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CMS fines payer $1.17M over drug coverage: 4 key notes

CMS fined Tampa, Fla.-based WellCare Health Plans $1.17 million after an audit revealed the payer failed to comply with several guidelines concerning beneficiaries and prescription drug benefits, Healthcare Finance News reports.

Here's what you should know.

1. CMS audited WellCare in September 2016, and found the payer failed to tell patients about uncovered prescription drugs. The payer then denied prescription coverage without adequate information.

2. WellCare focuses primarily on government health options.

3. CMS said in a notice that Wellcare's improper prior authorization process resulted in beneficiaries receiving alternative prescriptions or paying out-of-pocket.

4. WellCare can appeal the notice up to April 25, 2017.

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