Federal Enforcement Actions Against Medicare Advantage Plans

How is the federal government overseeing Medicare Advantage plans using enforcement actions?In this cross-sectional study examining 1173 unique MA contracts and 844 enforcement actions from 2010 to 2023, most enforcement actions were monetary penalties, with far fewer enrollment suspensions and contract terminations. Mean monetary penalties peaked at $6.50 per enrollee in 2019 and remained less than $3 in other years.This cross-sectional study found that the magnitude of enforcement actions for Medicare Advantage plans for nonadherence to federal standards was modest, raising concerns about these actions’ effectiveness in protecting patients and ensuring that plans meet federal standards.

Corresponding Author: David J. Meyers, PhD, Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 S Main St, Providence, RI 02912 (david_meyers@brown.edu).

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