up front.

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