Aetna hit with penalty, suspended from signing up new Medicare members

Apr 12 2010

The Wall Street Journal: Medicare officials have suspended the Aetna insurance company from enrolling new members for "its Medicare Advantage and Medicare prescription-drug plans because the insurer didn't comply with rules about changing drug-plan designs, the government said." The sanctions come after the government says the Connecticut-based insurance company did not "meet requirements to make sure seniors could continue on their medications during changes to the Aetna plans in 2009 and those offered this year." The action will not affect current Aetna customers and is "unlikely to have a big financial effect on Aetna, analysts said. ... The sanctions could present a problem if Aetna hasn't resolved the government's concerns by the fall, when open enrollment begins anew. The company is working with beneficiaries and the government to resolve the problem quickly, said Fred Laberge, a spokesman for the Hartford, Conn., insurer" (Johnson and Wisenberg Brin, 4/10).

The Philadelphia Inquirer: "After Aetna, the region's second-largest carrier, changed how it covered prescriptions, some of its senior-citizen subscribers were not able to receive the medication they needed or were not able to resolve appeals quickly enough, the government said. ... Aetna covers 586,000 senior citizens for prescriptions, either through a Medicare Advantage Plan with a Part D component or through a stand-alone Part D plan. ... Aetna, based in Connecticut, is the fourth major insurer sanctioned in this way in two years. In the last two years, the government has changed how it enforces Medicare regulations, said Robert Zirkelbach, a spokesman for America's Health Insurance Plans, a trade group. Although the government has always provided oversight, Zirkelbach said, there have been more sanctions and more public announcements of the sanctions" (Von Bergen, 4/10).

CQ Healthbeat: "Aetna, in a statement issued by its corporate headquarters in Hartford, Conn., said that it is fully cooperating with the government and is working to resolve the issues raised by CMS as soon as possible. 'Compliance problems are unacceptable to Aetna,' said Mark T, Bertolini, president. 'The issues raised by CMS have our utmost attention'" (Norman, 4/9).