Becker's Healthcare January 21, 2025
CMS issued nearly $2.5 million in fines on Jan. 17 across multiple health plans for Medicare contract violations related to Part C maximum out-of-pocket limits and cost-sharing requirements, and Part D coordination of benefits and low-income subsidy requirements.
All the reported issues occurred in 2021, and audits took place throughout 2023. Civil money penalties have been imposed to address these deficiencies, and the plans were required to refund affected members. Insurers can request a hearing to appeal the fines. Further noncompliance could lead to stricter enforcement actions, including contract termination.
Seven fines:
- Centene was fined $2 million for violating Part C requirements by charging enrollees more than the annual maximum out-of-pocket limits, potentially increasing their financial burden.
- Elevance Health...
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