Helaine I. Fingold, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Baltimore office, was quoted in AIS Health Radar on Medicare Advantage, in “Finalized Broker Pay Cap Appears to Exclude FMOs, but Impact Remains Unclear,” by Lauren Flynn Kelly. (Read the full version – subscription required.)
Following is an excerpt:
Building on a sweeping set of marketing-related provisions that went into effect this year, CMS’s recently finalized 2025 Medicare Advantage and Part D rule put new restraints on agent and broker compensation, among other things. The provisions advance the Biden administration’s ongoing efforts to shield consumers from misleading marketing, but with more of a focus on activities performed by independent agents and brokers rather than the broader third-party marketing organization (TPMO) industry that was targeted in previous rulemaking. Industry experts tell AIS Health, a division of MMIT, that the finalized provisions are still open to interpretation when it comes to the role of one type of TPMO — field marketing organizations (FMO) — which often conduct lead generating and advertising on behalf of plans. …
“I think a lot of people are relying on that [statement] to say the limits don’t apply,” weighs in Helaine Fingold, a member of the law firm Epstein Becker &Green, P.C. While CMS mentions independent agents, it doesn’t “say that means an individual agent, but that seems to be the implication.” In other words, it implies that individuals that have a relationship with an FMO but are working as independent contractors are impacted vs. the FMOs that employ the agents, she explains. …
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