CMS suspends new enrollment in CIGNA’s Medicare plans

CMS suspended new enrollment in CIGNA’s Medicare Advantage (MA) (Part C) and stand-alone prescription drug plans under Medicare Part D as of 11:59 p.m. on January 21, 2016. In a filing with the Securities and Exchange Commission (SEC), the company stated that the agency imposed “intermediate sanctions” based on findings that CIGNA failed to meet required standards for: (1) grievances and appeals in Part C and Part D plans; (2) formulary and benefit administration in prescription drug plans; and (3) compliance programs.

The company may neither market to nor enroll new members in any of its Part C or Part D plans. In the SEC filing, CIGNA stated that it was cooperating fully with the agency and is moving to resolve the issues as quickly as possible.

Under 42 C.F.R. sec. 422.752(b), CMS may impose suspension of marketing and enrollment of new members, when it finds serious violations of regulations that could lead to termination of a contract. It was reported that CMS’ January 21, 2016, letter to CIGNA said that the agency found “widespread and systemic failures impacting Cigna enrollees’ ability to access medical services and prescription medications” that “posed a serious threat to the health and safety of Medicare beneficiaries.” The letter also described Cigna’s “longstanding history of noncompliance.” It was also reported that the insurer must submit a corrective action plan by January 29, 2016.