Citing quality-of-care issues, the CMS has terminated its Medicare Advantage contract with Americas Health Choice, Vero Beach, Fla.
The 12,000 enrollees in the plan, all living in Florida, were moved on July 19 to United HealthCares Secure Horizons Medicare Advantage plan by the CMS, according to the agency.
Americas Health Choice failed to make services available to the extent that it posed an imminent and serious threat to the health of AHC enrollees, CMS said in a news release. This is the first time that the agency has pulled a Medicare Advantage contract for quality issues.
Americas Health still operates a stand-alone prescription-drug plan through Medicare Part D with 500 enrollees.
Delayed patient referrals, poor standards of care and shortages of specialty-care providers were among the specific reasons for the contracts termination, according to a letter the CMS sent Americas Health CEO Doug Werner on July 19. Examples cited in the letter included delays in chemotherapy treatments for cancer patients because drugs provided were not refrigerated properly, and a four-month wait for patients to see a cardiologist. The findings were based on an audit conducted by the CMS in January and February.
A spokesman for America's Health said that the company is focused on assisting members transition to Secure Horizons and just trying to make sure they receive continuity of care. -- by Rebecca Vesely
What do you think? Post a comment on this article and share your opinion with other readers. Submit your letter to Modern Healthcare Online at [email protected]. Please be sure to include your hometown and state, along with your organization and title.