Time runs short for plans to weigh in on new civil money penal­ties

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dickson

“This memo clearly puts plans on no­tice.” OLGA WALTHER Se­nior leg­isla­tive and pol­icy ad­viser, Gor­man Health Group

Com­ments are due Thurs­day on how the CMS will cal­cu­late 2017 civil money penal­ties for rule vi­o­la­tions by Medi­care Ad­van­tage and pre­scrip­tion drug plans.

The agency in Septem­ber pub­lished in­terim fi­nal rules up­dat­ing civil money penal­ties that would ac­count for in­fla­tion and in­clude a “catch-up” ad­just­ment that would ap­ply to penal­ties as­sessed af­ter Aug. 1, 2016, for vi­o­la­tions af­ter Nov. 2, 2015. The memo was re­leased af­ter in­dus­try stake­hold­ers said they didn’t know how the CMS cal­cu­lated the penal­ties and what ex­actly or­ga­ni­za­tions must do to com­ply.

Last year, Medi­care Ad­van­tage and Part D plans were slapped with more than $13 mil­lion worth of fines, com­pared with $4.9 mil­lion in civil money penal­ties in 2014. The largest in­di­vid­ual fine, $3.1 mil­lion, was levied on Hu­mana for var­i­ous vi­o­la­tions in­clud­ing en­rollees ex­pe­ri­enc­ing de­lays or be­ing de­nied ac­cess to med­i­cal ser­vices or drugs.

The pro­posed method­ol­ogy doc­u­ment comes while fed­eral agen­cies are in­creas­ing civil money penalty max­i­mums across the board to com­ply with the Fed­eral Civil Penal­ties In­fla­tion Ad­just­ment Act of 2015.

Gor­man Health Group, a Wash­ing­ton-based con­sult­ing firm, an­a­lyzed the doc­u­ment and found penal­ties among health plans for com­mon in­frac­tions will in­crease.

“This memo clearly puts plans on no­tice,” said Olga Walther, se­nior leg­isla­tive and pol­icy ad­viser at Gor­man.

Un­der the law, the CMS has the au­thor­ity to is­sue a penalty of up to $25,000 for each af­fected en­rollee.

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