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Medicare HMO in Trouble?

Federal officials have imposed a fine on Florida Healthcare Plus, a Medicare Advantage plan based in Coral Gables, for failing to notify members of upcoming changes in the plan by the deadline last fall, just before  open-enrollment season.

Meanwhile, the plan seems to have retrenched, with some of its offices closing around the state. Calls to Florida Healthcare Plus offices in Orlando, Jacksonville and West Palm Beach drew recorded messages that said those numbers were no longer in service.

In the Tampa office, Denise Perez, manager for provider relations, said there had been some layoffs at the company after it underwent a management change several months ago. Ray Quirantes, the former CEO, was replaced by Susan Molina.

"A lot of good things are happening," Perez said.

Two calls to the main office before 10 a.m. had not been returned by 2 p.m. A staffer there said Molina was planning to return the call during the afternoon.

The letter was sent to Molina from the Centers for Medicare and Medicaid Services (CMS) on April 7 by Gerard J. Mulcahy, director of oversight and enforcement for Medicare Parts C and D. (Part C is Medicare Advantage, in which managed-care plans receive premiums from CMS to pay for most of a beneficiary's care. Part D is the Medicare drug plan.)

Mulcahy wrote that CMS was imposing a fine of $40,890 for the company's failure to mail out documents to plan members by the deadline of Sept. 30, 2013. The documents showed what their plan covered and what changes in drugs, doctors, premiums or co-pays were going into effect in 2014. Open enrollment for Medicare was Oct. 15 - Dec. 7.

The plan apparently told CMS that it had sent out the documents to its 8,178 members in three batches, Oct. 26-Nov. 4, well after open enrollment was under way. That kind of deficiency has the potential to harm enrollees by withholding "vital" information, Mulcahy said.

CMS provides an avenue for plans to request a hearing. It is  not clear whether the company has done so.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.