Medicare agency orders Anthem parent to halt enrollments
Wednesday, January 21, 2009
The Centers for Medicare and Medicaid Services (CMS) has ordered WellPoint Inc., parent company of Anthem Blue Cross and Blue Shield, to stop enrolling Medicare beneficiaries and marketing its plans to them for now due to "significant compliance problems."
The order also applies to Anthem, which has 3.2 members in Ohio, including 345,000 in the Miami Valley.
A CMS spokesman said the number of complaints against WellPoint soared from fewer than 100 in December to more than 500 in the first 10 days of January, precipitating the federal agency's Jan. 12 letter outlining sanctions against the Indianapolis-based health benefits company.
In the letter, CMS claimed WellPoint has had "significant compliance problems" in meeting CMS' requirements for proper administration of the programs.
"Based on disclosures WellPoint made to CMS during the first nine days in January 2009, CMS determined that thousands of Medicare beneficiaries were denied access to critical medications including ... cardiac drugs, anti-seizure drugs, anti-clotting drugs, and drugs for asthma and Chronic Obstructive Pulmonary Disease (COPD), posing a serious threat to the health and safety of the beneficiaries," wrote Abby L. Block, director of CMS' Center for Drug and Health Plan Choice.
WellPoint spokeswoman Janice Kyser said in a prepared statement that the company "acted with urgency" after determining Jan. 1 there were issues with its members' ability to access Medicare Part D pharmacy benefits. By Jan. 2, it said the problem was fixed.
"We deeply regret this isolated incident and are pleased to report that, as a result of the steps we took, our Medicare members are able to access their benefits," Kyser said Wednesday, Jan. 21.
Beneficiaries enrolled in WellPoint plans do not need to do anything, the CMS spokesman said, but those encountering problems getting drugs or services should call their plan or (800) MEDICARE to file a complaint.
Contact this reporter at (937) 225-7457 or bsutherly@DaytonDailyNews.com.
