Helaine I. Fingold, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Baltimore office, was quoted in Fierce Healthcare, in “Court Pauses CMS Broker Compensation Rule for Medicare Advantage Plans,” by Noah Tong.
Following is an excerpt:
A recent lawsuit has pushed back against an industry-opposed Centers for Medicare & Medicaid Services (CMS) final rule on broker compensation in Medicare Advantage (MA) plans.
In Americans for Beneficiary Choice and Council for Medicare Choice v. the Department of Health and Human Services (HHS), a Texas district court judge ruled against the federal government and opted to pause enforcement of new CMS rules. A summary judgment is scheduled for July 17.
CMS established fixed broker and agent compensation in April as well as raised the pay cap for new enrollments to plans by $100, from $611 for initial sales to $711. Other contracts between MA plans and third-party marketing organizations are also deemed prohibitive because they created adverse incentives for brokers, CMS argues. The agency would like to eliminate volume-based bonuses.
“There was a focus on these administrative payments alleging that was a way for plans to get around the compensation limits that they were using the administrative costs to get money to agents or brokers in a manner that exceeded compensation limits,” Helaine Fingold, a partner at law firm Epstein Becker & Green, told Fierce Healthcare.
The plaintiffs argued CMS overstepped its authority in adopting this rule, and the court agreed much of the broker compensation requirements were “arbitrary and capricious,” deciding that compensation should not be limited. They also argued CMS did not provide sufficient data proving its viewpoint.
“There were a lot of pieces that industry felt very frustrated by, and there wasn’t a way to address them because they didn’t have the information on where CMS was coming from,” said Fingold. …
“Even if the court ultimately says, ‘CMS didn’t do what they needed to do and we’re not going to let this move forward,’ certainly this administration could come out in September with some alternatives that might try and get ahead of where the court is,” explained Fingold. “But that wouldn’t be effective until the 2026 plan year.”
People
Member of the Firm
