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Marketing & Sales Misrepresentations - Detection & Prevention Activities Every MAO Should Implement

Now that the Annual Election Period (AEP) dust has settled, it is important to ensure that we’re reflecting on our performance in the sales and marketing area not only from a numbers perspective, but from a Compliance perspective.

CMS and Compliance Officers alike have long been concerned with sales and marketing misconduct. In CMS’s memo released on October 8th, 2022, they gave the industry a warning related to what they viewed as large scale deceptive marketing and sales tactics at play in the industry.

In case we needed reminding, CMS states very clearly within their October 8th memo that MAOs are responsible for preventing, detecting, and correcting sales agents from intentionally or unintentionally misleading beneficiaries and misrepresenting plan benefits, services, or network.

A health plan’s preparation is always the key to prevention through comprehensive education, communication, and knowledge assessment of agents. Many organizations can fall short of comprehensive prevention and detection activities, But detection activities should be included in every facet of agent onboarding and oversight, including:

  • Agent contracting

  • Enrollment application completeness processing and timeliness monitoring

  • Lead management

  • Sales event management and oversight

  • Rapid disenrollment and cancellation monitoring

  • Sales event secret shops

  • Agent compensation audits

  • Monitoring of tele-sales or other sales calls

  • Customer service training around how to identify an allegation of sales misconduct

Effective detection activities are key to beneficiary protections and satisfaction. Reporting and corrective action procedures should be in place to help correct any non-compliance and ensure that corrective measures are effective in driving compliant sales operations. It is never too late to put good practices into place! The Open Enrollment Season is around the corner, as well as a year full of new age-ins and special elections. for support in developing and implementing your Sales Oversight program or to contract Rebellis Group to perform Sales Oversight activities for your organization.


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