The Centers for Medicare and Medicaid Services (CMS) suspended new enrollment in Cigna Corp.’s Medicare Advantage health insurance and prescription drug plans, citing “widespread and systemic” failures that kept patients from obtaining medical services and prescription drugs.
On Jan. 21, CMS sent Cigna a sanctions notice stating that Cigna had not properly managed appeals and grievances filed by patients who had been denied coverage for medical services and drugs. Among other violations, the letter also noted problems with Cigna’s formulary and said the insurer had failed to properly handle requests for prior authorization and exceptions. CMS said in the letter that Cigna’s deficiencies created “a serious threat to enrollees’ health and safety.”
The sanctions took effect immediately and will remain in place until Cigna takes steps to correct the violations. The suspension does not affect currently enrolled members. Cigna has until Feb. 1 to send CMS a written rebuttal and has until Feb. 8 to submit a written request for a hearing.
Herb Fritch, president of Cigna’s Medicare Advantage business unit, Cigna-HealthSpring, told Reuters “the findings in the audit are unacceptable and will be addressed in full partnership with CMS.” He added that the company has already started to working to correct some of the problems.
In December, shareholders approved Anthem Inc.’s proposed $54 billion purchase of Cigna. The merger, which has not yet been approved by federal regulators, would create the country’s largest health insurance company.