CMS fines 17 in­sur­ers for Rx plan vi­o­la­tions

Modern Healthcare - - LATE NEWS - —Shelby Liv­ingston

The CMS slapped nearly half of the health plans of­fer­ing Medi­care pre­scrip­tion drug ben­e­fits with fines for im­prop­erly deny­ing ben­e­fi­cia­ries ac­cess to drugs and other ser­vices.

The fines were a re­sult of a 2016 au­dit of 37 health plans made pub­lic last week. The agency is­sued fines to 17 of those plans.

It fined Min­netonka, Minn.-based Unit­edHealth­care, the na­tion’s largest in­surer, $2.5 mil­lion for fail­ing to com­ply with a range of Medi­care pre­scrip­tion drug re­quire­ments. The 17 in­sur­ers were fined a to­tal of $7.3 mil­lion.

Other fined in­sur­ers in­clude Wel­lCare Health Plans of Tampa, Fla., $1.17 mil­lion; and Pres­by­te­rian Health Plan of Al­bu­querque, AvMed of Mi­ami, and Com­mu­nity Care HMO of Tulsa, Okla., all of which re­ceived penal­ties of more than $750,000.

Vi­o­la­tions of the Medi­care Ad­van­tage Part D pre­scrip­tion drug re­quire­ments led to re­duced ac­cess to med­i­cal ser­vices and drugs, the CMS said. Some of the in­sur­ers’ plan mem­bers were in­ap­pro­pri­ately de­nied cov­er­age for drugs, some of which were for acute con­di­tions that needed im­me­di­ate at­ten­tion.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.