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 67 entries
| Date Action Taken | Organization Name | Action Taken | Basis for Action | Effective Date |
|---|---|---|---|---|
| 2023-05-23 | EmblemHealth, Inc. | Civil Money Penalty ($116,288) | Contract Administration | 2023-05-23 |
| 2023-03-16 | Imperial Health Plan of California | Civil Money Penalty ($39,208) | Contract Administration | 2023-03-16 |
| 2023-03-16 | Independence Health Group, Inc. | Civil Money Penalty ($6,032) | Contract Administration | 2023-03-16 |
| 2023-03-16 | Intermountain Health Care, Inc. | Civil Money Penalty ($17,980) | Contract Administration | 2023-03-16 |
| 2023-02-22 | Imperial Health Plan of California | Termination | Contract Administration | 2023-12-31 |
| 2023-01-23 | InnovAge Colorado PACE | Sanction Release | Deficiencies Corrected | 2023-01-23 |
| 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 |