CMS Terminates Florida HMO’s Medicare Advantage Plans
CMS on Friday terminated Medicare Advantage plans run by America's Health Choice of Vero Beach, Fla., citing delays and denials of medical care, the South Florida Sun-Sentinel reports. The termination, which affects about 12,000 beneficiaries, is the first CMS has made for quality-of-care reasons.CMS began investigating the insurer in January after beneficiaries complained about treatment authorization delays, medication errors, a lack of access to specialists and poor-quality medical care at company clinics, according to the Sun-Sentinel. Abby Block, director of the CMS Center for Beneficiary Choice, said the agency received additional details about the plans from employees and conducted a surprise inspection a few weeks ago, which led to the termination.
The company's quality problems posed "an imminent and serious threat to the health" of beneficiaries, according to Block (LaMendola, South Florida Sun-Sentinel, 7/21). Block said CMS was unaware of any harm to beneficiaries caused by substandard care but it had "to act quickly before that occurred" (Wessel, Orlando Sentinel, 7/21).
The investigation is ongoing and criminal charges could be filed against AHC executives, Block said. AHC said it would not seek a reversal of the decision in court, and in a statement said that it would "work with [CMS] during this transition." All beneficiaries were switched automatically to MA plans run by the UnitedHealthcare subsidiary Secure Horizons, which offers plans with similar costs and benefits as AHC plans. Secure Horizons will cover beneficiaries' medical bills until Sept. 30, at which time beneficiaries can switch to another health plan or to traditional Medicare. Block said, "Everything will be paid for. They need have no concern there will be any interruption in services" (South Florida Sun-Sentinel, 7/21). This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
