The CMS has fined Providence Health Plan in Beaverton, Ore., for what federal officials deemed “systemic” Medicare Advantage infractions.
The $164,600 civil money penalty (PDF) mostly pertained to coverage determinations. For example, the CMS said Providence failed to quickly notify its Medicare members about what services or prescription drugs were covered.
“Providence's failures in these areas were systemic and resulted in enrollees experiencing inappropriate delays or denials in receiving covered benefits and increased out-of-pocket costs,” Gerard Mulcahy, director of CMS' Medicare Parts C and D Oversight and Enforcement Group, said in a letter to Providence.
Providence Health Plan is part of Providence Health & Services, the Renton, Wash.-based health system that recorded more than $9.2 billion in revenue in the first nine months of its fiscal 2014. The plan has about 45,000 Medicare Advantage members and 437,000 total members.
Providence could appeal CMS' decision. It would have to request an appeal hearing by March 9. In a statement, the health plan did not address the violations in question and said it was reviewing what steps to take.
“As a five-star Medicare Advantage plan, we place a high priority on customer service,” according to the statement. “We are reviewing the CMS findings and considering our options, including the possibility we will appeal.”
The CMS has increased its oversight of Medicare Advantage plans the past few years. Providence's fine is the first the CMS has levied in 2015, and nearly three dozen insurers received similar fines last year. But critics argue the monetary punishments are a slap on the wrist and may not change noncompliant behavior in the industry.
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