Part C and Part D Enforcement Actions

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.

Date Action Taken Organization Name Action Taken Basis for Action Effective Date
2024-05-17
PACE Partners of Northeast Florida, Inc.
Suspension of Enrollment
Contract Administration
2024-05-18
2024-03-21
Village Senior Services Corporation
Civil Money Penalty ($10,208)
Contract Administration
2024-03-21
2024-03-21
Astiva Health, Inc.
Civil Money Penalty ($6,380)
Contract Administration
2024-03-21
2024-03-21
California Physicians' Service
Civil Money Penalty ($30,160)
Contract Administration
2024-03-21
2024-03-21
Blue Cross Blue Shield of Michigan Mutual Insurance Company
Civil Money Penalty ($7,424)
Contract Administration
2024-03-21
2024-03-21
Capital District Physicians' Health Plan, Inc.
Civil Money Penalty ($17,864)
Contract Administration
2024-03-21
2024-03-21
USAble Mutual Insurance Company
Civil Money Penalty ($5,336)
Contract Administration
2024-03-21
2024-03-21
CareSource Ohio, Inc.
Civil Money Penalty ($27,898)
Contract Administration
2024-03-21
2023-12-27
WellCare Health Insurance of North Carolina, Inc.
Termination
Contract Administration
2023-12-27
2023-12-27
WellCare Health Insurance of Arizona, Inc.
Termination
Contract Administration
2023-12-27
2023-12-27
Zing Health, Inc.
Termination
Contract Administration
2023-12-27
2023-12-06
UCare Minnesota
Civil Money Penalty ($13,224)
Contract Administration
2023-12-06
2023-11-02
Medica Holding Company
Civil Money Penalty ($62,060)
Contract Administration
2023-11-02
2023-11-02
Centene Corporation
Civil Money Penalty ($49,764)
Contract Administration
2023-11-02
2023-11-02
Blue Cross & Blue Shield of Rhode Island
Civil Money Penalty ($24,940)
Contract Administration
2023-11-02
2023-11-02
AvMed, Inc.
Civil Money Penalty ($5,336)
Contract Administration
2023-11-02
2023-10-13
Clear Spring Health Insurance Company
Termination
Contract Administration
2023-10-13
2023-09-19
UnitedHealthCare Plan of the River Valley, Inc.
Sanction Release
Deficiencies Corrected
2024-01-01
2023-09-19
Care Improvement Plus South Central Co.
Suspension of Enrollment
Contract Administration
2023-09-19
2023-08-07
EmblemHealth, Inc.
Civil Money Penalty ($19,024)
Contract Administration
2023-08-07
2023-08-07
Moda Health Plan, Inc.
Civil Money Penalty ($5,800)
Contract Administration
2023-08-07
2023-08-07
Aultman Health Foundation
Civil Money Penalty ($162,632)
Contract Administration
2023-08-07
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
2022-09-20
UnitedHealthcare Plan of the River Valley, Inc.
Suspension of Enrollment
Contract Administration
2022-09-20
2022-09-20
UnitedHealthcare of the Midwest, Inc.
Sanction Release
Deficiencies Corrected
2023-01-01
2022-09-20
UnitedHealthcare of Arkansas, Inc.
Sanction Release
Deficiencies Corrected
2023-01-01
2022-09-20
Triple S Advantage, Inc.
Sanction Release
Deficiencies Corrected
2023-01-01
2022-09-20
UnitedHealthcare of New Mexico, Inc.
Sanction Release
Deficiencies Corrected
2023-01-01
2022-09-20
MMM Healthcare, LLC
Sanction Release
Deficiencies Corrected
2023-01-01
2022-04-05
Anthem Inc.
Civil Money Penalty ($19,186)
Contract Administration
2022-04-05
2022-03-22
Centene Corporation
Civil Money Penalty ($88,192)
Contract Administration
2022-03-22
2022-03-22
Molina Healthcare, Inc.
Civil Money Penalty ($43,884)
Contract Administration
2022-03-22
2022-03-22
CIGNA
Civil Money Penalty ($85,436)
Contract Administration
2022-03-22
2022-03-22
EmblemHealth, Inc.
Civil Money Penalty ($106,325)
Contract Administration
2022-03-22
2022-03-22
BlueCross BlueShield of Tennessee
Civil Money Penalty ($142,676)
Contract Administration
2022-03-22
2022-03-22
Guidewell Mutual Holding Corporation
Civil Money Penalty ($52,258)
Contract Administration
2022-03-22
2022-02-25
Vibra Health Plan, Inc.
Civil Money Penalty ($9,328)
Contract Administration
2022-02-25
2022-02-25
Network Health Insurance Corporation
Civil Money Penalty ($11,236)
Contract Administration
2022-02-25
2022-02-25
Global Health Inc.
Civil Money Penalty ($26,182)
Contract Administration
2022-02-25
2022-02-25
Independence Health Group, Inc.
Civil Money Penalty ($26,500)
Contract Administration
2022-02-25
2022-02-25
CareSource Ohio Inc.
Civil Money Penalty ($66,250)
Contract Administration
2022-02-25
2022-02-25
CIGNA
Civil Money Penalty ($126,988)
Contract Administration
2022-02-25
2022-02-25
Paramount Care Inc.
Civil Money Penalty ($146,068)
Contract Administration
2022-02-25
2022-02-24
California Physicians' Service
Civil Money Penalty ($40,282)
Contract Administration
2022-02-24
2022-01-20
Vitality Health Plan of California, Inc.
Sanction Release
Deficiencies Corrected
2022-01-04
2021-12-22
InnovAge Colorado PACE
Suspension of Enrollment
Contract Administration
2021-12-22
2021-12-06
Clear Spring Health Insurance Company
Civil Money Penalty ($53,162)
Contract Administration
2021-12-06
2021-12-03
Eternal Health of Delaware, Inc.
Sanction Release
Deficiencies Corrected
2021-12-02
2021-10-26
Eternal Health of Delaware, Inc.
Suspension of Enrollment
Contract Administration
2021-10-27
2021-10-07
Imperial Insurance Companies, Inc.
Sanction Release
Deficiencies Corrected
2021-10-05
2021-09-17
InnovAge California PACE – Sacramento, LLC
Suspension of Enrollment
Contract Administration
2021-09-17
2021-09-02
UnitedHealthcare of the Midwest, Inc.
Suspension of Enrollment
Contract Administration
2021-09-02
2021-09-02
UnitedHealthcare of New Mexico, Inc.
Suspension of Enrollment
Contract Administration
2021-09-02
2021-09-02
UnitedHealthcare of Arkansas, Inc.
Suspension of Enrollment
Contract Administration
2021-09-02
2021-09-02
Triple-S Advantage, Inc.
Suspension of Enrollment
Contract Administration
2021-09-02
2021-09-02
MMM Healthcare, LLC
Suspension of Enrollment
Contract Administration
2021-09-02
2021-09-02
Blue Cross of Idaho Care Plus, Inc.
Sanction Release
Deficiencies Corrected
2021-09-02
2021-06-17
Imperial Insurance Companies, Inc.
Immediate Suspension of Enrollment
Contract Administration
2021-06-17
2021-04-29
Golden State Medicare Health Plan
Immediate Suspension of Enrollment
Contract Administration
2021-04-29
2020-12-08
Senior LIFE York, Inc.
Sanction Release
Deficiencies Corrected
2020-12-08
2020-11-17
CarePlus Health Plans, Inc.
Civil Money Penalty ($100,806)
Contract Administration
2020-11-17
2020-11-17
Anthem, Inc.
Civil Money Penalty ($318,975)
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
2020-10-21
LIFE PACE
Civil Money Penalty ($39,811)
Contract Administration
2020-10-21
2020-09-09
Blue Cross of Idaho Care Plus, Inc.
Suspension of Enrollment
Contract Administration
2020-09-09
2020-07-02
Vitality Health Plan of California, Inc.
Suspension of Enrollment
Contract Administration
2020-07-02
2019-08-22
Senior LIFE York, Inc.
Suspension of Enrollment
Contract Administration
2019-08-22
Page Last Modified:
01/26/2024 03:51 PM