Part C and Part D Enforcement Actions
CMS has the authority to take an enforcement action when CMS determines that a Medicare Plan either:
- substantially fails to comply with program and/or contract requirements,
- is carrying out its contract with CMS in a manner that is inconsistent with the efficient and effective administration of the Medicare Part C and Part D program requirements, or
- no longer substantially meets the applicable conditions of the Medicare Part C and D program.
Enforcement actions include:
- Civil money penalties (CMP)
- Intermediate sanctions (i.e., marketing, enrollment, payment suspensions), and
- Contract terminations.
CMS issued the following CMPs, intermediate sanctions, and terminations since 2006.
| Date Action Taken | Org. Name/Contract Number(H=MA-PD;S=PDP) | Action Taken | Basis for Action | Effective Date |
|---|---|---|---|---|
| 12/22/2009 | ProSalud HMO, Corp. | Termination | Contract Administration | 12/22/2009 |
| 11/30/2009 | ProSalud HMO, Corp. | Immediate Suspension of Enrollment and Marketing | Contract Administration | 11/30/2009 |
| 02/26/2010 | Fox Insurance Company | Immediate Suspension of Enrollment and Marketing | Contract Administration | 02/26/2010 |
| 09/14/2009 | Blue Cross Blue Shield of Kansas | Sanction Release | Deficiencies Corrected | 09/14/2009 |
| 02/19/2009 | WellCare Health Plans, Inc. | Suspension of Enrollment and Marketing | Contract Administration | 03/07/2009 |
| 01/15/2009 | Blue Cross Blue Shield of Kansas | Immediate Suspension of Enrollment and Marketing | Contract Administration | 01/15/2009 |
| 01/12/2009 | Wellpoint, Inc | Immediate Suspension of Enrollment and Marketing. | Contract Administration | 01/12/2009 |
| 12/16/2008 | Citrus Health Care | Suspension of Enrollment and Marketing | Contract Administration | 01/01/2009 |
| 09/30/2008 | MD Medicare Choice | Expedited Termination | Contract Administration | 09/30/2008 |
| 09/15/2008 | MD Medicare Choice | Suspension of Enrollment and Marketing | Contract Administration | Replaced by Termination |
| 03/20/2008 | Health Net | Sanction Release | Deficiencies Corrected | 03/20/2008 |
| 11/20/2009 | Citrus Health Care | Sanction Release (except for non-renewing PDP contract H5407) | Deficiencies Corrected | 11/20/2009 |
| 11/16/2009 | SDM HealthCare | Immediate Suspension of Enrollment and Marketing. (Replaced by Mutual Termination) | Contract Administration | 12/01/2009 |
| 11/03/2009 | WellCare Health Plans, Inc. | Sanction Release(except for non-renewing contracts H0967, H1340, H4577 and H6499) | Deficiencies Corrected | 11/03/2009 |
| 09/22/2011 | Aetna, Inc. | Civil Money Penalty ($20,000) | Required Beneficiary Notices | 09/22/2011 |
| 09/22/2011 | Blue Cross of Idaho Health Services, Inc. | Civil Money Penalty ($60,000) | Required Beneficiary Notices | 09/22/2011 |
| 09/22/2011 | Coventry Health and Life Insurance Company | Civil Money Penalty ($20,000) | Required Beneficiary Notices | 09/22/2011 |
| 09/22/2011 | Geisinger Indemnity Insurance Company | Civil Money Penalty ($20,000) | Required Beneficiary Notices | 09/22/2011 |
| 09/22/2011 | The Regence Group | Civil Money Penalty ($100,000) | Required Beneficiary Notices | 09/22/2011 |
| 09/22/2011 | WellCare Health Insurance of Arizona, Inc. | Civil Money Penalty ($20,000) | Required Beneficiary Notices | 09/22/2011 |
| 03/09/2010 | Fox Insurance Company | Immediate Termination | Contract Administration | 03/09/2010 |
| 10/08/2010 | Alliance Health and Life Insurance Co. | Civil Money Penalty ($41,660) | Required Beneficiary Notices | 12/09/2010 |
| 04/05/2010 | Aetna Life Insurance Company | Suspension of Enrollment and Marketing | Contract Administration | 04/21/2010 |
| 10/08/2010 | First Medical Health Plan | Civil Money Penalty ($57,240) | Required Beneficiary Notices | 12/09/2010 |
| 10/08/2010 | Humana Insurance Company | Civil Money Penalty ($55,880) | Required Beneficiary Notices | 12/09/2010 |
| 10/08/2010 | Mercy Health Plans | Civil Money Penalty ($16,970) | Required Beneficiary Notices | 12/09/2010 |
| 10/08/2010 | Puget Sound Health Partners | Civil Money Penalty ($2,000) | Required Beneficiary Notices | 12/09/2010 |
| 12/03/2010 | Universal American Corp. | Civil Money Penalty ($17,800) | Required Beneficiary Notices | 02/03/2011 |
| 10/25/2011 | Blue Cross Blue Shield of Tennessee | Civil Money Penalty ($20,000) | Required Beneficiary Notices | 12/28/2011 |
| 06/13/2011 | Aetna Life Insurance Company | Sanction Release | Deficiencies Corrected | 06/13/2011 |
| 01/16/2008 | Health Net Life Insurance Company | Immediate Suspension of Enrollment and Marketing | Contract Administration | 01/16/2008 |
| 09/05/2008 | SDM HealthCare | Sanction Release | Deficiencies Corrected | 09/05/2008 |
| 10/08/2010 | Blue Cross of Idaho Health Services, Inc. | Civil Money Penalty ($31,800) | Required Beneficiary Notices | 12/09/2010 |
| 11/19/2010 | Arcadian Management Services, Inc. | Suspension of Enrollment and Marketing | Contract Administration | 12/05/2010 |
| 11/19/2010 | Health Net, Inc. | Immediate Suspension of Enrollment and Marketing | Contract Administration | 11/19/2010 |
| 11/19/2010 | Universal American Corp. | Suspension of Enrollment and Marketing | Contract Administration | 12/05/2010 |
| 01/14/2011 | Aetna, Inc. | Civil Money Penalty ($171,240) | Required Beneficiary Notices | 03/15/2011 |
| 09/09/2009 | Wellpoint, Inc. | Sanction Release | Deficiencies Corrected. | 09/09/2009 |
| 12/03/2010 | Coventry Summit Health Plan | Civil Money Penalty ($34,820) | Required Beneficiary Notices | 02/03/2011 |
| 11/10/2009 | Bravo Health Insurance Company, Inc. | Civil Money Penalty ($45,000) | Required Beneficiary Notices | 01/12/2010 |
| 11/10/2009 | Molina HealthCare, Inc. | Civil Money Penalty ($11,200) | Required Beneficiary Notices | 01/12/2010 |
| 11/10/2009 | Touchstone Health, Inc. | Civil Money Penalty ($2,800) | Required Beneficiary Notices | 01/12/2010 |
| 11/10/2009 | VNS Choice | Civil Money Penalty ($25,000) | Required Beneficiary Notices | 01/12/2010 |
| 11/10/2009 | WellCare Health Plans, Inc. | Civil Money Penalty ($16,750) | Required Beneficiary Notices | 01/12/2010 |
| 11/10/2009 | American Health, Inc. | Civil Money Penalty ($25,000) | Required Beneficiary Notices | 01/12/2010 |
| 07/08/2011 | Arcadian Management Services, Inc. | Sanction Release | Deficiencies Corrected | 07/08/2011 |
| 05/17/2010 | Quality Health Plans, Inc. | Suspension of Enrollment and Marketing | Contract Administration | 06/02/2010 |
| 05/17/2010 | Quality Health Plans,Inc. | Civil Money Penalty ($586,800) | Contract Administration | 07/20/2010 |
| 08/01/2011 | Health Net, Inc. | Sanction Release | Deficiencies Corrected | 08/01/2011 |
| 08/05/2011 | Universal American Corp. | Sanction Release | Deficiencies Corrected | 08/05/2011 |
| 2012-02-29 | Quality Health Plans of New York, Inc. | Sanction Release | Deficiencies Corrected | 02/29/2012 |
| 05/07/2012 | Health Net, Inc. | Release From LIS Exclusion | Deficiencies Corrected | 05/07/2012 |
| 06/19/2012 | UnitedHealth Group, Inc. | Civil Money Penalty ($2,175,000) | Contract Administration | 08/21/2012 |
| 09/27/2012 | Aetna, Inc. | Release from LIS Exclusion | Deficiencies Corrected | 09/27/2012 |
| 2012-10-09 | Triple-S Salud, Inc. | Civil Money Penalty ($350,000) | Contract Administration | 2012-12-11 |
| 2012-10-09 | Universal American Corp. | Civil Money Penalty ($325,000) | Contract Administration | 2012-12-11 |
| 2012-10-09 | MAPFRE PRAICO Coproration | Immediate Suspension of Enrollment and Marketing | Contract Administration | 2012-10-09 |
| 2012-10-09 | Care 1st Health Plan | Civil Money Penalty ($50,000) | Contract Administration | 2012-12-11 |
| 09/30/2011 | National Health Plan Network, Inc. | Termination (Initial) | Contract Administration | 12/31/2011 |
| 9/25/2012 | National Health Plan Network, Inc. | Termination (Upheld) | Contract Administration | 11/30/2012 |
| 11/19/2012 | Universal Health Care Insurance Company, Inc. | Immediate Suspension of Enrollment | Contract Administration | 11/19/2012 |
| 12/14/2012 | The New York State Catholic Health Plan, Inc. | Civil Money Penalty ($75,000) | Contract Administration | 02/14/2013 |
| 12/14/2012 | Sterling Life Insurance Company | Civil Money Penalty ($75,000) | Contract Administration | 02/14/2013 |
| 12/14/2012 | Aveta Inc. | Civil Money Penalty ($75,000) | Contract Administration | 02/14/2013 |
| 12/14/2012 | Physician's United Plan, Inc. | Civil Money Penalty ($50,000) | Contract Administration | 02/14/2013 |
| 12/14/2012 | HealthSun Health Plans, Inc. | Civil Money Penalty ($50,000) | Contract Administration | 02/14/2013 |
| 12/14/2012 | Health Alliance Plan | Civil Money Penalty ($75,000) | Contract Administration | 02/14/2013 |
| 2013-01-15 | Silverscript Insurance Company | Immediate Suspension of Enrollment and Marketing | Contract Administration | 01/15/2013 |
| 2013-01-17 | Universal Health Care Insurance Company, Inc. | Immediate Suspension of Enrollment – State Specific - Addendum Added | Contract Administration | 01/17/2013 |
| 02/20/2013 | Public Health Trust of Miami-Dade | Civil Money Penalty ($175,000) | Contract Administration | 04/24/2013 |
- Page last Modified: 03/13/2013 5:11 PM
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