CMS Levies Fines Against Two Calif.-Based MA Plans in Q1 2015
According to Modern Healthcare, the fines marked "a record pace" for the agency. CMS only levied a single, $50,000 fine against an MA plan in Q1 2014.
Levying civil fines is the lowest-level and most-common enforcement action taking by CMS. Experts say the uptick in fines show CMS intends to pay more attention to MA plans.
The California-based MA plans that received fines were:
- Orange-based Citizens Choice Health Plan, which received the largest fine of $689,600 for inappropriately denying beneficiaries prescription drugs, not immediately notifying beneficiaries of coverage decisions and not offering beneficiaries the options of filing grievances or appeals (Herman, Modern Healthcare, 4/13); and
- Rancho Cucamonga-based Inland Empire Health Plan, which was fined $256,950 for failing to provide its members with Medicare benefits that adhere to CMS requirements (CMS notice, 1/29).
CMS Lifts Some MA Sanctions
The data also show CMS in Q1 2015 lifted sanctions against three MA plans that had been noncompliant, including Orange County Health Authority.
Sanctions can include prohibiting plans from enrolling members or marketing and can result in an MA plan's star rating temporarily being reduced to 2.5 stars. MA plans that have fewer than four stars are not eligible for Medicare bonus payments (Modern Healthcare, 4/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.