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Monday, Jan 25 2016

Full Issue

'Widespread And Systemic Failures' Cited In Cigna Medicare Advantage Suspension

The Centers for Medicare & Medicaid Services said Cigna did not handle complaints and grievances from patients properly. The suspension will not affect those already enrolled.

Cigna Corp. said Friday that enrollment into its Medicare Advantage and prescription-drug plans has been halted by the government, posing a challenge to the insurer as it aims to wind up its acquisition by Anthem Inc. In a letter to Cigna, the Centers for Medicare and Medicaid Services said it imposed the sanctions because of problems with the insurer鈥檚 coverage-appeals process, among other issues, and the agency cited a 鈥渓ongstanding history of noncompliance鈥 with requirements. Connecticut-based Cigna was also blocked as of 11:59 p.m. EST Thursday from marketing its Medicare plans. (Wilde Mathews, 1/22)

The U.S. government has suspended new enrollment in Cigna Corp's Medicare Advantage health insurance and prescription drug plans, saying Cigna had "widespread and systemic failures" that prevented patients from accessing medical services. The government said Cigna did not handle complaints and grievances properly from patients who had been denied coverage for health benefits or drugs, according to a Jan. 21 letter from its regulator, the Centers for Medicare and Medicaid. (Humer, 1/22)

U.S. regulators have temporarily banned health insurer Cigna from offering certain Medicare plans to new patients after a probe uncovered issues with current offerings. ... The sanctions, which took effect at the end of the day Thursday, do not affect patients who are already enrolled. CMS said could not provide an estimate for how many patients were affected. (Bomey, 1/22)

In other news on Medicare Advantage, a new study looks at CMS's cost predictions聽鈥

The Centers for Medicare and Medicaid Services under-predicts costs for Medicare Advantage patients with multiple chronic illnesses by about $2.6 billion annually, according to a study by Avalere Health. The report, published today and funded by the lobbying group America鈥檚 Health Insurance Plans, suggested Medicare Advantage鈥檚 risk-adjustment model is to blame for the cost discrepancies. (McIntire, 1/22)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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