CMS has fined seven payers a total of more than $430,000 for violating Medicare requirements related to Part D prescription drug benefits.
The insurers were penalized April 1 for errors within their formulary and benefit administration, coverage determinations, and appeals processes, which the agency said led to delayed access to medications, improper denials of coverage, and significant out-of-pocket costs for enrollees. The audits leading to the fines were conducted throughout 2024.
Seven fines:
Molina Healthcare: $285,476
Point32Health, parent of Harvard Pilgrim Health Care and Tufts Health Plan: $55,796
Aware Integrated, parent of BCBS Minnesota: $31,088
BCBS Tennessee: $21,692
Centene: $20,648
Presbyterian Health Plan: $14,152
Geisinger Health Plan: $5,800
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.