HealthNet Barred From Enrolling New Medicare Members

Lund Report:

The Centers for Medicare and Medicaid Services has sanctioned HealthNet because of serious deficiencies with its prescription drug plan

After conducting an audit last August, CMS found that “HealthNet’s conduct posed a serious threat to the health and safety of Medicare beneficiaries,” and “discovered glaring violations” of its prescription drug formulary, according to a letter sent by Brenda Tranchida, director of the program compliance and oversight group for CMS.

“Issues of access to care and prescription medication can readily result in a potentially dangerous decline in medical status in this vulnerable population, many of whom suffer from chronic and disabling health conditions,” she wrote.

The majority of HealthNet’s Medicare population – 62 percent – is low income, and they cannot afford to purchase medications not covered by the health plan, which intensifies the problem.

“HealthNet’s intractable failure to provide its enrollees with prescription drug benefits in conformance with applicable law, the terms of its contract and CMS guidance exposes them to imminent and serious health risks,” according to Tranchida. “CMS has found that HealthNet has continually subjected its enrollees to impermissible hurdles in their attempts to obtain needed, and in some cases, life sustaining, prescription medications.”

Since the audit, HealthNet’s senior leadership team was given numerous opportunities to correct these deficiencies during conference calls and email correspondence, but failed to do so, which led CMS to impose the sanction.

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