- Cigna had "widespread and systemic failures" in its appeals and grievances processes, according to a January 21 letter from the Centers for Medicare and Medicaid (CMS), Reuters reports. In response, CMS has suspended new enrollment in its Medicare Advantage health and drug plans, along with all marketing of those plans.
- CMS cited problems in Cigna's handling of complaints and grievances when patients had been denied coverage for health benefits or drugs. Cigna also failed to properly manage requests for prior authorizations and exceptions.
- Individuals who are already enrolled in the plan will not be affected, and impact may be limited as open enrollment for 2016 plans has already closed.
CMS halted enrollment in Cigna Medicare Advantage because the problems uncovered during an audit pose a threat to the health and safety of the Medicare patients who are enrolled in the plan.
For its part, Cigna has pledged to address the problems immediately and aggressively. Since the open enrollment period is over, there may not be material impact on Cigna's financials this year. However, there will be some cost to the insurer as people turning 65 can enroll in a Medicare-specific plan regardless of the time of the year.
As Herb Fitch, president of Cigna's Medicare Advantage business, and his management team work to address the deficiencies uncovered by CMS, Anthem's acquisition Cigna for $54 billion is still under review by antitrust regulators.