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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.

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Date Action Taken Organization Name Action Taken Basis for Action Effective Date
2016-01-21 Cigna-HealthSpring Immediate Suspension of Enrollment and Marketing Contract Administration 2016-01-21
2017-02-23 WellCare Health Plans, Inc. Civil Money Penalty ($1,174,300) Contract Administration 2017-02-23
2016-11-22 UnitedHealthcare Medicare & Retirement Civil Money Penalty ($2,498,850) Contract Administration 2016-11-22
2017-02-24 SCAN Health Plan Civil Money Penalty ($127,950) Contract Administration 2017-02-24
2017-01-12 Presbyterian Health Plan Civil Money Penalty ($775,375) Contract Administration 2017-01-12
2017-02-24 Peoples Health, Inc. Civil Money Penalty ($83,250) Contract Administration 2017-02-24
2017-02-23 MVP Health Plan, Inc. Civil Money Penalty ($85,200) Contract Administration 2017-02-23
2017-02-23 Independent Care Health Plan, Inc. Civil Money Penalty ($321,900) Contract Administration 2017-02-23
2016-11-21 Health Partners Plans, Inc. Civil Money Penalty ($32,600) Contract Administration 2016-11-21
2016-11-21 Health Plan of San Mateo Civil Money Penalty ($49,725) Contract Administration 2016-11-21
2016-10-11 Healthfirst, Inc. Civil Money Penalty ($38,125) Contract Administration 2016-10-11
2016-10-11 Health Care Service Corporation Civil Money Penalty ($115,625) Contract Administration 2016-10-11
2017-02-23 FirstHealth of the Carolinas, Inc. Civil Money Penalty ($28,975) Contract Administration 2017-02-23
2017-01-12 Centene Corporation Civil Money Penalty ($31,950) Contract Administration 2017-01-12
2017-02-24 Community Care HMO, Inc. Civil Money Penalty ($760,500) Contract Administration 2017-02-24
2016-11-21 Caidan Enterprises, Inc. Civil Money Penalty ($57,715) Contract Administration 2016-11-21
2017-01-12 AvMed, Inc. Civil Money Penalty ($764,375) Contract Administration 2017-01-12
2017-06-16 Cigna-HealthSpring Sanction Release Deficiencies Corrected 2017-06-16
2017-06-21 Elderplan, Inc. Civil Money Penalty ($132,000) Required Beneficiary Notices 2017-06-21
2017-06-21 CHRISTUS Health Plan Civil Money Penalty ($7,080) Required Beneficiary Notices 2017-06-21
2017-06-29 Fallon Community Health Plan Civil Money Penalty ($344,100) Contract Administration 2017-06-29
2017-07-14 Merit Health Insurance Company Civil Money Penalty ($59,600) Contract Administration 2017-07-14
2017-09-18 Premier Health Insuring Corporation Civil Money Penalty ($3,600) Contract Administration 2017-09-18
2017-09-26 USAble Mutual Insurance Company Suspension of Enrollment Contract Administration 2017-09-26
2017-10-03 Via Christi Healthcare Outreach for Elders, Inc. Suspension of Enrollment Contract Administration 2017-10-03
2017-11-14 Senior LIFE York, Inc. Civil Money Penalty ($37,396) Contract Administration 2017-11-14
2017-12-20 Riverside Health System Suspension of Enrollment Contract Administration 2017-12-20
2017-11-27 Affinity Health Plan, Inc. Civil Money Penalty ($35,300) Contract Administration 2017-11-27
2017-12-21 Baylor Scott & White Holdings Civil Money Penalty ($39,300) Contract Administration 2017-12-21
2017-12-11 BlueCross BlueShield of Alabama Civil Money Penalty ($27,000) Contract Administration 2017-12-11
2017-11-14 BlueCross BlueShield of Tennessee Civil Money Penalty ($74,400) Contract Administration 2017-11-14
2017-09-13 Express Scripts Holding Company Civil Money Penalty ($213,000) Contract Administration 2017-09-13
2018-02-06 Guidewell Mutual Holding Corporation (H1026, H2758, H5434, R3332, S5904) Civil Money Penalty ($30,900) Contract Administration 2018-02-06
2017-12-11 Indiana University Health Plans, Inc. Civil Money Penalty ($41,300) Contract Administration 2017-12-11
2017-11-27 Kaiser Foundation Health Plan, Inc. Civil Money Penalty ($45,900) Contract Administration 2017-11-27
2017-10-31 Excellus Health Plan, Inc. Civil Money Penalty ($105,400) Contract Administration 2017-10-31
2018-02-06 Merit Health Insurance Company Civil Money Penalty ($1,368,200) Contract Administration 2018-02-06
2017-12-11 Medical Mutual of Ohio Civil Money Penalty ($222,300) Contract Administration 2017-12-11
2018-02-06 SSM Healthcare Corporation Civil Money Penalty ($36,400) Contract Administration 2018-02-06
2017-11-14 USAble Mutual Insurance Company Civil Money Penalty ($67,500) Contract Administration 2017-11-14
2017-12-21 Vantage Holdings, Inc. Civil Money Penalty ($98,500) Contract Administration 2017-12-21
2018-02-21 Florida Health Care Plan, Inc. Civil Money Penalty ($23,800) Contract Administration 2018-02-21
2018-02-21 Cambia Health Solutions, Inc. Civil Money Penalty ($65,800) Contract Administration 2018-02-21
2018-02-21 Henry Ford Health System Civil Money Penalty ($43,300) Contract Administration 2018-02-21
2018-02-21 UCare Minnesota Civil Money Penalty ($61,500) Contract Administration 2018-02-21
2018-03-14 Merit Health Insurance Company Civil Money Penalty ($62,100) Contract Administration 2018-03-14
2018-05-09 Anthem, Inc. Civil Money Penalty ($243,200) Contract Administration 2018-05-09
2018-05-09 MVP Health Plan, Inc. Civil Money Penalty ($44,400) Contract Administration 2018-05-09
2018-06-18 Riverside Health System Sanction Release Deficiencies Corrected 2018-06-18
2018-07-26 Baylor Scott & White Holdings Civil Money Penalty ($40,000) Contract Administration 2018-07-26
2018-09-18 Via Christi Healthcare Outreach for Elders, Inc. Sanction Release Deficiencies Corrected 2018-09-18
2018-09-20 USAble Mutual Insurance Company Suspension of Enrollment Contract Administration 2018-09-20
2018-10-12 Omaha Health Insurance Company Immediate Suspension of Enrollment and Marketing Contract Administration 2018-10-12
2018-10-17 Omaha Health Insurance Company Sanction Release Deficiences Corrected 2018-10-17
2018-11-08 QHP Financial Group, Inc. Suspension of Enrollment and Marketing Contract Administration 2018-11-08
2019-01-08 CenterLight TeamCare Civil Money Penalty ($38,159) Contract Administration 2019-01-08
2019-02-27 Commonwealth Care Alliance, Inc. Civil Money Penalty ($42,900) Contract Administration 2019-02-27
2019-02-27 Neighborhood Health Plan of Rhode Island Civil Money Penalty ($29,800) Contract Administration 2019-02-27
2019-02-27 Local Initiative Health Authority of LA County Civil Money Penalty ($43,600) Contract Administration 2019-02-27
2019-02-27 Santa Clara County Health Authority Civil Money Penalty ($39,000) Contract Administration 2019-02-27
2019-02-27 Arkansas Superior Select, Inc. Civil Money Penalty ($49,600) Contract Administration 2019-02-27
2019-03-06 Senior LIFE Lehigh Valley, Inc. Civil Money Penalty ($38,159) Contract Administration 2019-03-06
2019-03-12 Agewell New York, LLC Civil Money Penalty ($39,200) Contract Administration 2019-03-12
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
2019-06-27 Constellation Health, LLC Termination Contract Administration 2019-06-27
2019-08-05 WellCare Health Plans, Inc. Civil Money Penalty ($373,800) Contract Administration 2019-08-05
2019-08-22 Senior LIFE York, Inc. Suspension of Enrollment Contract Administration 2019-08-22
2019-08-29 USAble Mutual Insurance Company Sanction Release Deficiencies Corrected 2019-08-29
2019-09-11 Care Improvement Plus South Central Insurance Company Suspension of Enrollment Contract Administration 2019-09-11