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 65 entries
Date Action Taken Organization Name Action Taken Basis for Action Effective Date
2020-11-17 CarePlus Health Plans, Inc. Civil Money Penalty ($100,806) Contract Administration 2020-11-17
2020-11-17 Centene Corporation Civil Money Penalty ($16,536) Contract Administration 2017-11-17
2020-11-17 MetroPlus Health Plan, Inc. Civil Money Penalty ($6,784) Contract Administration 2020-11-17
2020-11-17 Anthem, Inc. Civil Money Penalty ($318,975) Contract Administration 2020-11-17
2020-10-20 LIFE PACE Civil Money Penalty ($39,811) Contract Administration 2020-10-21
2020-09-22 Group 1001 Sanction Release Deficiencies Corrected 2020-09-22
2020-09-09 Blue Cross of Idaho Care Plus, Inc. Suspension of Enrollment Contract Administration 2020-09-09
2020-08-31 Care Improvement Plus South Central Insurance Co Sanction Release Deficiencies Corrected 2020-09-01
2020-07-21 Care N' Care Insurance Company of North Carolina Civil Money Penalty ($71,868) Contract Administration 2020-7-21
2020-07-02 Vitality Health Plan of California, Inc. Suspension of Enrollment Contract Administration 2020-07-02

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02/28/2020 04:32 PM
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