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CMS penalizes Providence for Medicare Advantage problems
Modern Healthcare

The CMS has fined Providence Health Plan in Beaverton, Ore., for what federal officials deemed “systemic” Medicare Advantage infractions.The $164,600 civil money penalty (PDF) mostly pertained to coverage determinations. For example, the CMS said Providence failed to quickly notify its Medicare members about what services or prescription drugs were covered. “Providence’s failures in these areas were systemic and resulted in enrollees experiencing inappropriate delays or denials in receiving covered benefits and increased out-of-pocket costs,” Gerard Mulcahy, director of CMS’ Medicare Parts C and D Oversight and Enforcement Group, said in a letter to Providence.

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