Referral Fees

newguy123

Expert
42
What are the rules in terms of paying out referral or marketing fees for medicare products being sold to individuals referred by their non insurance licensed cpa or attorney?
 
What are the rules in terms of paying out referral or marketing fees for medicare products being sold to individuals referred by their non insurance licensed cpa or attorney?




For a MA and PDP products violation you do not pass go and you do not collect the 200.00 commish you will go straight to MIPPA jail per CMS Marketing rules. Med supps I think it's o.k unless it's the AARP/UHC med supp- I'm pretty sure that's also grounds for termination of contract.Cold calling to sell the AARP/UHC Med Supps can also lead to termination of contract with cause.In some states like Florida it's almost impossible to operate as a Medicare health plan agent without having the AARP med supp in your quiver.
 
I just read the section of the 2013 CMS Marketing Guidelines relating to "gifts".http://www.cms.gov/Medicare/Prescri...scriptionDrugCovContra/Downloads/MMG_0511.pdf It starts at P. 46. Does not mention referral fees to accountants or lawyers who are referring their clients/contacts. Not expressly prohibited here that I can see.

CMS does address referrals solicited from "members" of a "plan sponsor", see pp 14-15 of above link. It's ok in a similar way that Virginia law allows in general, not contingent on sale, see below, except that "nominal gift" is $15 for Medicare members giving referrals per CMS. Need to review all rules around referrals to be compliant, "it's complicated", as they say on Facebook.

Here is a link to Virginia's law regarding referral fees paid to others who refer business, which would apply to accountants, attorneys, etc. http://www.scc.virginia.gov/boi/pro/files/comprob.pdf
See pp. 21-22

It's ok to do, seemingly, by this law, in Virginia, provided it's done within their guidelines, such as, the general rule is no more than $25 per referral, and can't be linked to a sale. I would call the state insurance authority to get their position on this, and check what is their take about this statute and Medicare Advantage. I so far see nothing in CMS about outside referral fees, only to "plan members". Each carrier's trainers should have a handle on this, too.

I would like to know if there is anything I have missed in CMS's guidelines. Referral fees are not something I am considering, for now, but having correct info. always helps.
 
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