Health plans that have been using quick fixes to update provider directories are facing an unwelcome wake-up call: fines that can range up to $25,000 per day per beneficiary. Moreover, payers found in violation of the Centers for Medicare & Medicaid Services (CMS) rules can be banned from new enrollment or marketing.
These penalties are specific to Medicare Advantage programs and policies sold through Healthcare.gov, but they are emblematic of a larger trend. Regulators are responding to consumer frustration by calling attention to those health plans who struggle to manage their provider network databases.
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