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 recent CMP, Intermediate Sanction, and Termination notices issued by CMS.
Showing 1-10 of 70 entries
| Date Action Taken | Organization Name | Action Taken | Basis for Action | Effective Date |
|---|---|---|---|---|
| 2019-09-11 | Care Improvement Plus South Central Insurance Company | Suspension of Enrollment | Contract Administration | 2019-09-11 |
| 2019-08-29 | USAble Mutual Insurance Company | Sanction Release | Deficiencies Corrected | 2019-08-29 |
| 2019-08-22 | Senior LIFE York, Inc. | Suspension of Enrollment | Contract Administration | 2019-08-22 |
| 2019-08-05 | WellCare Health Plans, Inc. | Civil Money Penalty ($373,800) | Contract Administration | 2019-08-05 |
| 2019-06-27 | Constellation Health, LLC | Termination | Contract Administration | 2019-06-27 |
| 2019-04-29 | Community PACE at Home, Inc. | Civil Money Penalty ($38,159) | Contract Administration | 2019-04-29 |
| 2019-04-29 | Franciscan ACO, Inc. | Civil Money Penalty ($38,159) | Contract Administration | 2019-04-29 |
| 2019-03-12 | Agewell New York, LLC | Civil Money Penalty ($39,200) | Contract Administration | 2019-03-12 |
| 2019-03-06 | Senior LIFE Lehigh Valley, Inc. | Civil Money Penalty ($38,159) | Contract Administration | 2019-03-06 |
| 2019-02-27 | Local Initiative Health Authority of LA County | Civil Money Penalty ($43,600) | Contract Administration | 2019-02-27 |
Page Last Modified:
06/21/2019 11:13 AM