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Suspended Medicare HMOs Still Listed

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Many Florida shoppers at Medicare.gov will find Day Break and Sunrise among their lowest-priced HMO options. But if they call to enroll in either one, they’re out of luck.

Florida Healthcare Plus, a small Coral Gables company that sponsors the two Medicare Advantage plans, is under state and federal suspension, unable to sign up new members during the current open-enrollment season for Medicare, Oct. 15-Dec. 7. Being frozen at this time of year can be a death sentence for such plans.

Kevin McCarty, state insurance commissioner, suspended Florida Healthcare Plus effective Sept. 23, saying the company was “financially impaired,” that it failed to maintain the amount of surplus funds the law requires.

His order said the suspension would last until the company filed an accurate financial statement, provided  sufficient funds to meet state requirements, and proved that those preparing and submitting statements were competent and trustworthy.

No information was available from state officials this week on which of the conditions remained unmet. The CEO of Florida Healthcare Plus, Susan Molina, could not be reached.

But a doctor’s office manager in Apopka, Ingrid Behner, had plenty to say. She told Health News Florida that the company has not fixed the payment problems that got it into hot water months ago, and it is still requiring patients to make co-payments for preventive services that are supposed to be free under the Affordable Care Act. She said a check from the company to the practice could not be cashed.

“They are so inept they should not be allowed to remain in business,” Behner said.

The Centers for Medicare and Medicaid Services (CMS) fined Florida Healthcare Plus $113,200 in July for delaying or denying patients’ access to medications and health services.  That’s on top of $40,000 it was fined in April for failure to notify members of changes in the plan for 2014, as required.

As Health News Florida reported last month, the state Office of Insurance Regulation caught a $600,000 error in the official report the company filed after its year-end audit. The error pushed the company below the state’s line of required surplus holdings for HMOs, intended to assure that they can cover all unpaid medical claims.

On Thursday, CMS officials in the regional office in Atlanta confirmed that the plans are not permitted to enroll new members. They could not immediately explain why the list of available plans at Medicare.gov includes DayBreak and Sunrise without any note that neither can enroll members into the plans.

The 11,000 Floridians currently enrolled in the plans can remain there if they choose – or through inertia – but members may be tempted to switch if they check the quality ratings at Medicare.gov.  

DayBreak and Sunrise were awarded only 2 stars out of a possible 5, or “below average," and are the lowest-rated plans available in the 16 counties where they have members.  Federal officials build the rating system from reports on medical care (rates of vaccination, infection, hospital readmission, etc.) and customer service.

--Health News Florida is part of WUSF Public Media. Contact Special Correspondent Carol Gentry at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.