A comprehensive new study conducted by health policy researchers at the Brown University School of Public Health has revealed significant insights into the federal oversight of Medicare Advantage plans, raising critical questions about the effectiveness of regulatory enforcement. The findings, published in the prestigious journal JAMA Internal Medicine, underscore a concerning trend: regulators, primarily the Centers for Medicare & Medicaid Services (CMS), predominantly impose relatively small financial penalties rather than deploying more severe enforcement actions, which might be insufficient to deter ongoing violations within this fast-expanding sector.
Medicare Advantage (MA), a privately managed alternative to the traditional Medicare program, now enrolls over half of all Medicare beneficiaries in the United States, representing a substantial portion of federal healthcare expenditure. Given its vast scale and impact, regulatory oversight by CMS is expected to be stringent. However, as the study highlights, enforcement actions over the past decade appear limited in scope and intensity. The research team leveraged data procured via a Freedom of Information Act request, examining all identified enforcement actions against Medicare Advantage insurers from 2010 through 2023.
This extensive dataset reveals that CMS possesses an arsenal of enforcement mechanisms at its disposal, including contract terminations, suspensions barring enrollment of new members, marketing restrictions, and financial penalties. Yet, the evidence indicates a troubling reliance on monetary penalties, which accounted for an overwhelming 87% of enforcement actions during the study period. In contrast, suspensions represented about 12%, while contract terminations remained rare, constituting less than 1%. This imbalance in enforcement methods may signal an institutional hesitancy to impose consequential sanctions on insurers.
Moreover, the financial penalties themselves often amounted to modest sums when distributed on a per-enrollee basis. The study found the peak average fine reaching about $6.50 per beneficiary in 2019, whereas in most other years, fines hovered below $3 per enrollee. While cumulatively these fines run into millions of dollars, they pale in comparison to the substantial revenues insurers earn per patient each year—often in the thousands of dollars—raising doubts about whether the penalties meaningfully influence insurer behavior or corrective actions.
David Meyers, associate professor of health services, policy, and practice at Brown University and co-author of the study, voiced concerns that the relatively minor fines effectively permit continued noncompliance. He remarked that “when fines are levied on plans, it almost means nothing compared to the profits the plans are making,” portraying a picture of regulatory inertia. This sentiment corroborates a growing narrative that the federal government may be inadequately vigilant in its stewardship of the Medicare Advantage program.
The temporal distribution of enforcement actions also reflects a pattern worth noting. Enforcement activity appears concentrated around CMS audit cycles, suggesting that violations are identified mainly during routine, scheduled reviews rather than through continuous, proactive monitoring. This episodic scrutiny may allow infractions to persist undetected between audit periods, undermining program integrity and beneficiary protections.
Further, the study documents disparities among the types of plans subjected to enforcement actions. Suspended or terminated contracts tended to have lower quality ratings and served disproportionately higher shares of low-income and minority beneficiaries. This disparity raises ethical and policy concerns about whether enforcement strategies inadvertently exacerbate inequities by disproportionately disrupting vulnerable populations’ access to care.
The Brown research team also shed light on the prevalence of enforcement actions themselves. Despite criticisms of leniency, about 42% of Medicare Advantage contracts experienced at least one enforcement action during the thirteen-year span, and around 20% faced multiple actions, primarily small fines. This suggests that while enforcement events are not uncommon, the nature and impact of the penalties may be insufficient to drive systemic improvements.
Meyers explained that CMS’s apparent preference for modest monetary penalties is partly rooted in how its enforcement system is structured. The agency’s legal framework and operational priorities may favor less aggressive measures due to challenges like constrained resources, potential legal challenges from insurers, and practical difficulties in terminating or suspending large health plans that serve numerous beneficiaries.
The study’s findings come at a crucial moment as Medicare Advantage continues to expand rapidly, reshaping the landscape of Medicare coverage. Concerns such as inappropriate denials and delays in covered care, aggressive marketing tactics, and the administrative burden for providers and patients have been increasingly documented. Yet, the research suggests robust regulatory responses have not followed, potentially allowing problematic practices to persist.
By collating and analyzing more than a decade’s worth of enforcement data, this study represents one of the first comprehensive investigations into CMS’s regulatory oversight patterns within Medicare Advantage. Its revelations of predominantly mild penalties and uneven enforcement strategies illuminate a critical area needing attention from policymakers, regulators, and stakeholders invested in protecting Medicare beneficiaries and ensuring the efficiency and fairness of the program.
In conclusion, the study shines a spotlight on the tension between regulator authority and regulatory action in the Medicare Advantage ecosystem. The evidence indicates that while CMS holds substantial legal power to enforce compliance, its predominant reliance on relatively minor financial penalties may be ineffectual at deterring violations or improving plan conduct. This gap poses a risk to beneficiary protections and the equitable functioning of a program of paramount importance to millions of Americans.
Subject of Research: Not applicable
Article Title: Federal Enforcement Actions Against Medicare Advantage Plans
News Publication Date: 4-May-2026
Web References: 10.1001/jamainternmed.2026.1237
Keywords: Health and medicine, Health care policy, Health care costs
