CMS Terminates Contract With South Florida Medicare Advantage Plan
CMS on Monday announced the cancellation of its Medicare Advantage contract with the SunCoast Physicians Health plan in South Florida, CQ HealthBeat reports. The agency did not provide a specific reason for the cancellation, but press accounts show that the plan failed to maintain $1.5 million in reserves required by the state to pay patient medical bills in case of financial problems.The plan is the second MA plan in South Florida that CMS cancelled in recent weeks. Last month, the agency cancelled its contract with a plan run by America's Health Choice, citing delays in care that posed an "imminent and serious risk" to beneficiaries.
CMS said all 600 of SunCoast's beneficiaries will be switched to Humana Gold Plus, another MA plan. Beneficiaries will be able to see their current primary care physicians and specialists until Oct. 31, at which point they must use providers in the Humana network. Beneficiaries also can choose to enroll in traditional Medicare coverage by Oct. 31.
According to SunCoast's Web site, a Florida court on Aug. 10 ordered the plan to liquidate its assets after finding that the company failed to maintain the $1.5 million minimum in reserves (Reichard, CQ HealthBeat, 8/14). The state said the plan had $1.47 million set aside as collateral pledged for a loan. According to Steven Romanello, the plan's attorney, the former chief financial officer Kenneth Feldman had pledged the money without approval, with the loan going to a management firm he ran. Romanello said it "was a complete, severe injustice that was done to the HMO" (LaMendola, South Florida Sun-Sentinel, 8/14). This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
