CMS Regulators fine carriers for giving Medicare Advantage private plan policyholders inaccurate information on costs, benefits and access to out-of network providers.
On July 14, 2015, Centers for Medicare and Medicaid Services slapped multiple insurers with fines for giving their policy holders inaccurate or incomplete and delayed information about benefits and costs including errors related to maximum out-of-pocket costs and situations in which policy holders could visit out-of-network providers.
All six letters were concerning Medicare Part D prescription drug benefits through the private Medicare Advantage plans. According to the recent 2016 Call Letter, CMS finalized its proposed reinforcement of existing rules to make certain plans are aware of their responsibility to maintain accurate directories, among other issues.
CMS also clarified its expectation that plans update directories in real time, and have regular, ongoing communications with providers to ascertain their availability and, specifically, whether they are accepting new patients or not
In the case of UnitedHealthcare, CMS regulators issued a $150,000 penalty because approximately 6,000 New York customers “received untimely information about their 2015 benefits in UnitedHealthcare’s CY 2015 ANOC documents.” The New York policyholders did not receive required information about increased premiums, cost-sharing, co-payments and deductibles until the first week of May — more than seven months after a Sept. 30 deadline. This at a time when United attributed a 13% jump in its 2nd quarter profits to the company’s Medicare and Medicaid plans.
Health Net AZ, which was recently acquired by Centene, was slapped with the largest fine of the group, nearly $350,000, for providing inaccurate information to approximately 14,000 policyholders. According to the letter, Health Net AZ had been warned about noncompliance before. In 2014, Health Net AZ received a letter of non-compliance for failing to accurately describe benefits and/or cost sharing information to its enrollees.
The additional 4 letters were sent to: Indiana University Health Plans, which was slapped with a $100,000 fine; Oregon based ATRIO Health Plans, which was slapped with approximately $70,000 in fines; Massachusetts based Fallon Community Health Plan, which was slapped with a $52,000 in penalties, and the Illinois based Carle Foundation, which was slapped with a $34,000 fine. The fines were based on various violations including incorrect information on out-of-network costs and when policyholders could access out-of-network providers.
Copy of CMS Announcement