Managed Healthcare Executive - February 2009 - (Page 5) NEWS ANALYSIS Because of those regular interactions with the agency, WellPoint executives were taken aback by CMS’ sanctions. “Since we have been meeting with CMS on a regular basis regardPunishment might be a sign of tougher ing our remediation process, we were surprised by this recent action,” an crack-downs or generally weak oversight emailed statement said. “We have IZABELLA IIZUKA | C O N T R I B U T I N G W R I T E R made signi cant progress in addressing these issues.” While some believe the harshness NATIONAL REPORTS — As far Part C and Part D plans for current sys- of WellPoint’s punishment is a sign as Vicki Gottlich is concerned, com- tems to work e ectively.” of tougher and more vigilant governputer snafus might just be the canary in WellPoint has 1.9 million members in ment enforcement, others disagree. Medicare’s coal mine. The technology its Part D plan and 472,000 in its private The fact that it took CMS months to sanction WellPoint is indicative of glitches at WellPoint Inc. that prompted Medicare health plans. the Centers for Medicare and Medicaid In its letter to the company, CMS another problem: not enough overServices (CMS) to ban the insurer from cited the insurer’s “longstanding and sight and enforcement of Medicare’s requirements. marketing and selling “We have been its Medicare health and concerned that, bedrug plans should raise cause CMS has seen a number of red ags its role more as a about the program’s fupartner than as a ture, according to Gotregulator, [the govtlich, senior policy aternment] has not torney with the Center acted e ciently and for Medicare Advocacy. su ciently when “Clearly, computer plans fail to comply systems need to be updated, but the problem with rules,” Gottlich here stems from the says. “We have had push toward private deother experiences of livery mechanisms, and, plan sponsors being within that push, the sanctioned by CMS, emphasis on providonly to engage in ing unlimited choices similar activity. rather than on quality of Those of us who choice,” she says. persistent” failure to meet Medicare’s re- follow it see this as a black eye for She believes patients wouldn’t have to quirements, resulting in a “serious threat” the entire Medicare Part D program, worry about such problems if the drug to the health of its members. While the as will the [WellPoint] bene ciaries bene t were administered by the tradi- sanctions were prompted by a urry of who couldn’t get their medicine. tional Medicare program. consumer complaints over a two-week “I don’t think the public will have “There would be fewer steps to go period, the computer problems had been the same perception, however. CMS through to complete information ex- going on for months. In fact, WellPoint did a good job of portraying this as change, and we would rely on contrac- had been providing CMS with details nding problems, hearing bene tors similar to the contractors who al- of its plans to x the problems and even ciary complaints during the rst nine ready process Part A and Part B claims,” hired a third-party company to report on days of the year, and then taking acshe says. “Second, there are just too many its progress. tion,” she says. MHE Imagezoo/Getty Images FEBRUARY 2009 CMS halts WellPoint Medicare plans ACTION SURPRISING 5
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