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.

Downloads

Date Action Taken	Organization Name	Action Taken	Basis for Action	Effective Date
Date Action Taken 2024-09-06	Organization Name Wellcare of Missouri Health Insurance Company, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2025-01-01
Date Action Taken 2024-09-06	Organization Name Care Improvement Plus South Central Insurance Co.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2025-01-01
Date Action Taken 2024-08-23	Organization Name PACE4DC, LLC	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2024-08-24
Date Action Taken 2024-06-25	Organization Name Zing Health, Inc.	Action Taken Termination Retraction	Basis for Action Contract Administration	Effective Date 2024-06-25
Date Action Taken 2024-05-17	Organization Name PACE Partners of Northeast Florida, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2024-05-18
Date Action Taken 2024-03-21	Organization Name Village Senior Services Corporation	Action Taken Civil Money Penalty ($10,208)	Basis for Action Contract Administration	Effective Date 2024-03-21
Date Action Taken 2024-03-21	Organization Name Astiva Health, Inc.	Action Taken Civil Money Penalty ($6,380)	Basis for Action Contract Administration	Effective Date 2024-03-21
Date Action Taken 2024-03-21	Organization Name California Physicians' Service	Action Taken Civil Money Penalty ($30,160)	Basis for Action Contract Administration	Effective Date 2024-03-21
Date Action Taken 2024-03-21	Organization Name Blue Cross Blue Shield of Michigan Mutual Insurance Company	Action Taken Civil Money Penalty ($7,424)	Basis for Action Contract Administration	Effective Date 2024-03-21
Date Action Taken 2024-03-21	Organization Name Capital District Physicians' Health Plan, Inc.	Action Taken Civil Money Penalty ($17,864)	Basis for Action Contract Administration	Effective Date 2024-03-21
Date Action Taken 2024-03-21	Organization Name USAble Mutual Insurance Company	Action Taken Civil Money Penalty ($5,336)	Basis for Action Contract Administration	Effective Date 2024-03-21
Date Action Taken 2024-03-21	Organization Name CareSource Ohio, Inc.	Action Taken Civil Money Penalty ($27,898)	Basis for Action Contract Administration	Effective Date 2024-03-21
Date Action Taken 2023-12-27	Organization Name WellCare Health Insurance of North Carolina, Inc.	Action Taken Termination	Basis for Action Contract Administration	Effective Date 2023-12-27
Date Action Taken 2023-12-27	Organization Name WellCare Health Insurance of Arizona, Inc.	Action Taken Termination	Basis for Action Contract Administration	Effective Date 2023-12-27
Date Action Taken 2023-12-06	Organization Name UCare Minnesota	Action Taken Civil Money Penalty ($13,224)	Basis for Action Contract Administration	Effective Date 2023-12-06
Date Action Taken 2023-11-02	Organization Name Medica Holding Company	Action Taken Civil Money Penalty ($62,060)	Basis for Action Contract Administration	Effective Date 2023-11-02
Date Action Taken 2023-11-02	Organization Name Centene Corporation	Action Taken Civil Money Penalty ($49,764)	Basis for Action Contract Administration	Effective Date 2023-11-02
Date Action Taken 2023-11-02	Organization Name Blue Cross & Blue Shield of Rhode Island	Action Taken Civil Money Penalty ($24,940)	Basis for Action Contract Administration	Effective Date 2023-11-02
Date Action Taken 2023-11-02	Organization Name AvMed, Inc.	Action Taken Civil Money Penalty ($5,336)	Basis for Action Contract Administration	Effective Date 2023-11-02
Date Action Taken 2023-10-13	Organization Name Clear Spring Health Insurance Company	Action Taken Termination	Basis for Action Contract Administration	Effective Date 2023-10-13
Date Action Taken 2023-09-19	Organization Name UnitedHealthCare Plan of the River Valley, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2024-01-01
Date Action Taken 2023-09-19	Organization Name Care Improvement Plus South Central Co.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2023-09-19
Date Action Taken 2023-08-07	Organization Name Aultman Health Foundation	Action Taken Civil Money Penalty ($162,632)	Basis for Action Contract Administration	Effective Date 2023-08-07
Date Action Taken 2023-08-07	Organization Name EmblemHealth, Inc.	Action Taken Civil Money Penalty ($19,024)	Basis for Action Contract Administration	Effective Date 2023-08-07
Date Action Taken 2023-08-07	Organization Name Moda Health Plan, Inc.	Action Taken Civil Money Penalty ($5,800)	Basis for Action Contract Administration	Effective Date 2023-08-07
Date Action Taken 2023-05-23	Organization Name EmblemHealth, Inc.	Action Taken Civil Money Penalty ($116,288)	Basis for Action Contract Administration	Effective Date 2023-05-23
Date Action Taken 2023-03-16	Organization Name Imperial Health Plan of California	Action Taken Civil Money Penalty ($39,208)	Basis for Action Contract Administration	Effective Date 2023-03-16
Date Action Taken 2023-03-16	Organization Name Independence Health Group, Inc.	Action Taken Civil Money Penalty ($6,032)	Basis for Action Contract Administration	Effective Date 2023-03-16
Date Action Taken 2023-03-16	Organization Name Intermountain Health Care, Inc.	Action Taken Civil Money Penalty ($17,980)	Basis for Action Contract Administration	Effective Date 2023-03-16
Date Action Taken 2023-02-22	Organization Name Imperial Health Plan of California	Action Taken Termination	Basis for Action Contract Administration	Effective Date 2023-12-31
Date Action Taken 2023-01-23	Organization Name InnovAge Colorado PACE	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2023-01-23
Date Action Taken 2022-11-30	Organization Name Elevance Health	Action Taken Civil Money Penalty ($38,512)	Basis for Action Contract Administration	Effective Date 2022-11-30
Date Action Taken 2022-11-30	Organization Name Humana, Inc.	Action Taken Civil Money Penalty ($131,660)	Basis for Action Contract Administration	Effective Date 2022-11-30
Date Action Taken 2022-11-30	Organization Name Kaiser Foundation Health Plan, Inc.	Action Taken Civil Money Penalty ($27,260)	Basis for Action Contract Administration	Effective Date 2022-11-30
Date Action Taken 2022-11-21	Organization Name InnovAge California PACE – Sacramento, LLC	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2022-11-21
Date Action Taken 2022-09-20	Organization Name UnitedHealthcare Plan of the River Valley, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2022-09-20
Date Action Taken 2022-09-20	Organization Name UnitedHealthcare of the Midwest, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2023-01-01
Date Action Taken 2022-09-20	Organization Name UnitedHealthcare of Arkansas, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2023-01-01
Date Action Taken 2022-09-20	Organization Name Triple S Advantage, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2023-01-01
Date Action Taken 2022-09-20	Organization Name UnitedHealthcare of New Mexico, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2023-01-01
Date Action Taken 2022-09-20	Organization Name MMM Healthcare, LLC	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2023-01-01
Date Action Taken 2022-04-05	Organization Name Anthem Inc.	Action Taken Civil Money Penalty ($19,186)	Basis for Action Contract Administration	Effective Date 2022-04-05
Date Action Taken 2022-03-22	Organization Name Centene Corporation	Action Taken Civil Money Penalty ($88,192)	Basis for Action Contract Administration	Effective Date 2022-03-22
Date Action Taken 2022-03-22	Organization Name Molina Healthcare, Inc.	Action Taken Civil Money Penalty ($43,884)	Basis for Action Contract Administration	Effective Date 2022-03-22
Date Action Taken 2022-03-22	Organization Name CIGNA	Action Taken Civil Money Penalty ($85,436)	Basis for Action Contract Administration	Effective Date 2022-03-22
Date Action Taken 2022-03-22	Organization Name EmblemHealth, Inc.	Action Taken Civil Money Penalty ($106,325)	Basis for Action Contract Administration	Effective Date 2022-03-22
Date Action Taken 2022-03-22	Organization Name BlueCross BlueShield of Tennessee	Action Taken Civil Money Penalty ($142,676)	Basis for Action Contract Administration	Effective Date 2022-03-22
Date Action Taken 2022-03-22	Organization Name Guidewell Mutual Holding Corporation	Action Taken Civil Money Penalty ($52,258)	Basis for Action Contract Administration	Effective Date 2022-03-22
Date Action Taken 2022-02-25	Organization Name Vibra Health Plan, Inc.	Action Taken Civil Money Penalty ($9,328)	Basis for Action Contract Administration	Effective Date 2022-02-25
Date Action Taken 2022-02-25	Organization Name Network Health Insurance Corporation	Action Taken Civil Money Penalty ($11,236)	Basis for Action Contract Administration	Effective Date 2022-02-25
Date Action Taken 2022-02-25	Organization Name Global Health Inc.	Action Taken Civil Money Penalty ($26,182)	Basis for Action Contract Administration	Effective Date 2022-02-25
Date Action Taken 2022-02-25	Organization Name Independence Health Group, Inc.	Action Taken Civil Money Penalty ($26,500)	Basis for Action Contract Administration	Effective Date 2022-02-25
Date Action Taken 2022-02-25	Organization Name CareSource Ohio Inc.	Action Taken Civil Money Penalty ($66,250)	Basis for Action Contract Administration	Effective Date 2022-02-25
Date Action Taken 2022-02-25	Organization Name CIGNA	Action Taken Civil Money Penalty ($126,988)	Basis for Action Contract Administration	Effective Date 2022-02-25
Date Action Taken 2022-02-25	Organization Name Paramount Care Inc.	Action Taken Civil Money Penalty ($146,068)	Basis for Action Contract Administration	Effective Date 2022-02-25
Date Action Taken 2022-02-24	Organization Name California Physicians' Service	Action Taken Civil Money Penalty ($40,282)	Basis for Action Contract Administration	Effective Date 2022-02-24
Date Action Taken 2022-01-20	Organization Name Vitality Health Plan of California, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2022-01-04
Date Action Taken 2021-12-22	Organization Name InnovAge Colorado PACE	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-12-22
Date Action Taken 2021-12-06	Organization Name Clear Spring Health Insurance Company	Action Taken Civil Money Penalty ($53,162)	Basis for Action Contract Administration	Effective Date 2021-12-06
Date Action Taken 2021-12-03	Organization Name Eternal Health of Delaware, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2021-12-02
Date Action Taken 2021-10-26	Organization Name Eternal Health of Delaware, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-10-27
Date Action Taken 2021-10-07	Organization Name Imperial Insurance Companies, Inc.	Action Taken Sanction Release	Basis for Action Deficiencies Corrected	Effective Date 2021-10-05
Date Action Taken 2021-09-17	Organization Name InnovAge California PACE – Sacramento, LLC	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-09-17
Date Action Taken 2021-09-02	Organization Name UnitedHealthcare of the Midwest, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-09-02
Date Action Taken 2021-09-02	Organization Name UnitedHealthcare of New Mexico, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-09-02
Date Action Taken 2021-09-02	Organization Name UnitedHealthcare of Arkansas, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-09-02
Date Action Taken 2021-09-02	Organization Name Triple-S Advantage, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-09-02
Date Action Taken 2021-09-02	Organization Name MMM Healthcare, LLC	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-09-02
Date Action Taken 2021-06-17	Organization Name Imperial Insurance Companies, Inc.	Action Taken Immediate Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2021-06-17
Date Action Taken 2020-07-02	Organization Name Vitality Health Plan of California, Inc.	Action Taken Suspension of Enrollment	Basis for Action Contract Administration	Effective Date 2020-07-02

Page Last Modified:

09/10/2024 06:18 PM

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Downloads

Part C and Part D Enforcement Actions

Downloads

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