CMS Sanctions Cigna over Substantial Failures in Medicare Plans

CMS log blueBy: Karina Gonzalez 

Centers for Medicare and Medical Services (CMS) has  banned Cigna from enrolling and selling new Medicare products because of issues with Part C (Medicare Advantage Plans) and Part D (Prescription Drug Program )that increased enrollees out-of-pocket expenses which led to delays or denials  in receiving medical services and prescription drugs.  These sanctions were imposed effective 1/21/2016 because CMS  determined that “Cigna’s conduct posed a serious threat to the health and safety of Medicare beneficiaries.” 

CMS conducted an audit of Cigna’s Medicare operations and concluded that Cigna substantially failed to comply with CMS  requirements for Part C and Part D organization/coverage determinations, appeals and grievances, Part D formulary and benefit administrations, access to facilities and records and ineffective compliance program.  CMS found that Cigna’s failures in these areas were widespread and systemic.

Cigna’s acquisition of HealthSpring in 2012  brought an additional 1 million Medicare beneficiaries and created an organizational structure that CMS described as “decentralized and fragmented.”  The sanctions will remain in effect until CMS is satisfied that the deficiencies that are the basis for the sanctions have been corrected and are not likely to recur.

 

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