Almost half of the health plans offering Medicare prescription drug benefits has been slapped by CMS (Centers for Medicare & Medicaid Services) with fines for improperly refusing beneficiaries access to drugs and other services
The fines were a result of a 2016 audit of thirty-seven health policies made public this week. The fines were issued by agency to 17 of those plans.
It fined Minnetonka, Minn.-based UnitedHealthcare, the largest insurer of nations, $2.5 million for failing to comply with a range of Medicare prescription drug requirements. A total of $7.3 million were being fined to the 17 insurers.
CMS said that the Medicare Advantage Part D prescription drug requirements’ violations led to reduced access to medical services and drugs.
In accordance to a CMS notice sent to UnitedHealthcare in the month of November and made public Wednesday, UnitedHealthcare was fined for violations that occurred in 56 of the insurer's Medicare Advantage and Part D contracts,.
Some of the insurer's plan members were unsuitably denied coverage for drugs, few of which were to be utilized to treat acute conditions that required immediate attention. Delayed access to medications was also experienced by the plan members, never got their medications or had to pay higher out-of-pocket costs than necessary.
A UnitedHealthcare spokesman stated in an email, "We instantly addressed the findings of this planned audit, which occurred previous year, and remain committed to assisting our members with the care they need, when they need it.”
The CMS also dealt WellCare Health Plans in the place of Tampa, Fla., a $1.17 million fine. Albuquerque-based Presbyterian Health Plan, Miami-based AvMed, and Tulsa, Okla.-based Community Care HMO also got penalties of more than $750,000.
A smaller fine of $31,950 has been received by the St. Louis-based Centene Corp.
In a recent memo sent to the health plans this week, the CMS pointed out that the penalty’s size doesn't essentially reflect overall plan performance. The fine is evaluated by the number of plan members affected by an insurer's violations, so larger policies will likely get higher fines.
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