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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
2012-10-09 Triple-S Salud, Inc. Civil Money Penalty ($350,000) Contract Administration 2012-10-09
2012-10-09 Universal American Corp. Civil Money Penalty ($325,000) Contract Administration 2012-10-09
2012-10-09 MAPFRE PRAICO Coproration Immediate Suspension of Enrollment and Marketing (Mutual Termination) Contract Administration 2012-10-09
2012-10-09 Care 1st Health Plan Civil Money Penalty ($50,000) Contract Administration 2012-10-09
11/19/2012 Universal Health Care Insurance Company, Inc. Immediate Suspension of Enrollment Contract Administration 11/19/2012
2012-12-14 The New York State Catholic Health Plan, Inc. Civil Money Penalty ($75,000) Contract Administration 2012-12-14
2012-12-14 Sterling Life Insurance Company Civil Money Penalty ($75,000) Contract Administration 2012-12-14
2012-12-14 Aveta Inc. Civil Money Penalty ($75,000) Contract Administration 2012-12-14
2012-12-14 Physician's United Plan, Inc. Civil Money Penalty ($50,000) Contract Administration 2012-12-14
2012-12-14 HealthSun Health Plans, Inc. Civil Money Penalty ($50,000) Contract Administration 2012-12-14
2012-12-14 Health Alliance Plan Civil Money Penalty ($75,000) Contract Administration 2012-12-14
2013-01-15 Silverscript Insurance Company Immediate Suspension of Enrollment and Marketing Contract Administration 01/15/2013
2013-01-17 Universal Health Care Insurance Company, Inc. Immediate Suspension of Enrollment – State Specific - Addendum Added (Mutual Termination) Contract Administration 01/17/2013
2013-02-20 Public Health Trust of Miami-Dade Civil Money Penalty ($175,000) Contract Administration 2013-02-20
2013-04-03 Centene Corporation Civil Money Penalty ($100,000) Contract Administration 2013-04-03
2013-04-03 Torchmark Corporation Civil Money Penalty ($150,000) Contract Administration 2013-04-03
2013-04-23 Smart Insurance Company Immediate Suspension of Enrollment and Marketing Contract Administration 2013-04-23
2013-08-01 Alexian Brothers Community Services Civil Money Penalty ($25,000) Contract Administration 2013-08-01
2013-08-01 Silver Star Health Network Civil Money Penalty ($25,000) Contract Administration 2013-08-01
2013-10-24 Medical Card System, Inc. Civil Money Penalty ($23,410) Required Beneficiary Notices 2013-10-24
2013-10-24 InnovaCare, Inc. Civil Money Penalty ($49,710) Required Beneficiary Notices 2013-10-24
2013-10-24 Independence Blue Cross Civil Money Penalty ($47,945) Required Beneficiary Notices 2013-10-24
2013-10-24 Health Net, Inc. Civil Money Penalty ($86,530) Required Beneficiary Notices 2013-10-24
2013-10-24 Centene Corporation Civil Money Penalty ($25,710) Required Beneficiary Notices 2013-10-24
2013-11-21 Health Alliance Plan Civil Money Penalty ($423,200) Contract Administration 2013-11-21
2013-12-20 Silver Script Insurance Company Sanction Release Deficiencies Corrected 2014-01-01
2014-01-24 Orange County Health Authority Immediate Suspension of Enrollment and Marketing Contract Administration 2014-01-24
2014-02-26 SilverScript Insurance Company Release from LIS Exclusion Deficiences Corrected 2014-02-21
2014-03-31 Independence Blue Cross Civil Money Penalty ($50,000) Contract Administration 2014-03-31
2014-04-07 Florida Healthcare Plus, Inc. Civil Money Penalty ($40,890) Contract Administration 2014-04-07
2014-04-07 Commonwealth Care Alliance, Inc. Civil Money Penalty ($49,510) Contract Administration 2014-04-07
2014-04-24 Aetna, Inc. Civil Money Penalty ($407,800) Contract Administration 2014-04-24
2014-04-24 Aetna, Inc. Civil Money Penalty ($101,500) Contract Administration 2014-04-24
2014-04-23 UCare Minnesota Civil Money Penalty ($30,000) Contract Administration 2014-04-23
2014-04-23 Independent Health Association, Inc. Civil Money Penalty ($154,600) Contract Administration 2014-04-23
2014-04-23 Lifetime Healthcare, Inc. Civil Money Penalty ($447,450) Contract Administration 2014-04-23
2014-04-23 Simply Healthcare Plans, Inc. Civil Money Penalty ($252,750) Contract Administration 2014-04-23
2014-04-24 Anthem Insurance Company & BCBSMA & BCBSRI & BCBSVT Civil Money Penalty ($100,950) Contract Administration 2014-04-24
2014-04-24 Blue Cross and Blue Shield of Arizona, Inc. Civil Money Penalty ($60,000) Contract Administration 2014-04-24
2014-05-28 Capital Blue Cross Immediate Suspension of Enrollment and Marketing Contract Administration 2014-05-28
2014-06-11 Blue Cross and Blue Shield of Florida Civil Money Penalty ($176,000) Contract Administration 2014-06-11
2014-06-11 HealthPartners, Inc. Civil Money Penalty ($21,800) Contract Administration 2014-06-11
2014-06-11 Tufts Associated HMO, Inc. Civil Money Penalty ($137,700) Contract Administration 2014-06-11
2014-06-12 Express Scripts Medicare Civil Money Penalty ($334,300) Contract Administration 2014-06-12
2014-06-12 WellCare Health Plans, Inc. Civil Money Penalty ($290,050) Contract Administration 2014-06-12
2014-06-12 USAble Mutual Insurance Company Civil Money Penalty ($51,150) Contract Administration 2014-06-12
2014-07-16 Blue Cross and Blue Shield of North Carolina Civil Money Penalty ($290,250) Contract Administration 2014-07-16
2014-07-16 Cambia Health Solutions, Inc. Civil Money Penalty ($254,000) Contract Administration 2014-07-16
2014-07-16 Cuatro LLC Civil Money Penalty ($80,600) Contract Administration 2014-07-16
2014-07-17 Florida Healthcare Plus, Inc. Civil Money Penalty ($113,200) Contract Administration 2014-07-17
2014-07-17 Geisinger Health System Civil Money Penalty ($180,400) Contract Administration 2014-07-17
2014-07-17 Moda Health Plan, Inc. Civil Money Penalty ($312,300) Contract Administration 2014-07-17
2014-07-17 Network Health Insurance Corporation Civil Money Penalty ($81,700) Contract Administration 2014-07-17
2014-08-11 SummaCare, Inc. Immediate Suspension of Enrollment and Marketing Contract Administration 2014-08-11
2014-09-11 SilverScript Insurance Co. Civil Money Penalty ($20,700) Contract Administration 2014-09-11
2014-09-11 Local Initiative Health Authority for L.A. County Civil Money Penalty ($234,850) Contract Administration 2014-09-11
2014-09-11 Stonebridge Life Insurance Company Civil Money Penalty ($370,400) Contract Administration 2014-09-11
2014-09-19 Torchmark Corporation Civil Money Penalty ($40,000) Contract Administration 2014-09-19
2014-09-30 Florida Healthcare Plus, Inc. Immediate Suspension of Enrollment Contract Administration 2014-09-30
2014-10-29 Chinese Community Health Plan Immediate Suspension of Enrollment and Marketing Contract Administration 2014-10-29
2014-11-06 Phoenix Health Plans, Inc. Civil Money Penalty ($146,600) Contract Administration 2014-11-06
2014-11-06 Aultman Health Foundation Civil Money Penalty ($93,700) Contract Administration 2014-11-06
2015-01-07 Providence Health Plan Civil Money Penalty ($164,600) Contract Administration 2015-01-07
2015-01-29 Inland Empire Health Plan Civil Money Penalty ($256,950) Contract Administration 2015-01-29
2015-01-29 Health Plan of the Ohio Upper Valley Civil Money Penalty ($194,950) Contract Administration 2015-01-29
2015-01-29 Soundpath Health, Inc. Civil Money Penalty ($250,100) Contract Administration 2015-01-29
2015-01-29 Senior Whole Health Holdings, Inc. Civil Money Penalty ($229,350) Contract Administration 2015-01-29
2015-01-29 New West Health Services Civil Money Penalty ($349,800) Contract Administration 2015-01-29
2015-02-05 Orange County Health Authority Sanction Release Deficiencies Corrected 2015-02-05
2015-02-25 Capital Blue Cross Sanction Release Deficiencies Corrected 2015-02-25
2015-02-25 Southwest Catholic Health Network Civil Money Penalty ($202,200) Contract Administration 2015-02-25
2015-02-25 Citizens Choice Health Plan Civil Money Penalty ($689,600) Contract Administration 2015-02-25
2015-02-25 AlohaCare Civil Money Penalty ($32,700) Contract Administration 2015-02-25
2015-02-25 PacificSource Community Health Plans, Inc. Civil Money Penalty ($90,000) Contract Administration 2015-02-25
2015-03-12 HealthPlus of Michigan Immediate Suspension of Enrollment Contract Administration 2015-03-12
2015-03-25 SummaCare, Inc. Sanction Release Deficiencies Corrected 2015-03-25
2015-04-16 Aetna Inc. Civil Money Penalty ($1,000,000) Contract Administration 2015-04-16
2015-04-08 Health First Health Plans, Inc. Civil Money Penalty ($420,600) Contract Administration 2015-04-08
2015-04-23 Express Scripts, Inc. Sanction Release Deficiencies Corrected 2015-04-23
2015-05-27 HealthPlus of Michigan Sanction Release Deficiencies Corrected 2015-05-27
2015-07-09 New West Health Services Civil Money Penalty ($204,200) Contract Administration 2015-07-09
2015-08-03 Health Net of Arizona Civil Money Penalty ($227,450) Required Beneficiary Notices 2015-08-03
2015-07-13 Fallon Community Health Plan Civil Money Penalty ($52,045) Required Beneficiary Notices 2015-07-13
2015-07-13 Atrio Health Plans Civil Money Penalty ($69,405) Required Beneficiary Notices 2015-07-13
2015-07-14 Indiana University Health Plan, Inc. Civil Money Penalty ($101,675) Required Beneficiary Notices 2015-07-14
2015-07-14 The Carle Foundation Civil Money Penalty ($34,445) Required Beneficiary Notices 2015-07-14
2015-07-14 UnitedHealthcare of New York Civil Money Penalty ($149,150) Required Beneficiary Notices 2015-07-14
2015-07-17 Torchmark Corporation Non-Immediate Suspension of Enrollment and Marketing Contract Administration 2015-08-01
2015-09-10 Chinese Community Health Plan Sanction Release Deficiencies Corrected 2015-09-10
2015-11-17 Alexian Brothers Community Services Suspension of Enrollment Contract Administration 2015-11-18
2016-01-21 Cigna-HealthSpring Immediate Suspension of Enrollment and Marketing Contract Administration 2016-01-21
2016-02-26 Ultimate Health Plans, Inc. Immediate Suspension of Enrollment and Marketing Contract Administration 2016-02-26
2016-02-24 AHMC Central Health LLC Civil Money Penalty ($153,850) Contract Administration 2016-02-24
2015-11-23 Care N' Care Insurance Company, Inc. Civil Money Penalty ($327,100) Contract Administration 2015-11-23
2015-11-19 Envision Pharmaceutical Services Civil Money Penalty ($2,596,700) Contract Administration 2015-11-19
2016-02-29 Health Net, Inc. Civil Money Penalty ($458,250) Contract Administration 2016-02-29
2015-12-29 Humana, Inc. Civil Money Penalty ($3,100,900) Contract Administration 2015-12-29
2015-12-29 Independence Health Group, Inc. Civil Money Penalty ($206,400) Contract Administration 2015-12-29
2015-11-23 SelectHealth, Inc. Civil Money Penalty ($174,800) Contract Administration 2015-11-23
2015-11-20 SilverScript Insurance Company Civil Money Penalty ($594,100) Contract Administration 2015-11-20
2016-02-29 Tenet Healthcare Corporation Civil Money Penalty ($127,200) Contract Administration 2016-02-29
2016-02-24 Trinity Health Civil Money Penalty ($30,000) Contract Administration 2016-02-24
2016-02-24 Universal Care, Inc. Civil Money Penalty ($62,950) Contract Administration 2016-02-24
2016-04-07 Torchmark Corporation Sanction Release Deficiencies Corrected 2016-04-07
2016-05-26 Clover Health Civil Money Penalty ($106,095) Contract Administration 2016-05-26
2016-06-02 Medical Card System, Inc. Civil Money Penalty ($652,650) Contract Administration 2016-06-02
2016-09-08 Express Scripts Medicare Civil Money Penalty ($5,325) Required Beneficiary Notices 2016-09-08
2016-08-09 Blue Cross of Idaho Care Plus, Inc. Civil Money Penalty ($102,820) Required Beneficiary Notices 2016-08-09
2016-08-09 AgeWell New York, LLC Civil Money Penalty ($3,325) Required Beneficiary Notices 2016-08-09
2016-09-13 Ultimate Health Plans, Inc. Sanction Release Deficiencies Corrected 2016-09-13
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
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