Medicare is doing more to police Advantage and Part D lapses, but does it matter?

Modern Healthcare December 4, 2014
Bob Herman

Last month, the CMS quietly fined a small health insurer in Arizona $146,600 for violating several Medicare rules. In somewhat fiery language for a government agency, the CMS called the company’s lapses “systemic.”

The insurer, Phoenix Health Plans, offers a few different Medicare Advantage HMOs for seniors and the disabled. Its membership is nominal, covering about 10,600 people.

But insurance companies of all sizes are increasingly finding themselves in similar situations with the government. This year, nearly three dozen health insurance companies have faced similar fines (called civil money penalties) or, worse, temporary suspension from enrolling or marketing to new Medicare members. Critics of Medicare Advantage view the increased oversight from the CMS as acknowledgment of serious flaws in the...

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