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Aetna Inc. must pay the federal government $1 million because its websites and customer service agents allegedly relayed inaccurate information about which pharmacies were in-network for various Medicare Advantage and prescription drug plans.
According to a notice from the Centers for Medicare and Medicaid Services, the company erroneously indicated that nearly 7,000 retail pharmacies were in-network. In addition to imposing civil monetary penalties, the agency has granted Aetna beneficiaries a special enrollment period to dis-enroll from Aetna plans and re-enroll in another Part D plan.
"Unfortunately, a select number of pharmacies were listed incorrectly in CMS Plan Finder as participating in some of Aetna's Part D pharmacy networks," an Aetna spokeswoman said in a statement. "These issues were swiftly resolved, and the majority of pharmacies and our members were not affected by this situation."
The CMS said the bad information meant enrollees had to pay cash at the point of sale for their prescription or to leave the pharmacy without their medications.
“This issue of noncompliance directly adversely impacted thousands of beneficiaries and had the substantial likelihood of impacting all Medicare beneficiaries enrolled in Aetna plans with incorrect pharmacy listings,” the agency said in the notice.
In all, 3,767 complaints against Aetna were logged between Jan. 1 and April 2. Of those complaints, 73% were related to in-network pharmacy coverage.
The company has until June 2 to appeal the fine, according to the CMS.
Virgil Dickson writes for Modern Healthcare, a sister publication of Business Insurance.
Increased investment spending and health care reform costs reduced Aetna Inc.'s fourth-quarter profits by more than one-third in 2014 compared to prior-year results, even as the company's total revenue grew by 12.1%.