Capital Blue Cross facing deadline to fix problems in Medicare programs

Written by Ben Allen, General Assignment Reporter | Jun 2, 2014 12:40 PM
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(Harrisburg) --  Capital Blue Cross, a health insurer based in Dauphin County, is working to satisfy the federal government after it halted enrollment for two Medicare programs.

In a letter last week, the Centers for Medicare and Medicaid Services called the problems "widespread and systemic".

The letter from CMS ordered Capital Blue Cross to stop advertising its Medicare Part C and Part D programs.

It says it found enrollees had to pay for services and prescription drugs covered by Medicare.

Gerard Mulcahy, Director of the Enforcement Group for Medicare Parts C and D, writes Capital Blue Cross doesn't have consistent procedures and a lack of internal controls.

"We're not gonna be happy until CMS is satisfied and we're gonna work on that on a day to day basis, on an hourly basis, until we get things where everything is back to where it was before," says Todd Shamash, head of Regulatory Affairs at Capital Blue Cross. He says it has a team working to resolve the issues.

"At this point, we're undertaking a full review of not only the letter, but our practices and our protocols here. This just happened a few days ago. For us, it's a matter of taking this very seriously, and have a lot of resources working on this," says Shamash.

Capital Blue Cross is facing a Thursday deadline to submit a plan to fix the issues.

CMS says the failures posed a serious threat to the health and safety of its members.

Shamash says it’s their goal to get a plan in place by then.

The halt on new enrollees does not affect current enrollees.

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