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.

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Showing 1 – 10 of 77 entries

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Date Action Taken	Organization Name	Action Taken	Basis for Action	Effective Date
Date Action Taken 2025-01-17	Organization Name Molina Healthcare, Inc.	Action Taken Civil Money Penalty ($67,976)	Basis for Action Contract Administration	Effective Date 2025-01-17
Date Action Taken 2025-01-17	Organization Name Elevance Health, Inc.	Action Taken Civil Money Penalty ($149,060)	Basis for Action Contract Administration	Effective Date 2025-01-17
Date Action Taken 2025-01-17	Organization Name The Carle Foundation	Action Taken Civil Money Penalty ($101,500)	Basis for Action Contract Administration	Effective Date 2025-01-17
Date Action Taken 2025-01-17	Organization Name Medco Containment Life and Medco Containment NY	Action Taken Civil Money Penalty ($32,364)	Basis for Action Contract Administration	Effective Date 2025-01-17
Date Action Taken 2025-01-17	Organization Name Baylor Scott & White Holdings	Action Taken Civil Money Penalty ($37,816)	Basis for Action Contract Administration	Effective Date 2025-01-17
Date Action Taken 2025-01-17	Organization Name Centene Corporation	Action Taken Civil Money Penalty ($2,000,000)	Basis for Action Contract Administration	Effective Date 2025-01-17
Date Action Taken 2025-01-17	Organization Name Humana Inc.	Action Taken Civil Money Penalty ($99,064)	Basis for Action Contract Administration	Effective Date 2025-01-17
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

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Part C and Part D Enforcement Actions

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