Compliance monitoring is crucial for organizations involved in Medicare advertising to ensure they adhere to the strict regulations set forth by the Centers for Medicare & Medicaid Services (CMS). Proper compliance not only protects beneficiaries from misleading information but also safeguards organizations from potential penalties and reputational damage.

Effective compliance monitoring helps organizations:

1. Maintain regulatory adherence
2. Protect beneficiary interests
3. Preserve brand integrity
4. Avoid costly penalties
5. Ensure consistent messaging across all marketing channels

To help organizations navigate the complex landscape of Medicare marketing regulations, here’s a detailed checklist based on CMS Marketing Guidelines:

Medicare Advertising Compliance Checklist

Content and Messaging

• Avoid using absolute superlatives (e.g., “the best,” “highest ranked”) unless substantiated with supporting data provided during CMS marketing review process[1]
• Do not use qualified superlatives (e.g., “one of the best,” “among the highest rank”) without supporting data[1]
• Refrain from making offensive or insulting statements[1]
• Do not state that enrollees will not be disenrolled due to failure to pay premiums[1]
• Avoid using the term “free” to describe zero-dollar premiums, premium reductions, or cost-sharing for those with dual eligibility[1]

Marketing Practices

• Do not use high-pressure tactics or intimidation to enroll beneficiaries[1]
• Use conventional mail and other print media for contacting beneficiaries[1]
• Include an opt-out function in all marketing emails[1]
• Do not engage in door-to-door solicitation[1]
• Avoid approaching beneficiaries in common areas like parking lots or hallways[1]

Digital Marketing

• Ensure websites are clear and easy to navigate[1]
• Include company name and logo on websites[1]
• Maintain current contract year content through December 31 of each year[1]
• Use required marketing disclaimers on websites containing plan-specific information[1]
• Clearly indicate when a phone number will direct individuals to a licensed agent/broker[1]

Compliance and Certification

• Ensure all marketing representatives are certified (licensed, appointed, trained) to sell advertised plans[1]
• Have CareFree Compliance review generic websites[1]
• Do not ask for health information without including a statement that such information is optional[1]
• Avoid requesting beneficiary identification numbers or financial information[1]

Accessibility and Disclosures

• Include TTY: 711 after all phone numbers[1]
• Specify days and hours of operation after phone numbers[1]
• Keep Medicare Advantage content separate from other lines of business[1]
• Update content within 30 days of receipt[1]

Prohibited Practices

• Do not ask for referrals from beneficiaries via websites[1]
• Avoid providing links to foreign drug sales[1]
• Do not offer enrollment into plans directly on websites[1]

By adhering to this checklist and regularly reviewing marketing materials against CMS guidelines, organizations can significantly improve their compliance efforts in Medicare advertising. Remember, compliance is an ongoing process that requires constant vigilance and adaptation to changing regulations.

IntegriShield is a leading advocate for compliance solutions in various industries. With a focus on ethical practices and integrity, IntegriShield provides comprehensive solutions to ensure businesses maintain the highest standards of compliance.

Citations:

[1] https://cdn.carefreeagency.com/pdfs/DOs_DONTs_Medicare_Marketing.pdf?v=1.52

[2] https://www.cms.gov/files/document/medicare-communications-marketing-guidelines-2-9-2022.pdf

[3] https://fastercapital.com/topics/identifying-affiliate-program-abuse.html

[4] https://www.brandverity.com/blog/affiliate-compliance-guide

[5] https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/2017%20final%20draft%20mmg_020916%20-%20clean%202-10-16.pdf

[6] https://www.cms.gov/medicare/health-drug-plans/managed-care-marketing/medicare-guidelines

[7] https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Copy-3-of-FinalPartCMarketingGuidelines

[8] https://www.cms.gov/medicare/health-plans/managedcaremarketing/downloads/finalmmg051509.pdf