Importance: Enrollment in Medicare Advantage (MA) plans continues to increase, now covering more than half of Medicare beneficiaries and receiving more than 494 billion in annual federal payment. Therefore, robust oversight is essential to monitor plans' adherence to federal standards and initiate enforcement actions when necessary to ensure program integrity and protect beneficiaries. Objective: To examine Centers for Medicare suspended contracts enrolled more dually eligible beneficiaries (28. 9% vs 18. 8%). Conclusions and Relevance: This cross-sectional study found that federal enforcement actions against MA plans were highly variable from year-to-year and imposed modest fines. Enforcement actions may be relatively modest in magnitude, raising concerns about their effectiveness in deterring nonadherence. The design of oversight and enforcement actions warrant further evaluation to determine what amount of enforcement actions are needed to protect patients and ensure plans meet federal standards.
Chen et al. (Mon,) studied this question.