Elevance Health is in some hot water over noncompliance with Centers for Medicare and Medicaid Services (CMS) regulations. According to the report, CMS is even threatening sanctions against Elevance and possibly blocking enrollment to Elevance Health Medicare Advantage plans. Here’s what you should know.
Elevance Health Medicare Advantage Noncompliance
CMS has threatened sanctions against Elevance Health for failing to comply with required risk-adjustment data submission rules.
According to CMS, noncompliance dates back to 2018 when Elevance reportedly submitted diagnostic data using encrypted USB drives, rather than using the required electronic systems. The use of encrypted USB drives is explicitly prohibited under CMS regulations, since it’s much less secure.
However, Elevance Health states that the issue relates to claims before April 3, 2023, and that they have followed all CMS regulations since.
Unless the issues are fixed to CMS’s satisfaction, new members will be blocked from enrolling in Elevance Health Medicare Advantage plans, starting as early as March 31, 2026.
Current Elevance Health Medicare Advantage Plans Still Active
Despite the potential sanctions, Elevance has disclosed in an SEC filing that all current Medicare Advantage members and their benefits will not be affected. So if you currently rely on an Elevance Health Medicare Advantage plan for your healthcare needs, nothing should change because of the potential sanctions.
However, anyone looking to sign up for a Medicare Advantage plan or switch plans won’t be able to sign up for an Elevance Health Medicare Advantage plan until CMS is satisfied the issues are resolved.
What Is Elevance Health
Elevance Health is a nationwide insurance company, dedicated to providing whole health care. Their goal is to improve the health of humanity by addressing not only physical needs, but also behavioral and social needs, as they’re all essential to overall wellbeing.
They currently have nearly 100,000 associates and serve over 100 million people.
Find a Medicare Advantage Plan that Works for You
If CMS is not satisfied that Elevance Health has resolved the issues, they won’t be able to accept new Medicare Advantage members. However, there are plenty of other Medicare Advantage plans available in Nevada. If you or someone you know is looking for an MA plan that works for their unique needs, contact us at Health Benefits Associates.
Our team of knowledgeable local agents understand the Nevada healthcare landscape and will help you find the right Medicare Advantage plan to suit your needs. Schedule an appointment by calling 775-828-1216 today.
