BluePeak News Alert: Scrutiny of Medicare Marketing Practices Continues to Increase

August 25, 2022

Scrutiny of Medicare Marketing Practices Continues to Increase

This week, the United States Senate Finance Committee sent letters to 15 state insurance commissioners and state health insurance assistance programs requesting data about Medicare Advantage marketing complaints, as part of an investigation into potentially deceptive marketing tactics practiced by Medicare Advantage Plans. This action comes as plans are already working to ensure compliance with the new Third-Party Marketing Organization (TPMO) related regulations issued by Centers for Medicare & Medicaid Services (CMS), which go into effect in 10/01/22 at the start of marketing activities for the 2023 Annual Enrollment Period (AEP). Read the Senate Finance Committee newsroom release here, which includes a copy of the full letter sent to state officials.

Based on the Health Plan Management System (HPMS) memo dated 10/8/2021 and further clarified via the 2/9/22 update to the Medicare Communications and Marketing Guidelines, as well as the 2023 Medicare Part C and D final rule (CMS-4192-F), CMS solidified its stance that Medicare Advantage plans are responsible for oversight of TPMOs, Field Marketing Organizations (FMO), and tele-sales lead generating sales and marketing activities. Such guidance further reaffirms that CMS holds plans responsible to oversee not just brokers and agents, but other entities that may participate in the enrollment process.

If your plan needs assistance developing or implementing a sales and marketing oversight plan in compliance with the latest CMS requirements, BluePeak can help.

End-to-end Review of Sales Process

BluePeak conducts comprehensive assessments of the entire sales process, from lead generation through to enrollment confirmation. Assessments can be customized, but generally BluePeak reviews standard policies, oversight processes, and workflow of tele-sales, agents, brokers and field marketing organizations (FMOs), including how they work with other entities. BluePeak’s assessment includes evaluating the approach for managing sales-related complaints received through the Compliant Tracking Module (CTM) or directly by the plan and ensuring that potential issues are quickly addressed. Our assessment report will provide a roadmap for areas of improvement.

Agent and Broker Education

BluePeak develops customized computer-based training for sales agents and brokers highlighting changes and new features of the plan-specific benefit design. This helps to ensure that the features and benefits of a plan are being accurately represented and minimizes member confusion. BluePeak’s training also includes education on compliant practices, including how information can and cannot be shared or used.

AEP Agent Secret Shopping Reviews

BluePeak performs live and recorded reviews of prospective sales calls to evaluate their compliance. BluePeak secret shopper representatives will conduct mock prospective member calls. During the call, the secret shoppers will request plan information, review in-network providers and confirm formulary covered medications. The secret shopper will test hold times, TTY, language line, agent knowledge of the plan benefits, as well as provide you feedback on agent soft skills, all while ensuring your contracted agents are following the CMS marketing guidelines. BluePeak can also listen to call recordings to provide retrospective identification of potential compliance issues or concerns.

With BluePeak’s help, your plan can face this increased regulatory sales and marketing scrutiny with confidence.

Contact BluePeak

BluePeak Advisors is a division of Gallagher Benefit Services, Inc.