Insurance Provider Sanctioned

By Dan Heath
The Press-Republican (Plattsburgh, NY)
McClatchy-Tribune Information Services
November 24, 2010

PLATTSBURGH -- Universal American allegedly violated Medicare regulations

A company that offers Medicare Advantage health and prescription-drug plans locally faces sanctions starting Dec. 5.

The U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services plans to impose intermediate marketing and enrollment sanctions on Houston-based Universal American Corp.

The company is one of three sanctioned or to be sanctioned for alleged violations of Medicare rules and regulations.

The other two are Health Net of Woodland Hills, Calif., and Arcadian Management Services of Oakland, Calif.

"Current members in Health Net, Arcadian and Universal American health and drug plans who are having difficulty getting their prescriptions filled or accessing needed medical services should contact 1-800-MEDICARE or their local state health-insurance assistance program for help," Centers for Medicare and Medicaid Services Deputy Administrator Jonathan Blum said in a press release.

"Beneficiaries who may have already enrolled in one of these plans as part of the annual enrollment period should call 1-800-MEDICARE if they have any additional questions about that enrollment."

Universal American has about 300,000 people enrolled in Medicare Advantage health and prescription-drug plans in 50 states and Washington, D.C.

The sanctions don't impact those currently enrolled in all three companies' health and drug plans.

Universal American is to be sanctioned because it allegedly didn't provide proper oversight of sales agents, who misled beneficiaries about network providers who were not actually part of the network or drugs that were not part of the plan's formulary.

The sanctions don't apply to Universal America's national stand-alone prescription-drug plans.

The Centers for Medicare and Medicaid Services said the violations resulted in delays in treatment and may have caused in risks to patient health.

Universal American's alleged violations were identified during monitoring by the Centers for Medicare and Medicaid Services and were raised to that agency by both plan members and other partners of the centers.

The sanctions will remain in effect until the companies can prove they have corrected the violations and they are unlikely to recur.

If that doesn't happen, the companies face penalties that could range from fines to possible termination of their contracts with Medicare.

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