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Health Net and two other insurers suspended from Medicare program Posted: December 2nd, 2010

By Maryalene LaPonsie

Insurance company Health Net is prohibited from marketing or enrolling new members in its Medicare plans according to a notice issued by the Centers for Medicare & Medicaid Services (CMS) on Nov 19. The sanctions come on the heels of a CMS audit that uncovered multiple violations of Medicare rules. Two other companies, Arcadian Management Services and Universal American Corporation, are also subject to government sanctions.

The sanctions against Arcadian and Universal American go into effect on December 5, 2010 and will remain in effect until the companies have corrected the identified deficiencies.Health Net, however, is subject to an immediate sanction because its audit revealed significant issues with its claim processing procedure. Since January, more than 127,000 prescription drug claims have been improperly rejected.

While the insurers are prohibited from enrolling new members, the sanctions do not affect the coverage of those currently enrolled in Medicare Advantage or Medicare Part D plans through the companies. Health Net currently serves 660,000 Medicare beneficiaries throughout the nation while Universal American has 300,000 enrollees and Arcadian has 66,000 Medicare members.

Current members who are concerned about their coverage or benefits are encouraged to contact the CMS at 1-800-MEDICARE.