Medicare Suspends, Fines Insurer QHP

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  • May 28, 2010
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Quality Health Plans (QHP) received notice on May 17 of the Centers for Medicare & Medicaid Services’ (CMS) intent to impose intermediate sanctions and a civil monetary penalty (CMP). The  federal agency contends that the Tampa, Fla.-based insurer has failed to comply with a number of administrative and contract management requirements.

The insurer’s problems were raised to CMS by complaints from plan members, according to a CMS press release. Following an extensive review of denied claims, documents, and an on-site audit at QHP’s Tampa headquarters, CMS says it found that the plan had (among other things) failed to fully meet obligations to Medicare beneficiaries by not providing them with timely monthly premium invoices, denying their coverage of approved Part D prescription drugs, and allowing contradictory and inappropriate payments for medications specifically excluded on CMS’ drug formulary.
According to CMS, the plan recently sent enrollees a lump sum bill for the entire amount of back premium, in some cases up to $1,000, with no payment options. QHP’s current standalone prescription drug plan enrollees are largely comprised of low income subsidy (LIS) beneficiaries (75 percent) and the average lumped premium bill was approximately $332.
The first notice of intent would suspend QHP’s marketing and enrollment of new members in its two Medicare Advantage health plans and a standalone prescription drug plan. The second notice of intent would impose a CMP of $586,800 against QHP.
Under the sanction, CMS says it will closely monitor the plan to determine that corrective actions have been taken and, if new issues arise, may impose additional penalties and may consider the possibility of termination of the QHP contract with Medicare.
According to CMS, about 17,400 Medicare beneficiaries in New York and Florida are currently enrolled in QHP’s Medicare contracts.
“While most QHP enrollees should experience no problems, current members with premium payment concerns or those who are having difficulty paying past due balances should call 1-800-MEDICARE or contact their local state health insurance assistance program for help,” said Jon Blum, CMS deputy administrator and director of the Center for Medicare.
In a May 18 statement, QHP said the CMS notification of the sanctions will not affect the company’s ability to continue to provide service to its members and providers. The insurer said it is cooperating fully with CMS on its review and is working to resolve the issues CMS has raised as soon as possible.
Source: CMS May 17 press release

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No Responses to “Medicare Suspends, Fines Insurer QHP”

  1. Doug Moore says:

    What has happened since May 18th, 2010?