What Happens If I Misuse the Medicare Name or Marks?

Infographic explaining Medicare Marketing Guidelines for Misuse of the Medicare Name and Marks

The Medicare Marketing Guidelines (MMG) notes a United States Code (U.S.C.) that prohibits the misuse of the Medicare Prescription Drug Benefit Program name and marks. The MMG, in Section 150.4, also describes what could be interpreted as misuse and the penalties associated with it. Here’s what brokers should know about misusing the Medicare name or marks.

What Does the MMG Count as Misuse?

Misuse counts as the misrepresentation of any Medicare term, product, or mark (also known as logo) that gives the impression that a product or mark is approved, endorsed, or authorized by the Department of Health and Human Services (DHHS), CMS, or Medicare, according to the MMG. If a broker is intentionally misrepresenting a Medicare product or mark, or should know that they are doing so, the misrepresentation can count as misuse.

For example, all brokers should be aware that a Medicare contract awarded by CMS does not equate to an endorsement (Section 40.4). The following statements, either printed on a marketing document or said aloud during an appointment, would count as misuse of the Medicare name:

  • This Medicare Advantage plan is endorsed by Medicare.
  • This Medicare Part D plan is recommended by CMS.
  • This Medicare Plan K is endorsed by the DHHS.

What Happens If a Broker Misuses the Medicare Name or Marks?

The inspector general of the Department of Health and Human Services (DHHS) will be authorized to impose the following penalties on a broker:

  • Anyone found to be misusing the Medicare name or mark could face fines up to $5,000 for each violation. So, if the phrase “This Medicare Advantage plan is endorsed by Medicare” is found on four separate types marketing documents a broker is using, he or she could be subject to up to $20,000 in fees.
  • If the misuse occurs in a broadcast or telecast, a broker could be subject to $25,000 in fines.

What Else Can Excelsior Do for Brokers?

First, Excelsior has more Medicare guidelines tailored to brokers and broken down topic-by-topic on our online resource center. Next, Excelsior has technology and services to help you grow your business. And last but not least, we have experienced regional sales directors who can train you to potentially double or triple your income with compliant cross-selling techniques. Learn more about the Excelsior team and how we can help you by contacting us today.

Note: For the most current information, see the CMS Medicare Marketing Guidelines.



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