CMS notifies Medicare Part D provider Aetna of possible sanctions

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The Centers for Medicare & Medicaid Services recently notified Aetna Insurance Company of its intent to impose an intermediate sanction to ensure that Medicare beneficiaries continue to have access to prescription drugs under Medicare's requirements.

The sanction will prevent Aetna from marketing to and enrolling new beneficiaries effective April 21, according to a CMS release. Aetna, which is one of the largest insurance providers in the country, received the notification because it has continued to improperly administer the Medicare drug benefit in the plan's national stand-alone prescription drug plan (PDP) and its 25 Medicare Advantage prescription drug (MA-PD) contracts, according to CMS. There are roughly 1 million Medicare beneficiaries enrolled in Aetna's PDP and MA-PD plans.

CMS intends to closely monitor the Aetna plans to determine whether adequate corrective measures have been taken. CMS recently terminated its Medicare prescription drug contracts with Fox Insurance Company (McKnight's, 3/11/10), and has said similar action could be taken against Aetna if deficiencies continue.

To read CMS's letter to Aetna, click here.