CMS Rule Seeks More Oversight of TPMOs, ‘Chain of Enrollment’

Following up on its October 2021 “Third Party Marketing” memorandum warning of misleading tactics by some organizations, CMS in its latest Medicare Advantage and Part D proposed rule said it believes “additional regulatory oversight” is needed to protect beneficiaries from “bad actors” in this space. The agency observed that an increase in third-party marketing activities in recent years has been accompanied by a rise in marketing-related complaints from beneficiaries, such as those who do not understand how an agent or broker obtained their information.

While previous guidance and rules have focused more on MA organizations’ relationships with agents and brokers, the new proposed rule serves to address the prevalence of lead-generating entities that may not directly contract with MAOs but qualify as first tier, downstream or related entities (FDRs), explains Helaine Fingold, a partner in the Health Care and Life Sciences practice at the law firm Epstein, Becker & Green, P.C.