CMS Spooks MA Plans With Warning About Secret Shopping, Enhanced Monitoring

If Medicare Advantage organizations and Prescription Drug Plans (PDPs) this open enrollment season have the haunting feeling they’re being watched, it’s because they are. After implementing new rules aimed at better protecting beneficiaries from confusing and misleading Medicare marketing, CMS in October issued two memos informing plans that they’ve done some digging into recent marketing activities and they don’t like what they’ve seen so far.

CMS has reported that marketing-related complaints more than doubled between 2020 and 2021 — which it largely attributed to the actions of third-party marketing organizations (TPMOs) — and has expressed particular concern with third-party marketers’ claims that some benefits are widely available to seniors when they vary by service area. To address these concerns, CMS made key changes this year, such as requiring TPMOs to use a standardized disclaimer that they do not offer every plan available in the area, clarifying that independent agents and brokers qualify as TPMOs, and stipulating that plans in their contracts with TPMOs require full recordings of sales calls with beneficiaries.