CMS Removes Medicare Advantage Sanctions on Cigna

June 2017 ~

CMS has lifted enrollment and marketing sanctions against Cigna, allowing the insurer to resume marketing and enrollment for its Medicare Advantage and prescription drug plans.

According to an Securities and Exchange Commission (SEC) filing, the insurer can immediately reinstate marketing tactics for Medicare Advantage (MA) and Part D plans as well as begin enrolling individuals in those plans with effective dates beginning July 1.

In January 2016, Cigna was banned from both marketing and enrolling people in MA and Part D plans since following claims that the insurer violated regulations regarding coverage determinations, appeals and grievances; Part D formulary and benefit administration; access to facilities and records; and compliance program effectiveness. According to CMS, these violations led to increased out-of-pocket expenses for enrollees, as well as delays or denials in receiving medical services and prescription drugs.

“We are a better and stronger company as a result of collaborating with CMS and investing further in our processes and technology over the past year and half,” stated Shawn Morris, interim president for Cigna-HealthSpring. “As a company that puts customers first, we look forward to continuing that partnership while delivering high-quality healthcare plans to both existing and new customers.”

Cigna said in its SEC filing that it expects that approximately 60% of its Medicare Advantage customers will be in a plan with Medicare star ratings of four or higher.


Source(s): Modern Healthcare; FierceHealthcare; Healthcare Finance; HealthcareDIVE;