CMS fines UnitedHealthcare $2.5M over improper Medicare denials, delays

Morgan Haefner - Print  | 

CMS fined Minnetonka, Minn.-based UnitedHealthcare $2.5 million after an audit found systemic compliance problems with its Medicare health plans that led beneficiaries to experience delayed or denied access to prescription drug coverage, according to the Star Tribune.

The scheduled audit examined the insurer's May 2016 operations and whether UnitedHealthcare complied with the established rules for Medicare Part D prescription drug plans. UnitedHealthcare is one of 17 insurers facing fines ranging from $32,000 to $2.5 million for compliance issues discovered in CMS' audits.

Federal officials said in a Nov. 22 letter that in UnitedHealthcare's case, "some of the denials were for prescription drugs that are used to treat acute conditions that require immediate treatment," the report states. In addition, some beneficiaries saw higher out-of-pocket costs. 

In a statement to the Star Tribune, UnitedHealthcare said it "immediately addressed the findings of this planned audit, which occurred last year," and is "committed to helping our members with the care they need, when they need it." 

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