CMS Enforcement: Recent CMP Notices

Like clockwork, the civil money penalty (CMP) notices issued as a result of 2019 Program Audits are out. CMPs are issued by the Centers for Medicare & Medicaid Services (CMS) when conditions of non-compliance adversely affect or have a substantial likelihood of adversely affecting enrollees. These conditions can be identified in Program Audits, through complaints to CMS, through self-disclosure, and through other means. This year, beneficiaries from Hawaii to Maine are enrolled in plans that received an enforcement notice from the Centers for Medicare & Medicaid Services. 

In 2019, CMS released a memo regarding the posted notices, indicating five parent organizations were issued CMPs for Program Audits at that time. This year’s memo notes six parent organizations were issued CMPs on February 28: five relative to 2019 Program Audits and one as for 2018 Program Audit results. Almost 19% of currently enrolled beneficiaries are in affected Medicare Advantage or Part D contracts in receipt of a CMP. Here is additional information by the numbers:

6 parent organizations issued CMP

82 affected contracts 

$1,190,370 total CMP dollars (ranging from $28,302 to $381,272)

9,435,133 members in affected contracts (February 2020)

Ask any conference presenter for their slide decks and there is bound to be a statistic or chart showing how quickly enrollment is growing in Medicare Advantage. According to the Congressional Budget Office, it is expected by 2029, 47% of all Medicare beneficiaries will be enrolled in the program. 

What to expect

While over the past few years, the agency has issued proposed rules and guidance to refine program administration, and President Trump has issued his Executive Order focused on protecting and improving Medicare, do not expect to rest on laurels when it comes to quality or adherence to regulations. Furthermore, expect continued oversight from the Medicare Parts C and D Oversight and Enforcement Group, or MOEG. In fact, the division is revising audit protocols and is seeking to memorialize the approach to increase minimum penalty amounts in regulation, consistent with the 3-year audit cycle. In addition, expect more to come regarding the 2019 audit results and the future of CMP methodology.