Medicare Advantage Fines

Medicare Advantage plans are being fined by the Centers for Medicare & Medicaid Services (“CMS”) at a record pace. In the first quarter of this year, CMS has levied $2.5 million in fines on ten plans as the agency attempts to tighten the noose on bad practices. The top penalty for this first quarter went to Citizens Choice Health Plan which is based in Orange, California. CMS stated this particular plan’s fines were based on inappropriateness of prescription drug denials to their Medicare members.

CMS has also imposed sanctions on some plans as a stricter form of punishment. While a health plan is under sanctions, their star rating is reduced to 2 ½ stars. Medicare Advantage plans who do not have a four star rating forego bonus payments from CMS.

CMS appears to be ramping up their enforcement efforts into the second quarter of 2015. Most notably is an April fine issued to Aetna in the amount of $1 million.

Modern Healthcare recently produced a top 25 list of Medicare Advantage insurers, ranked by total enrollment as of March 2015. The top ten in the list are:

  1. UnitedHealth Group
  2. Humana
  3. Kaiser Foundation Health Plan
  4. Aetna
  5. Anthem
  6. Cigna Corp.
  7. Blue Cross and Blue Shield of Michigan
  8. WellCare Health Plans
  9. Highmark Health
  10. Health Net

This list of plans above currently enroll nearly 11.6 million Americans.


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