Medicare Star Ratings: How Broker Calls Hit Your Bonus

For a Medicare Advantage organization, a complaint about a sales call made by a downstream broker is not a customer-service matter. It is a payment event. The complaint enters CMS's Complaint Tracking Module, the CTM feeds a Star Ratings measure scored against your membership, and your star rating determines whether your contract qualifies for a higher benchmark. The agency that made the call bears none of that. You do.

This is the part of third-party marketing oversight that gets discussed as a compliance obligation when it is actually a revenue mechanism. Here is the chain, with each link cited.

The chain, in four steps

CMS's own Technical Notes define the measure without ambiguity. The description is "Rate of complaints filed with Medicare about the health plan," the metric is "Rate of complaints about the health plan per 1,000 members," and the notes state that "Complaints data are pulled after the end of the measurement timeframe to serve as a snapshot of CTM data." More stars is better "because it means fewer complaints."

The payment side is equally explicit. Section 422.258(d)(7)(i) provides that "a qualifying plan means a plan that had a quality rating of 4 stars or higher based on the most recent data available for such year," and that for such a plan the applicable percentage "must be increased… For 2014 and subsequent years, by 5.0 percentage points." For a qualifying plan serving a qualifying county, that increase "must be doubled."

The rating reaches your revenue a second way as well. Under 42 CFR § 422.266(a)(2), the beneficiary rebate percentage a plan must provide is determined by its quality rating under the same 5-star system.

So a broker you do not employ, working a lead you did not buy, saying something on a call you never heard, moves a number that helps decide your benchmark and your rebate percentage.

Why it lands on the plan and not the agency

Because the regulation says so, in one sentence.

CMS restates the same principle in the CY2027 final rule: MA organizations and Part D sponsors "are responsible for ensuring all downstream entities meet CMS's requirements."

There is no version of this where the exposure stops at the agency. Delegation moves the work. It does not move the responsibility.

What CMS does with a complaint

Plans often assume marketing conduct surfaces during a scheduled program audit. It does not. It surfaces when someone complains, which makes it unpredictable in a way an audit calendar is not.

CMS describes its own practice in the CY2027 final rule: "CMS has requested call recordings based on complaints from CMS's Complaint Tracking Module (CTM). The requested recordings were chosen based on the severity of the allegations in the complaint." The reviews are used "to determine if the claims against the agent or broker were supported by the call recording."

CMS is not the only party asking. The same passage notes that "other governmental entities, such as the Department of Justice (DOJ) have relied on call recordings for investigations."

And CMS has already done this at scale. In its review of hundreds of sales, marketing, and enrollment audio calls, CMS found that only one plan option from one MA organization was discussed in over 80 percent of the calls reviewed. That is a published finding from completed reviews, not a warning about hypothetical ones.

The oversight problem, stated plainly

Every plan has a compliance program covering first tier, downstream and related entities. Attestations, training certificates, secret shopping, contract language, periodic file reviews.

None of it tells you what was said on Tuesday's calls.

The exposure is created in the words spoken on individual sales calls, at volume, by people you do not employ, on dialers you do not own. When a complaint arrives naming a specific call, the plan is in the position of asking the agency to produce the evidence that will be used to judge the plan. If the agency produces a recording, it is a file the agency controls and could have edited. If the agency produces nothing, the plan absorbs the finding.

This gets harder from October 1, 2026, when two marketing rules change for every TPMO dialing on your behalf: marketing and sales call retention drops from 10 years to 6, and the required disclaimer must now be spoken prior to the discussion of any benefits rather than within the first minute. That second change matters to you specifically. Under the old rule, disclaimer compliance was a timestamp your vendor could point to. Under the new one, it is a question about the order of what was said, which can only be answered by knowing the content of the call.

What real oversight of downstream calls requires

Strip out the process and three things are actually needed:

1. Coverage. Every call made in your name, not a sample. A complaint names one specific call, and it will not be one of the two per hundred anybody reviewed.
2. Evidence you did not have to trust anyone for. A recording handed over by the party being investigated is worth less than a record that can be checked independently.
3. Content, not just metadata. The carrier proves a call happened. Your CDRs prove duration and disposition. Neither tells you whether the disclaimer preceded the benefits discussion, or whether one plan was pitched exclusively.

Where a signed record fits

This is what Klariqo does. It runs on the dialer your downstream agencies already have, including VICIdial, and turns every call into a Klariqo Call Record (KCR): quality review applied to 100 percent of calls against your rulebook, with a full transcript, sealed into a signed, tamper-evident record. Every record is witnessed on JLINC and carries an independent RFC 3161 trusted timestamp (DigiCert), the standard behind legal e-signatures.

For a plan overseeing downstream sellers, the useful property is who has to be trusted: nobody. A KCR can be verified at verify.klariqo.com or with the open-source verifier, with no account and no login. Change one byte of a record and the signature breaks. So when an agency hands you evidence about a call your brand is being judged on, you are not taking their word that the file is complete and unedited. You can check it.

That is the same structure the lead-generation industry already adopted for web forms. Buyers stopped accepting "we got consent" and started requiring a certificate they could verify themselves. Nothing equivalent has existed for the call, which is where the content rules actually get broken.

Plans that want this can require it the way every other downstream standard gets required: written into the agency agreement, with the record delivered per call. Scoring runs at $0.02 per minute, roughly ten cents on a five-minute call, which is a rounding error against a benchmark measured in percentage points.

A KCR does not make a call compliant, and it will not tell you whether a given sales call was lawful. What it removes is the blind spot. When a CTM complaint names a call from eight months ago, you either have a provable record of what was said or you have an agency's account of it.

You can see what the record looks like without talking to anyone: upload a call at klariqo.com/try and get a signed KCR back in about a minute. New accounts start with $5 in free credits.

FAQ

Do broker complaints affect Medicare Star Ratings? Yes. Complaints filed with Medicare are recorded in CMS's Complaint Tracking Module, and CTM data feeds Star Ratings measure C28, "Complaints about the Health Plan," scored as a rate of complaints per 1,000 members under the Part C and D Star Ratings Technical Notes.

How do Star Ratings affect Medicare Advantage payment? Under 42 CFR § 422.258(d)(7)(i), a plan rated 4 stars or higher is a qualifying plan, and the applicable percentage used to calculate its benchmark is increased by 5.0 percentage points for 2014 and subsequent years. That increase is doubled for a qualifying plan serving a qualifying county.

Is an MA organization responsible for what its downstream agencies say on calls? Yes. 42 CFR § 422.504(i)(1) states that notwithstanding any relationship with first tier, downstream and related entities, the MA organization maintains ultimate responsibility for complying with all terms and conditions of its CMS contract.

Does CMS listen to Medicare sales calls? Yes, but not on a fixed schedule. CMS states it has requested call recordings based on complaints in its Complaint Tracking Module, selected by the severity of the allegation, and that the Department of Justice has also relied on call recordings for investigations.

What changes for TPMO calls on October 1, 2026? Marketing and sales call retention drops from 10 years to 6, with audio required for the first 3 years, and the TPMO disclaimer must be conveyed prior to the discussion of any benefits rather than within the first minute of the call.

How can a plan verify what a downstream agency's agents actually said? Only by having the content of the calls. A signed, independently timestamped record with a transcript lets a plan confirm what was said and confirm the record has not been altered, without relying on the agency that produced it.

Sources: 2026 Part C & D Star Ratings Technical Notes (CMS) · 42 CFR § 422.258 · 42 CFR § 422.266 · 42 CFR § 422.504 · CY2027 final rule, 91 FR 17384

This article describes federal regulations and CMS methodology as published and is not legal advice. Confirm application to your organization with your compliance counsel.