On October 16, 2019, a Medicare Advantage plan administered by UnitedHealthcare was sanctioned by the Centers for Medicare & Medicaid Services (CMS) for failing to comply with medical loss ratio (MLR), which set a threshold for how much money a health plan must spend towards enrollees’ health care. Medicare Advantage plans must maintain an MLR ratio of 85% to be compliant with the law. The sanction from CMS will prevent UnitedHealthcare from enrolling any new members in the noncompliant health plan until Contract Year 2020, though current enrollees will be able to remain members of the plan. This is the third consecutive year that the company failed to meet the MLR requirements. UnitedHealthcare has stated that it aims to bring the health plan into compliance with the MLR requirements in 2020. If the health plan fails to comply with the MLR requirements for five consecutive years, the federal government can terminate the Medicare Advantage contract with the health insurer, preventing it from being offered, though this is the first time CMS has sanctioned a health plan for failing to comply with the requirement.
Last Updated on May 15, 2020 by Aimed Alliance
