Medicare Compliance Tips on Privacy and Confidential Information

Compliance March 4, 2019 0
medicare compliance

The Centers for Medicare and Medicaid Services has an effective medicare compliance program that decreases the risk of economic losses, reputational damage, and even criminal acts. This promotes a culture of prevention, detection, and resolution throughout the industry. Understanding Medicare compliance is key to maintaining a clean record and making more sales.

Privacy and Security

As an agent, you have the responsibility to protect the sensitive information of beneficiaries. This can reduce the risk of identity theft and the negative impact it will have on your clients. PHI (Protected Health Information) and PII (Personally Identifiable Information) can be classified as “non-public” personal information that can individually identify someone. These items can include:

  • Medical records
  • Patient information
  • Social security numbers
  • Addresses
  • Phone numbers
  • Bank account numbers
  • Routing numbers

We have a responsibility to protect Non-Public Information at all times. Do not use or give out Non-Public Information to anyone without approval. Accessing PHI, when it is not needed to complete your job, or just out of curiosity, is strictly prohibited.

Handling Confidential Information

It is your responsibility to keep confidential and proprietary information secure and protected from inappropriate access at all times. You must securely store it and protect it from other parties in your household or while traveling.


How can you maintain confidential information?

When you are handling confidential information, remember the following:

  • Store PHI (protected health information) in an out-of-sight location, such as a trunk.
  • Keep electronic equipment, such as laptops and iPads, secured when not in use.
  • Encrypt electronic devices containing PHI, such as laptops, tablets or smartphones.
  • Use a cable and lock on laptops when in your office, or if traveling at a hotel.
  • Do not put your laptop in checked luggage. Keep it as a carry-on item when on a plane.
  • Refrain from having over the phone or in-person conversations about PHI in public places where your conversation may be overheard.
  • Collect and secure all PHI before leaving a sales meeting, such as at a beneficiary/member’s home or in a restaurant.

What are some high-risk areas?

There are some circumstances where a beneficiary’s confidential information could be compromised. Keep the following in mind:

  • Be careful when you are leaving a public sales event or sales event in a public place. Double check to make sure you are not leaving any paperwork or information behind.
  • When you are sending emails, be sure you are sending them to the correct recipient. Check each letter and symbol carefully.
  • Be sure to send emails with PHI in a secure and encrypted manner.
  • Refuse to return member information (such as completed member enrollment applications) upon termination.
  • Never leave information in an unsecured environment or throw way beneficiary information or documents into the trash.
  • Do not leave copies of important documents in your car.

Why SMA?

At Senior Market Advisors, we make sure our agents have the tools they need. Our compliance team makes sure you are educated on all CMS rules and regulations. Plus, our lead management system, online sales training, custom quote engine, and top tier commissions make sure our agents are set up for success. Ready to start contracting? Fill out this form or give us a call at 844-452-5020.

Kelsey Davis
Kelsey Davis
Marketing Manager at Senior Market Advisors
After studying marketing and design at Butler University, Kelsey joined us to help with social media, content writing, and email marketing. When she's not in the office, you can probably find her watching The Office or designing prints for her Etsy shop! Fun fact: When she was in school, she spent a summer interning in Australia and while there, she swam in the Great Barrier Reef!