Question

How will the federal government enforce compliance in the Medicare Advantage program? Which two other Medicare regulations do you think are the most important for managed care organizations and why?

Answer 1

CMS can take action or contract action if they decide that a Medicare Plan Sponsor has done one of the following, considerably neglects to or abide by the programs and/or contract requirement, or is participating in a contract with CMS in a manner that isn’t consistent with the active and effective administration of Medicare Part C and Part D or no longer meets the appropriate conditions of the Part C and D Medicare program. Actions that can be enforced or contract are either civil money penalties (CMP), intermediate sanctions; suspension of marketing, enrollment, payments for example, and of course terminations. (Centers For Medicare & Medicaid Services, 2013).