On January 21, 2016, the Centers for Medicare and Medicaid Services (CMS) imposed immediate intermediate sanctions (suspension of enrollment and marketing) for the Cigna-HealthSpring Medicare Advantage - Prescription Drug Plan contract numbers: H0150, H0354, H0439, H1415, H2108, H2165, H2676, H3945, H3949, H4407, H4454, H4513, H4528, H5410, H6751, H6972, H7020, H7787, H8423, H9460, H9725; and Prescription Drug Plan contract number S5617.
CMS determined that Cigna's conduct poses a serious threat to the health and safety of Medicare beneficiaries in that Cigna’s violations resulted in enrollees experiencing delays or
denials in receiving medical services and prescription drugs, and
increased out-of-pocket costs for medical services and prescription
drugs.
CMS auditors concluded that Cigna substantially failed to comply with CMS requirements regarding:
- Part C and Part D coverage determinations, appeals and grievances;
- Part D formulary and benefit administration;
- access to facilities and records; and
- compliance program effectiveness.
In a letter to Cigna-HealthSpring, CMS states that Cigna has had a longstanding history of non-compliance with CMS requirements. Cigna has received numerous notices of non-compliance, warning letters, and corrective action plans from CMS over the past several years. A number of these notices were for the same violations discovered during this audit, demonstrating that Cigna has not corrected issues of non-compliance.
CMS states that Cigna’s acquisition of HealthSpring, Inc. in 2012, which
expanded its presence in the Medicare segment and added more than 1
million beneficiaries to Cigna’s existing operations, contributed to
creating an organizational structure that is decentralized and
fragmented. On December 9, 2015, members of Cigna’s senior leadership
met with CMS to discuss the serious nature of the deficiencies
discovered during the audit. At that time, Cigna discussed with CMS that
an integration of operations among its various legal entities is
necessary to run an effective organization. This breakdown in its
operations has made it difficult for Cigna to adequately monitor and
oversee whether it is in compliance with the Medicare Parts C and D
requirements and has resulted in substantial failures that require
considerable correction in order for Cigna to return to a state of
compliance with CMS.
Current members of the above plans are not affected by the sanctions and
may remain with their Medicare plan. Members who wish to switch
Medicare plans may contact Medicare at 1-800-633-4227 and a
determination will be made on a case-by-case basis. See our article on
Special Enrollment Periods, CMS sanctions section.
Read CMS letter outlining details of Cigna's non-compliance:
www.cms.gov/ Medicare/ Compliance-and-Audits/ Part-C-and-Part-D- Compliance-and-Audits/ Downloads/ Cigna_Sanction_01_21_16.pdf