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Medicare News
Medicare Advantage Plans by Americas Health Choice
Terminated in Florida
Centers for Medicare & Medicaid Services cite
delays and denials
July 25, 2007 -
CMS on
Friday terminated Medicare Advantage plans run by
America's Health
Choice of Vero Beach, Fla., citing delays and denials of
medical care, the
South Florida
Sun-Sentinel reports. The termination, which affects about
12,000 beneficiaries, is the first CMS has made for quality-of-care
reasons.
CMS began investigating the insurer in January
after beneficiaries complained about treatment authorization delays,
medication errors, a lack of access to specialists and poor-quality
medical care at company clinics, according to the Sun-Sentinel.
Abby Block, director of the CMS Center for
Beneficiary Choice, said the agency received additional details about
the plans from employees and conducted a surprise inspection a few weeks
ago, which led to the termination.
The company's quality problems posed "an imminent
and serious threat to the health" of beneficiaries, according to Block (LaMendola,
South Florida Sun-Sentinel, 7/21).
Block said CMS was unaware of any harm to
beneficiaries caused by substandard care but it had "to act quickly
before that occurred" (Wessel,
Orlando Sentinel,
7/21).
The investigation is ongoing and criminal charges
could be filed against AHC executives, Block said.
AHC said it would not seek a reversal of the
decision in court, and in a statement said that it would "work with
[CMS] during this transition."
All beneficiaries were switched automatically to MA
plans run by the UnitedHealthcare subsidiary
Secure Horizons,
which offers plans with similar costs and benefits as AHC plans.
Secure Horizons will cover beneficiaries' medical
bills until Sept. 30, at which time beneficiaries can switch to another
health plan or to traditional Medicare. Block said, "Everything will be
paid for. They need have no concern there will be any interruption in
services" (South Florida Sun-Sentinel, 7/21).
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