The CMS (Centers for Medicare and Medicaid Services) has levied a $3.1 million penalty against the Humana, the single greatest enforced against 129 agencies found in violation of Medicare Advantage and prescription drug plans in the 2015 audit.
Humana’s civil penalty was deployed on an audit of its Medicare operations from the day of April 20, 2015 through the day of May 7, 2015, CMS claimed. The systemic failure of Humana in complying with needs regarded to Parts C and Part D resulted in enrollees experiencing unsuitable delays or refusals in gaining covered benefits or increased out-of-pocket costs, CMS claimed.
Other agencies with fines at a million or above involve: Envision Pharmaceutical Services, $2.59 million; Medical Card System, $1.29 million; Aetna, $ 1 million; and UnitedHealth Group, $2.1 million.
The March 3 release of the civil penalties, along with a list of agencies gaining suspension of enrollment and marketing tasks, furthers CMS’s objective of making better the industry standards and offering continued transparency, in accordance to Jerry Mulcahy, director Medicare Parts C and D Oversight and Enforcement Group, who sent out the notice to entire Medicare Advantage agencies.
The civil money penalties were enforced for violations regarded to failure to comply with Part D formulary benefit administration; Part C and Part D organization/coverage determinations, requests, and grievances; and invalid information submissions.
Actions for suspension of marketing and enrollment were levied against: Arcadian Management Services, Universal American Corp, Health Net, MAPFRE PRAICO, Silverscript Insurance Company, Orange County Health Authority, Smart Insurance Company, Capital Blue Cross, SummaCare, Torchmark Corporation, Chinese Community Health Plan, Cigna-HealthSpring, and Ultimate Health Plans.
Those cited with instant suspension of enrollment involved: Universal Health Care Insurance Company, Florida Healthcare Plus, Universal Health Care Insurance Company, HealthPlus of Michigan, and Alexian Brothers Community Services.
CMS stated that it policies to post civil money penalty enforcement actions to its website within the 1st quarter of the following program audit year. For the 2016 program audit violations, violation notices will be posted in the 1st quarter of the year 2017 to permit the public and plan sponsors to more conveniently compare the audit violations, CMS claimed.
Your email address will not be published. Required fields are marked *
Aetna Announces The Completion of $1 Billion Bond Public Offering
Aetna Declares A Brighter Experience For Entire Members of Aetna Dental Team
Urgent care chain utilizes patient feedback to empower performance
Patrick Conway is quitting CMS to supervise BCBS North Carolina
Copyright© 2015 Healthcare insurance News All Right Reserved