Feds Lift WellPoint's Medicare Advantage, Part D Suspension

John Commins, for HealthLeaders Media , September 10, 2009

WellPoint, Inc. will resume marketing its Medicare Advantage and Medicare Part D health plans on Oct. 1 and begin enrolling new customers on Nov. 15 for the 2010 contract year after CMS lifted a nine-month ban on new enrollments this week.

In a letter to WellPoint sent yesterday, CMS Program Compliance and Oversight Director Brenda J. Tranchida noted, "WellPoint has made sufficient progress in correcting its deficiencies to merit lifting the marketing and enrollment sanctions." However, Tranchida also noted that  "a recent CMS audit identified some continuing deficiencies in WellPoint's appeals and grievances processes."

As a result, Tranchida wrote, WellPoint will remain under its existing corrective action plans for its appeals and grievances processes. The insurer will also remain under its existing communications CAP, which requires WellPoint to disclose to CMS any new significant compliance issues. CMS will periodically ask WellPoint for specific data to assure that the deficiencies do not recur.

CMS also told WellPoint that it will not be automatically assigned new low-income subsidy members, although those low-income members can again choose WellPoint products during the upcoming Annual Enrollment Period.

CMS imposed the sanctions on Jan. 12 after a rash of consumer complaints about cost hikes and denied drug benefits. WellPoint blamed the snafus on a series of computer glitches, but CMS said at the time that it was suspending enrollment because the health insurer had failed to take corrective measures.

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