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
-
HPMSMemo2024CMPPenaltyUpdate01262024 (PDF) -
2019 CMP Methodology 06_21_2019 (PDF) -
CMP Methodology 2019 Comments Responses (PDF) -
HPMS Memo CMP Methodology 06_21_2019 (PDF)
Date Action Taken | Organization Name | Action Taken | Basis for Action | Effective Date |
---|---|---|---|---|
Wellcare of Missouri Health Insurance Company, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2025-01-01
|
|
Care Improvement Plus South Central Insurance Co.
|
Sanction Release
|
Deficiencies Corrected
|
2025-01-01
|
|
PACE4DC, LLC
|
Suspension of Enrollment
|
Contract Administration
|
2024-08-24
|
|
Zing Health, Inc.
|
Termination Retraction
|
Contract Administration
|
2024-06-25
|
|
PACE Partners of Northeast Florida, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2024-05-18
|
|
California Physicians' Service
|
Civil Money Penalty ($30,160)
|
Contract Administration
|
2024-03-21
|
|
Blue Cross Blue Shield of Michigan Mutual Insurance Company
|
Civil Money Penalty ($7,424)
|
Contract Administration
|
2024-03-21
|
|
Capital District Physicians' Health Plan, Inc.
|
Civil Money Penalty ($17,864)
|
Contract Administration
|
2024-03-21
|
|
USAble Mutual Insurance Company
|
Civil Money Penalty ($5,336)
|
Contract Administration
|
2024-03-21
|
|
CareSource Ohio, Inc.
|
Civil Money Penalty ($27,898)
|
Contract Administration
|
2024-03-21
|
|
Village Senior Services Corporation
|
Civil Money Penalty ($10,208)
|
Contract Administration
|
2024-03-21
|
|
Astiva Health, Inc.
|
Civil Money Penalty ($6,380)
|
Contract Administration
|
2024-03-21
|
|
WellCare Health Insurance of North Carolina, Inc.
|
Termination
|
Contract Administration
|
2023-12-27
|
|
WellCare Health Insurance of Arizona, Inc.
|
Termination
|
Contract Administration
|
2023-12-27
|
|
UCare Minnesota
|
Civil Money Penalty ($13,224)
|
Contract Administration
|
2023-12-06
|
|
Medica Holding Company
|
Civil Money Penalty ($62,060)
|
Contract Administration
|
2023-11-02
|
|
Centene Corporation
|
Civil Money Penalty ($49,764)
|
Contract Administration
|
2023-11-02
|
|
Blue Cross & Blue Shield of Rhode Island
|
Civil Money Penalty ($24,940)
|
Contract Administration
|
2023-11-02
|
|
AvMed, Inc.
|
Civil Money Penalty ($5,336)
|
Contract Administration
|
2023-11-02
|
|
Clear Spring Health Insurance Company
|
Termination
|
Contract Administration
|
2023-10-13
|
|
UnitedHealthCare Plan of the River Valley, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2024-01-01
|
|
Care Improvement Plus South Central Co.
|
Suspension of Enrollment
|
Contract Administration
|
2023-09-19
|
|
Aultman Health Foundation
|
Civil Money Penalty ($162,632)
|
Contract Administration
|
2023-08-07
|
|
EmblemHealth, Inc.
|
Civil Money Penalty ($19,024)
|
Contract Administration
|
2023-08-07
|
|
Moda Health Plan, Inc.
|
Civil Money Penalty ($5,800)
|
Contract Administration
|
2023-08-07
|
|
EmblemHealth, Inc.
|
Civil Money Penalty ($116,288)
|
Contract Administration
|
2023-05-23
|
|
Imperial Health Plan of California
|
Civil Money Penalty ($39,208)
|
Contract Administration
|
2023-03-16
|
|
Independence Health Group, Inc.
|
Civil Money Penalty ($6,032)
|
Contract Administration
|
2023-03-16
|
|
Intermountain Health Care, Inc.
|
Civil Money Penalty ($17,980)
|
Contract Administration
|
2023-03-16
|
|
Imperial Health Plan of California
|
Termination
|
Contract Administration
|
2023-12-31
|
|
InnovAge Colorado PACE
|
Sanction Release
|
Deficiencies Corrected
|
2023-01-23
|
|
Elevance Health
|
Civil Money Penalty ($38,512)
|
Contract Administration
|
2022-11-30
|
|
Humana, Inc.
|
Civil Money Penalty ($131,660)
|
Contract Administration
|
2022-11-30
|
|
Kaiser Foundation Health Plan, Inc.
|
Civil Money Penalty ($27,260)
|
Contract Administration
|
2022-11-30
|
|
InnovAge California PACE – Sacramento, LLC
|
Sanction Release
|
Deficiencies Corrected
|
2022-11-21
|
|
UnitedHealthcare Plan of the River Valley, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2022-09-20
|
|
UnitedHealthcare of the Midwest, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2023-01-01
|
|
UnitedHealthcare of Arkansas, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2023-01-01
|
|
Triple S Advantage, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2023-01-01
|
|
UnitedHealthcare of New Mexico, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2023-01-01
|
|
MMM Healthcare, LLC
|
Sanction Release
|
Deficiencies Corrected
|
2023-01-01
|
|
Anthem Inc.
|
Civil Money Penalty ($19,186)
|
Contract Administration
|
2022-04-05
|
|
Centene Corporation
|
Civil Money Penalty ($88,192)
|
Contract Administration
|
2022-03-22
|
|
Molina Healthcare, Inc.
|
Civil Money Penalty ($43,884)
|
Contract Administration
|
2022-03-22
|
|
CIGNA
|
Civil Money Penalty ($85,436)
|
Contract Administration
|
2022-03-22
|
|
EmblemHealth, Inc.
|
Civil Money Penalty ($106,325)
|
Contract Administration
|
2022-03-22
|
|
BlueCross BlueShield of Tennessee
|
Civil Money Penalty ($142,676)
|
Contract Administration
|
2022-03-22
|
|
Guidewell Mutual Holding Corporation
|
Civil Money Penalty ($52,258)
|
Contract Administration
|
2022-03-22
|
|
Vibra Health Plan, Inc.
|
Civil Money Penalty ($9,328)
|
Contract Administration
|
2022-02-25
|
|
Network Health Insurance Corporation
|
Civil Money Penalty ($11,236)
|
Contract Administration
|
2022-02-25
|
|
Global Health Inc.
|
Civil Money Penalty ($26,182)
|
Contract Administration
|
2022-02-25
|
|
Independence Health Group, Inc.
|
Civil Money Penalty ($26,500)
|
Contract Administration
|
2022-02-25
|
|
CareSource Ohio Inc.
|
Civil Money Penalty ($66,250)
|
Contract Administration
|
2022-02-25
|
|
CIGNA
|
Civil Money Penalty ($126,988)
|
Contract Administration
|
2022-02-25
|
|
Paramount Care Inc.
|
Civil Money Penalty ($146,068)
|
Contract Administration
|
2022-02-25
|
|
California Physicians' Service
|
Civil Money Penalty ($40,282)
|
Contract Administration
|
2022-02-24
|
|
Vitality Health Plan of California, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2022-01-04
|
|
InnovAge Colorado PACE
|
Suspension of Enrollment
|
Contract Administration
|
2021-12-22
|
|
Clear Spring Health Insurance Company
|
Civil Money Penalty ($53,162)
|
Contract Administration
|
2021-12-06
|
|
Eternal Health of Delaware, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2021-12-02
|
|
Eternal Health of Delaware, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2021-10-27
|
|
Imperial Insurance Companies, Inc.
|
Sanction Release
|
Deficiencies Corrected
|
2021-10-05
|
|
InnovAge California PACE – Sacramento, LLC
|
Suspension of Enrollment
|
Contract Administration
|
2021-09-17
|
|
UnitedHealthcare of the Midwest, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2021-09-02
|
|
UnitedHealthcare of New Mexico, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2021-09-02
|
|
UnitedHealthcare of Arkansas, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2021-09-02
|
|
Triple-S Advantage, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2021-09-02
|
|
MMM Healthcare, LLC
|
Suspension of Enrollment
|
Contract Administration
|
2021-09-02
|
|
Imperial Insurance Companies, Inc.
|
Immediate Suspension of Enrollment
|
Contract Administration
|
2021-06-17
|
|
Vitality Health Plan of California, Inc.
|
Suspension of Enrollment
|
Contract Administration
|
2020-07-02
|