CMS Hands Out Civil Money Penalties To 3 More Medicare Plans

Hey Medicare Nation!

Today, I’m finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020!

THREE more plan sponsors to discuss!

CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00!

HUGE Penalty people!

According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it “discovered” a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ….. reimbursement requests from enrollees.

HCSC has the right to Appeal CMS Decision.


NEXT Up….. is Triple-S Management Corporation!

CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020.

CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of $329,872.00!

CMS reported that Triple-S failed to comply with Medicare requirements related to Part D Formulary and benefit administration.

Triple-S has the right to Appeal CMS decision.

Last up….. is Tufts Health Plan, Inc.

CMS sent notice to Mr. Thomas Crosswell, President and CEO of Tufts Health Plan, Inc., to advise them of CMS’ determination to impose a Civil Money Penalty in the amount of $28,302.00.

CMS Auditors reported that Tufts failed to comply with Medicare requirements related to Part D Formulary and benefit administration and coverage determinations, appeals, and grievances in violations of Medicare regulations.

Tufts has the right to Appeal CMS’ decision.

If YOU are unhappy with any of the three Medicare Advantage Plan Sponsors, give Medicare a call.

You can request a “Special Election Period,” based on your experience with any of these companies.

Call Medicare at  800 – 633 – 4227  24hrs a day, 7 days a week.


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