Medicare Compliance & Reimbursement

As the competition to enroll Florida seniors in Medicare+Choice plans heats up, more health plans are crossing the line. Vista Health Plan Inc. has been suspended from signing up new Medicare+Choice members as a result of alleged marketing violations, the Centers for Medicare & Medicaid Services announced July 21. And CarePlus Health Plans Inc. has been fined $75,000 for marketing violations of its own. Among the violations allegedly committed by Broward County, FL-based Vista: asking prospective members to fill out a 'transition of care' form, which could be construed as seeking to determine their health status and then disqualify those with poor health; allowing seniors to attend for free a Halloween party for which non-seniors were charged $20 admission; and a Vista salesman extolling the HMO's virtues on radio programs by using a script not approved by CMS. The plan's current M+C members will not be affected by the suspension, but the plan cannot enroll new members until the suspension is lifted. CarePlus Chief Executive Officer Mike Fernandez told the Ft. Lauderdale Sun-Sentinel that one of the Coral Gables-based plan's violation involved a sales rep promising "unlimited pharmacy benefits," rather than "unlimited generic pharmacy benefits," on a radio show, and the other involved the distribution of marketing posters that had not been approved by CMS. Fernandez also said the responsible employees have been fired.