Findings from Brown University School of Public Health Broaden Understanding of Managed Care (Federal Enforcement Actions Against Medicare Advantage Plans): Managed Care

2026 MAY 15 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Current study results on Managed Care have been published. According to news reporting originating in Providence, Rhode Island, by NewsRx journalists, research stated, “Enrollment in Medicare Advantage (MA) plans continues to increase, now covering more than half of Medicare beneficiaries and receiving more than $494 billion in annual federal payment. Therefore, robust oversight is essential to monitor plans’ adherence to federal standards and initiate enforcement actions when necessary to ensure program integrity and protect beneficiaries.”

The news reporters obtained a quote from the research from the Brown University School of Public Health, “To examine Centers for Medicare & Medicaid Services (CMS) enforcement actions against MA contracts and characteristics of contracts and beneficiaries involved with enforcement actions. This is a cross-sectional study of CMS enforcement actions against MA contracts that were preferred provider organizations or health maintenance organizations from 2010 to 2023. Data were analyzed from May 2025 to January 2026. Enforcement actions, including civil money penalties, suspension of enrollment, and contract termination. The outcomes of interest were number of enforcement actions and contracts affected and mean monetary penalties per MA enrollee. There were 1173 unique MA contracts and 844 enforcement actions from 2010 to 2023. A total of 493 unique MA contracts (42.0%) received an enforcement action during the study period. Most of enforcement actions originated from program audit (544 actions [64.5%]). Enforcement activity varied widely across years: in 2012, 100 contracts (19.2%) received monetary penalties, while only 5 contracts (0.9%) received such penalties in 2019. Most enforcement actions were monetary penalties (737 actions [87.3%]), with far fewer enrollment suspensions (99 actions [11.7%]) and contract terminations (8 actions [0.9%]). Financial penalties peaked at $6.50 per enrollee in 2019 and remained less than $3 in other years. Compared with contracts that did not receive enforcement actions, contracts that were terminated had lower star ratings (mean [SD], 2.5 [0.5] stars vs 3.6 [0.6] stars) and enrolled a much lower share of White beneficiaries (44.7% vs 68.7%); suspended contracts enrolled more dually eligible beneficiaries (28.9% vs 18.8%). This cross-sectional study found that federal enforcement actions against MA plans were highly variable from year-to-year and imposed modest fines. Enforcement actions may be relatively modest in magnitude, raising concerns about their effectiveness in deterring nonadherence.”

According to the news reporters, the research concluded: “The design of oversight and enforcement actions warrant further evaluation to determine what amount of enforcement actions are needed to protect patients and ensure plans meet federal standards.”

This research has been peer-reviewed.

For more information on this research see: Federal Enforcement Actions Against Medicare Advantage Plans. JAMA Internal Medicine, 2026. JAMA Internal Medicine can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

Our news correspondents report that additional information may be obtained by contacting Amal N. Trivedi, Dept. of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island. Additional authors for this research include Zihan Chen, Hayden Rooke-Ley, Jeffery Marr and David J. Meyers.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1001/jamainternmed.2026.1237. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

The publisher of the journal JAMA Internal Medicine can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

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