Medicare Imposes Sanctions on Three Health and Drug Sponsors

On November 19, 2010 the Centers for Medicare & Medicaid issued a notice to three Medicare health and drug plans.

CMS has issued a notice to three Medicare health and drug plan sponsors imposing sanctions for violations of Medicare's rules and regulations. This action ensures that beneficiaries continue to have access to the essential Medicare services to which they are entitled, and also protects Medicare beneficiaries from misleading marketing practices.

Under the notices issued, Health Net of Woodland Hills, California, is required to immediately suspend marketing to and enrolling new beneficiaries in its prescription drug and Medicare Advantage plans. Intermediate sanctions also were imposed on Medicare Advantage plans sponsored by Arcadian Management Services of Oakland, California, and Universal American Corporation of Houston, Texas. The marketing and enrollment suspensions for Arcadian and Universal American were effective on December 5. These sanctions will remain in effect until each of the three plans demonstrates to CMS that it has corrected the related deficiencies and that those deficiencies are not likely to recur. CMS' actions will not impact the one million Medicare beneficiaries currently enrolled in these three health and drug plans across the country.

"Current members in Health Net, Arcadian and Universal American health and drug plans who are having difficulty getting their prescriptions filled or accessing needed medical services should contact (800) MEDICARE or their local state health insurance assistance program for help," said Jonathan Blum, deputy administrator of CMS' Center for Medicare. "Beneficiaries who may have already enrolled in one of these plans as part of the annual enrollment period should call (800) MEDICARE if they have any additional questions about that enrollment."

CMS will closely monitor the plans until the determination is made that corrective actions have been taken and to ensure that these deficiencies are not likely to recur. If the sponsors do not come into compliance with Medicare requirements, penalties that could be imposed range from fines to the possibility of termination of the sponsors' contracts with Medicare.

CMS encourages plan members who may have concerns with their Medicare Advantage or Part D coverage to contact (800) MEDICARE ((800) 633-4227) or their SHIP to help get them resolved.

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