Compliance Audits

Mitigate Risk and Ensure Compliance to Medicare Advantage and Medicaid Plan Sales

Medicare compliance and Medicaid insurance plan sales audits, as mandated by Centers for Medicare and Medicaid Services (CMS), protect your brand equity and minimize risk. These assessments allow your organization to quickly identify agent-specific liabilities related to the sale of healthplan products.

Second To None’s Medicaid and Medicare Compliance solutions can help you continuously and accurately understand how well managed care or healthplan provider sales agents adhere to company-defined sales standards, as well as CMS regulations. We utilize a national team of male and female senior (55+) consumers to conduct all secret shops and evaluations.

Compliance audits are available during Annual Enrollment Periods (AEP) as well as throughout the calendar year, and may focus on Medicare Advantage, Medicaid Part D, TTY/TDD Services and Foreign Language Interpreter Monitoring.
An optimally designed and managed Medicare Advantage Compliance Audit supports a cross-section of internal stakeholders in ensuring consistent adherence to brand standards:

  • Sales Operations
  • Call Center Operations
  • TTY and TDD Customer Support
  • Foreign Language Interpreters
  • Legal
  • Human Resources & Training

Sample applications of Medicare Compliance Audits:

Informal Sales Events
Formal Events
Face to Face Sales Events: Senior auditor (55+) evaluates sales agent’s entire presentation
Call Center Monitoring: Assessing plan knowledge of call center representatives
TTY/TDD Call Center Services: Ensuring hearing-impaired beneficiaries are properly supported
Foreign Language Interpreters: Monitoring availability of call center interpreters

Medicare Compliance Audits help answer crucial organizational questions:

Are sales agents appearing at planned events?
Are plans presented clearly and accurately?
Do consumers feel pressured or mislead into making a purchase decision?
Are alternative plans presented or mentioned in a disparaging manner?

Medicare, Managed Care and Healthplan Compliance audits can be enhanced in richness through optional gathering of video, audio and/or photographic images to supplement the detailed written reports.

Our robust analytics and reporting services deliver clear, fact-based marketing and merchandising compliance insights to the right people at the right time, enabling you to focus with pinpoint accuracy on the most important action planning and priorities, at every level of your organization.

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