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Part C and Part D Enforcement Actions

CMS has the authority to take enforcement or contract actions when CMS determines that a Medicare Plan Sponsor 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 and contract actions include:

  • Civil money penalties (CMP)
  • Intermediate sanctions (i.e., suspension of marketing, enrollment, payment), and
  • Terminations.

Below is a list of all CMS Enforcement and Contract Actions since 2006.

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Date Action Taken Organization Name 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 (Mutual Termination) 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 (Mutual Termination) Contract Administration 01/17/2013
02/20/2013 Public Health Trust of Miami-Dade Civil Money Penalty ($175,000) Contract Administration 04/24/2013
2013-04-03 Centene Corporation Civil Money Penalty ($100,000) Contract Administration 06/04/2013
2013-04-03 Torchmark Corporation Civil Money Penalty ($150,000) Contract Administration 06/04/2013
2013-04-23 Smart Insurance Company Immediate Suspension of Enrollment and Marketing Contract Administration 2013-04-23
2013-08-01 Alexian Brothers Community Services Civil Money Penalty ($25,000) Contract Administration 2013-10-02
2013-08-01 Silver Star Health Network Civil Money Penalty ($25,000) Contract Administration 2013-10-02
2013-10-24 Medical Card System, Inc. Civil Money Penalty ($23,410) Required Beneficiary Notices 2013-12-26
2013-10-24 InnovaCare, Inc. Civil Money Penalty ($49,710) Required Beneficiary Notices 2013-12-26
2013-10-24 Independence Blue Cross Civil Money Penalty ($47,945) Required Beneficiary Notices 2013-12-26
2013-10-24 Health Net, Inc. Civil Money Penalty ($86,530) Required Beneficiary Notices 2013-10-24
2013-10-24 Centene Corporation Civil Money Penalty ($25,710) Required Beneficiary Notices 2013-12-26
2013-11-21 Health Alliance Plan Civil Money Penalty ($423,200) Contract Administration 2013-11-21
2013-12-20 Silver Script Insurance Company Sanction Release Deficiencies Corrected 2014-01-01
2014-01-24 Orange County Health Authority Immediate Suspension of Enrollment and Marketing Contract Administration 2014-01-24
2014-02-26 SilverScript Insurance Company Release from LIS Exclusion Deficiences Corrected 2014-02-21
2014-03-31 Independence Blue Cross Civil Money Penalty ($50,000) Contract Administration 2014-06-03
2014-04-07 Florida Healthcare Plus, Inc. Civil Money Penalty ($40,890) Contract Administration 2014-06-10
2014-04-07 Commonwealth Care Alliance, Inc. Civil Money Penalty ($49,510) Contract Administration 2014-06-10
2014-04-24 Aetna, Inc. Civil Money Penalty ($407,800) Contract Administration 2014-04-24
2014-04-24 Aetna, Inc. Civil Money Penalty ($101,500) Contract Administration 2014-04-24
2014-04-23 UCare Minnesota Civil Money Penalty ($30,000) Contract Administration 2014-04-23
2014-04-23 Independent Health Association, Inc. Civil Money Penalty ($154,600) Contract Administration 2014-04-23
2014-04-23 Lifetime Healthcare, Inc. Civil Money Penalty ($447,450) Contract Administration 2014-04-23
2014-04-23 Simply Healthcare Plans, Inc. Civil Money Penalty ($252,750) Contract Administration 2014-04-23
2014-04-24 Anthem Insurance Company & BCBSMA & BCBSRI & BCBSVT Civil Money Penalty ($100,950) Contract Administration 2014-04-24
2014-04-24 Blue Cross and Blue Shield of Arizona, Inc. Civil Money Penalty ($60,000) Contract Administration 2014-04-24
2014-05-28 Capital Blue Cross Immediate Suspension of Enrollment and Marketing Contract Administration 2014-05-28
2014-06-11 Blue Cross and Blue Shield of Florida Civil Money Penalty ($176,000) Contract Administration 2014-06-11
2014-06-11 HealthPartners, Inc. Civil Money Penalty ($21,800) Contract Administration 2014-06-11
2014-06-11 Tufts Associated HMO, Inc. Civil Money Penalty ($137,700) Contract Administration 2014-06-11
2014-06-12 Express Scripts Medicare Civil Money Penalty ($334,300) Contract Administration 2014-06-12
2014-06-12 WellCare Health Plans, Inc. Civil Money Penalty ($290,050) Contract Administration 2014-06-12
2014-06-12 USAble Mutual Insurance Company Civil Money Penalty ($51,150) Contract Administration 2014-06-12
2014-07-16 Blue Cross and Blue Shield of North Carolina Civil Money Penalty ($290,250) Contract Administration 2014-07-16
2014-07-16 Cambia Health Solutions, Inc. Civil Money Penalty ($254,000) Contract Administration 2014-07-16
2014-07-16 Cuatro LLC Civil Money Penalty ($80,600) Contract Administration 2014-07-16
2014-07-17 Florida Healthcare Plus, Inc. Civil Money Penalty ($113,200) Contract Administration 2014-07-17
2014-07-17 Geisinger Health System Civil Money Penalty ($180,400) Contract Administration 2014-07-17
2014-07-17 Moda Health Plan, Inc. Civil Money Penalty ($312,300) Contract Administration 2014-07-17
2014-07-17 Network Health Insurance Corporation Civil Money Penalty ($81,700) Contract Administration 2014-07-17
2014-08-11 SummaCare, Inc. Immediate Suspension of Enrollment and Marketing Contract Administration 2014-08-11
2014-09-11 SilverScript Insurance Co. Civil Money Penalty ($20,700) Contract Administration 2014-09-11
2014-09-11 Local Initiative Health Authority for L.A. County Civil Money Penalty ($234,850) Contract Administration 2014-09-11
2014-09-11 Aegon N.V. Civil Money Penalty ($370,400) Contract Administration 2014-09-11
2014-09-19 Torchmark Corporation Civil Money Penalty ($40,000) Contract Administration 2014-09-19
2014-09-30 Florida Healthcare Plus, Inc. Immediate Suspension of Enrollment Contract Administration 2014-09-30
2014-10-29 Chinese Community Health Plan Immediate Suspension of Enrollment and Marketing Contract Administration 2014-10-29
2014-11-06 Phoenix Health Plans, Inc. Civil Money Penalty ($146,600) Contract Administration 2014-11-06
2014-11-06 Aultman Health Foundation Civil Money Penalty ($93,700) Contract Administration 2014-11-06