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 this 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.
Violations of the Medicare Advantage Part D prescription drug requirements led to reduced access to medical services and drugs, the CMS said.
UnitedHealthcare was fined for violations that occurred in 56 of the insurer's Medicare Advantage and Part D contracts, according to a CMS notice sent to UnitedHealthcare in November and made public Wednesday.
Some of the insurer's plan members were inappropriately denied coverage for drugs, some of which were to be used to treat acute conditions that needed immediate attention. Plan members also experienced delayed access to medications, never received their medications or had to pay higher out-of-pocket costs than necessary.
"We immediately addressed the findings of this planned audit, which occurred last year, and remain committed to helping our members with the care they need, when they need it,” a UnitedHealthcare spokesman said in an email.
The CMS also dealt WellCare Health Plans in Tampa, Fla., a $1.17 million fine. Albuquerque-based Presbyterian Health Plan, Miami-based AvMed, and Tulsa, Okla.-based Community Care HMO also received penalties of more than $750,000.
St. Louis-based Centene Corp. received a smaller fine of $31,950.
In a memo sent to the health plans this week, the CMS noted that the size of the penalty doesn't necessarily reflect overall plan performance. The fine is determined by the number of plan members affected by an insurer's violations, so larger plans will likely receive higher fines.
