TCPA Rules for Medical Billing Sales Calls

The four core TCPA rules

The Telephone Consumer Protection Act (TCPA) is codified at 47 USC 227 and implemented by the FCC. It governs autodialed calls, pre-recorded messages, and text messages to US phone numbers. Four core rules matter for medical billing sales outreach:

Rule 1: Prior express written consent for autodialed marketing calls

Automatic Telephone Dialing Systems (ATDS), predictive dialers, and prerecorded messages to mobile numbers for marketing purposes require prior express written consent. The consent must:

• Be in writing (electronic signature satisfies)
• Clearly authorize the specific caller to make autodialed or prerecorded calls
• Disclose that consent is not a condition of purchase
• Include the phone number to which consent applies

Live-agent manual dial calls to mobile numbers have slightly relaxed consent standards but still require consent for prerecorded messages.

Rule 2: DNC Registry compliance

The National Do Not Call Registry maintained by the FTC protects personal residential and mobile numbers. Companies making telemarketing calls must:

• Scrub calling lists against the Registry every 31 days
• Maintain an internal do-not-call list
• Honor opt-out requests within 10 business days
• Not call numbers on the Registry (with limited exceptions for EBR or written consent)

Business phone lines are not on the National DNC Registry, but the TCPA's underlying restrictions still apply.

Rule 3: Text-call equivalence

The FCC treats calls and text messages as equivalent under TCPA. An opt-out via reply text to a marketing message revokes consent for calls as well. An opt-out via voice call revokes consent for text messages as well.

This rule prevents the pattern of "stopped calling but still texting" that some vendors have used as a workaround.

Rule 4: Established Business Relationship (EBR)

The EBR exception permits calls to a former customer for:

• 18 months after the last purchase, transaction, or payment
• 3 months after the last inquiry or application

The EBR ends immediately when the recipient asks the caller to stop, regardless of the remaining window. Continued calls after an opt-out request are TCPA violations that vendors cannot excuse by pointing to an EBR.

Statutory damages structure

TCPA creates a private right of action. Individuals and businesses can sue directly. Statutory damages:

• $500 per violation for negligent violations
• Up to $1,500 per violation for willful or knowing violations
• No cap on total damages
• Attorney's fees not automatic but many state analogs award them

Class-action settlements for pattern violations:

• Historical range: $10 million to $75 million
• Recent settlements involving major consumer brands have exceeded $100 million
• Settlements often include injunctive relief (compliance program requirements, third-party monitoring)

State attorneys general can also bring TCPA claims. Florida has been particularly active with the Florida Telephone Solicitation Act, which adds state-level enforcement on top of federal TCPA.

Consent record requirements

Callers must maintain documented evidence of prior express written consent for the duration of the calling relationship plus a reasonable period after. The record should include:

• Date and time consent was obtained
• Method (web form submission, checkbox, verbal recording, signed document)
• Exact language displayed to the consumer
• Specific phone number(s) consent covers
• Any subsequent changes to the consent (renewal, revocation, opt-out)

Inability to produce the consent record on request is a strong defensive posture for the recipient in a TCPA action.

What triggers TCPA scrutiny in medical billing sales

Specific patterns that generate TCPA enforcement or class actions:

1. Purchased or shared lead lists where consent flowed to a different original recipient
2. Prerecorded voicemail drops without prior express consent
3. SMS marketing to mobile numbers without opt-in
4. Continued calls after opt-out request past the 10-business-day cure period
5. Calls to numbers on the DNC Registry without EBR or written consent
6. Reassigned number problem — the previous number holder consented; the current holder did not

The FCC has adopted a "reassigned numbers database" to help callers identify numbers that have been reassigned since consent was obtained. Callers relying on outdated consent have limited protection under TCPA.

Health-specific TCPA considerations

Medical billing sales outreach faces a few specific TCPA constraints:

• HIPAA-authorized calls — calls conveying healthcare-related information under a HIPAA authorization have somewhat different rules from pure marketing calls, but this exemption does not extend to marketing outreach to physician practices for business services
• Medicare marketing — cold-calling Medicare beneficiaries is prohibited under CMS marketing guidelines regardless of TCPA. This applies to consumer-side outreach but has downstream implications for provider-side marketing that mentions Medicare products.
• State-level rules — several states (Washington, Florida, California) have layered stricter rules on top of federal TCPA

Recipient's TCPA enforcement playbook

For a physician practice receiving TCPA-violating medical billing sales calls:

1. Send a written opt-out by email to the vendor, referencing the specific number to be removed and the 10-business-day cure period
2. Document each subsequent call (date, time, phone number, caller identification)
3. Register the number at DoNotCall.gov (personal cell numbers on the plan)
4. File a complaint at consumercomplaints.fcc.gov after 31 days on the registry
5. Consult a TCPA plaintiff-side attorney for pattern violations; most work on contingency because statutory damages fund the fee

Individual TCPA cases can settle for $2,000 to $5,000 per violating call in demand-letter negotiations. Pattern cases can escalate to class actions with much larger settlements.

Bottom line

TCPA is one of the most enforced consumer-protection statutes in the US. The rules are simple: get prior express written consent for autodialed marketing, honor opt-outs within 10 business days, and treat calls and texts as equivalent. Statutory damages of $500 to $1,500 per violation make persistent violators expensive targets, and the mechanism is designed to be usable without an attorney until damages accumulate.