Best Practices for Maintaining the Highest Compliance Standards

Maintaining the highest standards for compliance isn’t just a requirement, it’s how we protect beneficiaries from confusing or misleading tactics. As a key partner, your role is crucial!

Please ensure all lead generation activities, including those of your downlines and vendors, follow the Centers for Medicare & Medicaid Services (CMS) rules, federal/state laws, and the policies of carriers you contract to sell with.

Best Practices for Lead Generation Oversight & Monitoring

• Regular Monitoring: Routinely review all marketing and communication materials, websites, and talking points/scripts used by your lead vendors to ensure they meet CMS compliance standards.

• Active Auditing: Conduct periodic checks to verify that leads were generated with proper consent and in a transparent manner.

• Keep Records: Maintain clear documentation of all your oversight activities, including audit findings and corrective action.

• Reporting to Carriers: Please submit monthly reports to your carriers regarding any staff disciplinary actions or violations connected to beneficiary interactions.

• Call Recording is a Must: Remember, all marketing, sales, and enrollment calls (including lead vendor calls and web-based audio) must be recorded in their entirety.

• Working with Lead Companies: When utilizing lead generation companies, it is essential to partner with reputable organizations. These companies must be able to furnish all advertisements and lead recordings upon request.

• Being Clear with Lead Materials & Disclosures: Lead forms must clearly let beneficiaries know that their information will be shared with a licensed sales agent who will contact them.

• Multi-Channel Clarity: This disclosure needs to happen verbally (on the phone), in writing (mail or paper forms), or electronically (via email or chat).

• Transfer Transparency: If you transfer a beneficiary, they must be told they are being moved to a licensed sales agent who is able to enroll them in a plan.

• TPMO Data Sharing Update: If you share personal data with another TPMO, the beneficiary must provide prior express written consent through a clear disclosure that lists each individual entity receiving the data and allows the beneficiary to consent or reject to the sharing of their data with each individual TPMO.

  • General terms like “marketing partners” are no longer sufficient for Permission to Contact (PTC).

  • The Requirement: You must provide a clear and conspicuous list of the actual organizations that will receive the consumer’s data. Instead of a vague link to “marketing partners,” the consumer must be able to see the specific names of the agencies or carriers they are consenting to be contacted by.

Setting Clear Permission to Contact (PTC) Standards

Permission to Contact must be easy to find, clear, and easy to read.

• No “Buried” Language: The PTC language cannot be hidden in small print or deep within disclaimers.

• Event-Specific Consent: Permission is for a specific event only; it cannot be treated as a blanket consent for all future contacts.

• Website Requirements: Lead generation sites should be simple to navigate. To solicit for MA or prescription drug plans, they can only require a user to enter a zip code, county, or state for general content access. They cannot require a consumer to enter in their health status, gender, or date of birth.

TCPA & FCC Transparency Disclosures

When requesting contact information, please ensure your agencies disclose the following points to stay compliant:

• Calls may be made using an auto-dialer, text, or robocall.
• The communication is for marketing purposes.
• Cellular carrier charges may apply.
• Granting permission does not impact eligibility or services, and it can be changed at any time.

What to Avoid: Prohibited “Misleading” Tactics

Carriers strictly prohibit sources that use “bait-and-switch” or high-pressure methods. Non-compliant leads are those that use tactics like:

• Financial Hooks: Promises of “Cash Assistance,” “Financial Relief,” “Stimulus Help”, “Free groceries,” “monthly cash allowance,” or using any lifestyle-related rewards or surveys to gather leads.

• Misleading Language and/or Benefits: Making false or exaggerated claims about plan features, such as promising “unlimited dental coverage” or exaggerated grocery card allowances that aren’t available on all plans.

  • Framing the purpose of calls as “discussing additional benefits” or “upgrading” a beneficiary’s current plan. This terminology creates a compliance risk where beneficiaries may mistakenly believe they are adding onto their existing plan rather than replacing it with a different MA product.

  • Making false or exaggerated claims about plan features, such as promising “unlimited dental coverage” or exaggerated grocery card allowances that aren’t available on all plans.

• Government Mimicry: Using domain names, logos (like flag themes), or headlines that try to look like government agencies or using words like “Medicare” or “Social Security” in a way that suggests the communication is from the government.

• Disconnected Tactics: Anything that isn’t strictly focused on Medicare products is prohibited, including promoting unrelated products or services (e.g., life insurance, non-health discounts) alongside Medicare enrollment.

Remember, if an investigation occurs, your agency must be ready to provide the entire “chain of enrollment.” This includes lead source materials, lead vendor scripts, advertisements, call recordings, and proof of Permission to Contact.

Failure to comply will unfortunately result in a requirement to stop using those leads and may lead to corrective action or suspension.

Ritter is committed to supporting you in maintaining the highest compliance standards. If you have any questions or need assistance with your lead generation practices, please don’t hesitate to reach out to our Compliance team.