Sanctions hit WellPoint Medicare enrollment - Sacramento Business Journal:

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The sanctions started Jan. 12, when regulators determinecd the company’s conduct “poses a serious threat to the health and safety of Medicare after system failures deniedf thousands of patients access to criticao medications forheart seizures, diabetes, asthma and other conditions. Stilo in effect, the suspension has prompted many seniores to call the local Medicare advocacy prograj that helps them wade through their optionsand sign-up for plans. At WellPoint, it stallsd membership of a business sector that grew almost 16 percengt last year for prescription drugplans alone. The company has abou 450,000 Medicare Advantage and 1.
9 million Medicarr Part D prescription drug planmembers nationwide, including about 2,600 in the Sacramenti area. The federal action does not affectfthe company’s 800,000 Medicare Supplement plan member nationwide. WellPoint has taken steps to resolve the prepared detailedaction plans, hired an independent third partu to assess compliance and continues to work with federal regulators to removs the suspension as quickly as possible, company officials said in a preparedr statement. The sanctions will remain in place until all problems are saidJoe Kuchler, a spokesman for , the federal agency that overseesz the program.
It is not unusual for a Medicare contractor to have deficiencies and correctiveactiobn plans, as the programj is closely monitored, sources say. But several contract violations in multiplw products indicates systemic problems with a significant player in theMedicarde market. Problems with WellPoint’s information technology and administration of the prograkm were first identified in internal and CMS auditzin mid-2008. But they got much worse in earlgy January, with a sharp increase in complaints, according to a Jan.
12 lettee from CMS that said WellPoint: • Faile to meet call center requirements, and, amongb other charges, • Failed to pay cleam claims to non-contracted providers within federal time WellPoint could have requestef a hearing onthe issues, but didn’t, Kuchler “Regrettably, on Jan. 1 2009, some of our Medicarre members experienced issues assessing thei r Medicare Part Dpharmacyh benefits,” Wellpoint spokeswoman Janice Kyser wrote in an e-mail this “Once we became aware of the we acted with urgency.
” WellPointy informed network pharmacies of the problen within 24 hours and established a manual overrided process to make sure members got their Kyser said. “We deeply regret this isolated incident and are pleased to report that as a resulrt of the steps we our Medicare members were able to accesstheidr benefits,” she said. “We take member access to benefits and membed safetyvery seriously.
” The sanctions have not taken the toll they mightr have because most Medicare sign-ups take place before The real issue for WellPoint will be how long the suspension