Guidance for the compliance work in front of you
Organized by what you’re actually trying to do — not by content type.
What examiners look for, and how to document it in advance.
Moving from periodic cleanup to continuous verification.
Call recording, disclaimers, and monitoring that holds up to review.
What it actually takes to run this in-house versus with a partner.
Medicare Advantage marketing compliance
In February 2026, OIG issued new Industry Compliance Program Guidance for Medicare Advantage — its first major update since 1999. It arrives alongside CMS’s Third-Party Marketing Organization (TPMO) rules, which require call recording, specific disclaimers, documented permission to contact, and reporting of agent or broker non-compliance to CMS.
CMS has reported that more than 80% of sampled 2021 marketing calls reviewed had compliance deficiencies — the clearest evidence yet that ad hoc call review isn’t enough. A defensible program needs continuous monitoring, consistent scoring against CMS and state criteria, and documentation that’s ready before an examiner asks for it.
See how MemberONE builds this →Provider directory accuracy
Directory accuracy requirements are inconsistent between federal bodies and still evolving at the state level, and NPPES self-reported data only tells you what a provider last submitted — not what’s true today. That gap shows up downstream in claims denials, credentialing delays, and member access complaints.
Closing it means direct outreach to confirm current data, validating results against NPPES rather than trusting it outright, and keeping a documented trail that shows the work — not just the outcome.
See how ProviderONE builds this →
