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 71 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 Franciscan ACO, Inc. Civil Money Penalty ($38,159) Contract Administration 2019-04-29
2019-04-29 Community PACE at Home, 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 Commonwealth Care Alliance, Inc. Civil Money Penalty ($42,900) Contract Administration 2019-02-27
Page Last Modified:
06/21/2019 11:13 AM