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 62 entries
| Date Action Taken | Organization Name | Action Taken | Basis for Action | Effective Date |
|---|---|---|---|---|
| 2022-11-30 | Elevance Health | Civil Money Penalty ($38,512) | Contract Administration | 2022-11-30 |
| 2022-11-30 | Humana, Inc. | Civil Money Penalty ($131,660) | Contract Administration | 2022-11-30 |
| 2022-11-30 | Kaiser Foundation Health Plan, Inc. | Civil Money Penalty ($27,260) | Contract Administration | 2022-11-30 |
| 2022-11-21 | InnovAge California PACE – Sacramento, LLC | Sanction Release | Deficiencies Corrected | 2022-11-21 |
| 2022-09-20 | UnitedHealthcare Plan of the River Valley, Inc. | Suspension of Enrollment | Contract Administration | 2022-09-20 |
| 2022-09-20 | UnitedHealthcare of the Midwest, Inc. | Sanction Release | Deficiencies Corrected | 2023-01-01 |
| 2022-09-20 | UnitedHealthcare of Arkansas, Inc. | Sanction Release | Deficiencies Corrected | 2023-01-01 |
| 2022-09-20 | Triple S Advantage, Inc. | Sanction Release | Deficiencies Corrected | 2023-01-01 |
| 2022-09-20 | UnitedHealthcare of New Mexico, Inc. | Sanction Release | Deficiencies Corrected | 2023-01-01 |
| 2022-09-20 | MMM Healthcare, LLC | Sanction Release | Deficiencies Corrected | 2023-01-01 |