In an unprecedented move, federal officials terminated a Medicare Advantage contract Thursday with a health maintenance organization that serves more than 12,000 people in an area that includes the Treasure Coast and Okeechobee County.

The decision to immediately end the contract with America’s Health Choice Medical Plans was based on an investigation conducted within recent weeks into “allegations of serious plan misconduct,” said Abby Block, director of the federal Center for Beneficiary Choices.

“America’s Health Choice failed to make services available to the extent that it posed an immediate and serious threat to its members,” Block said.

Among the allegations Block listed were serious delays in patient referrals, the mishandling of medication and failure to provide adequate access to health care.
This is the first time a Medicare Advantage contract has been terminated by the Centers for Medicare and Medicaid Services, which oversees the Center for Beneficiary Choices, Block said.

America’s Health Choice members are immediately being transferred to SecureHorizons, a UnitedHealthcare company with 80,000 Medicare Advantage members in Florida.

“Our first priority is to provide a smooth transition for the more than 12,000 Medicare beneficiaries who were enrolled in Medicare Advantage plans that will no longer be offered by America’s Health Choice Medical Plans,” said Peter Ashkenaz, SecureHorizons’ vice president of public relations.

Officials selected SecureHorizons because its Medicare Advantage plans most closely resembled those of America’s Health Choice.

SecureHorizons will also conduct a series of town hall meetings on the changes next week.

America's Health Choice members will not be locked into the SecureHorizons plan. Medicare officials are giving them until Sept. 30 to search for a new Medicare Advantage provider if any of them don't want SecureHorizons.
In general, Medicare Advantage beneficiaries can apply for new plans only between Nov. 15 and Dec. 31.

America’s Health Choice issued a brief statement Friday afternoon acknowledging that it is “no longer offering Medicare Advantage benefits to its members.” The statement said the company would work with the centers during the transition to SecureHorizons.

Spokesman Jason Mankiewicz said the company would not comment beyond the statement.

America’s Health Choice has had a long history of noncompliance with Medicare policies, Block said.

In July 2005, Medicare officials placed the HMO on intermediate sanctions, preventing it from advertising its Medicare Advantage plans or enrolling new clients.

Block said an audit of the company earlier this year turned up more problems. Medicare officials decided in April not to renew America’s Health Choice’s contract for 2008, a decision the company had been appealing.
The immediate termination of the contract can only be appealed through the court system.

Any America’s Health Choice member with immediate questions on the changes can contact SecureHorizons’ member services line at (888) 507-9352 or call (800) MEDICARE (633-4227).