With Medicare enrollment upon us, two of the largest health plans in Oregon are trying to recoil from penalties imposed by the Centers for Medicare and Medicaid Services for violating drug benefits, coverage decisions and handling consumer complaints – Moda Health and Regence BlueCross BlueShield of Oregon.
Earlier this summer, CNS imposed civil fines on these two insurers after conducting federal audits, saying they’ve been seeing the same kind of deficiencies year after year.
Moda Health paid a penalty of $312,000 because of its failure to properly manage its drug purchasing plan.
“This is first time this has ever happened to us,” Jonathan Nicholas, vice president of marketing, told The Lund Report in an email response.
“CMS conducted an audit of our Medicare operations in September, 2013, and we quickly did everything they asked of us. The penalty was announced this year on July 17, but weeks earlier Moda already had submitted corrective action plans to CMS and a final validation audit had taken place July 7 and 8. CMS notified us on July 25, one week after they levied the fine that we now are in full compliance.”
When asked to disclose its current Medicare enrollment in Oregon, Nicholas declined to respond, calling this “proprietary information.” However, an earlier article in The Oregonian, pointed out that Moda had 10,300 Medicare enrollees in its Part D drug coverage plan, but didn’t list out its total membership.
From the perspective of Regence, meanwhile, which was fined $254,000 on July 16 for failure to properly manage its prescription drug program and failure to reach out to patients or doctors to get information necessary to make appropriate clinical decisions, its spokesman, Jared Ishkanian, told The Lund Report, “Providing accurate, high quality service for our customers is our top priority. We have implemented system corrections and increased oversight to ensure problems do not reoccur, and are committed to helping any impacted members resolve any problems associated with this issue.”
Currently Regence has 8,000 members on its Part D plan and, counting all Medicare beneficiaries, a total of 74,000.
Across the country, the other insurers that have been penalized in the last year for similar violations are Capital BlueCross in Pennsylvania; Blue Cross and Blue Shield companies in Arizona, Florida and North Carolina; Aetna; WellCare, based in Florida; the Health Alliance Plan in Michigan; and CalOptima in Southern California, officials said.
Federal officials say they have repeatedly criticized, and in many cases penalized, Medicare health plans for serious deficiencies, including the improper rejection of claims for medical services and unjustified limits on coverage of prescription drugs.
Diane can be reached at [email protected].
