CMS Imposition of Immediate Sanctions on Cigna-HealthSpring: Suspension of Enrollment and Marketing for Cigna-HealthSpring MAPDs and PDPs.

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