First on the list to get paid are the community pharmacies, the small businesses which get hurt the worst. As mentioned after all of this and with Medicare suspending their marketing and enrollment back in March Fox is back in court wanting to be reinstated. CMS doesn’t feel they are yet meeting their obligations. You can read about the suspension from CMS below.
I do have to say you have to be pretty bad and out there on violations to be shut down by CMS, so their grounds I’m sure are pretty lock solid and with plenty of proof, not to mention unpaid claims. It was just last month that Consumer Watchdog advised HHS not to trust insurance companies and this appears to be an example of why the warning was issued.
Consumer Watchdog Warns Sebelius on Health Insurers – Good Reason for This as Insurer Subsidiaries Are in The Game to Play Just As Private Equity Groups Diversify and Collaborate Holdings
As health insurance companies and provider acquisitions and mergers take place, we need to be aware this is a changing world and there’s a lot going on sometimes behind the scenes with subsidiary action, stay alert and advised. BD
ALEXANDRIA, VA – The Fox Insurance Co. has agreed to wire $13.6 million in overdue payments for Medicare Part D prescription drug claims to ProCare Pharmacy Benefit Management, Inc., as a result of pressure from the Centers for Medicare & Medicaid, the National Community Pharmacists Assoc. and Senators Max Baucus (D-Mont.) and Charles Grassley (R-Iowa).
The payments come more than four months after CMS terminated its contract with Fox for the Medicare Part D drug plan after a review revealed multiple policy violations. CMS officials said it was the first termination of a contract for Part D since the program was created. As a result, more than 123,000 people who were enrolled in the Fox Insurance plan were transferred to coverage by other companies.
As part of the agreement, ProCare is closing claims and processing payments for claims from Feb. 16-28, 2010, in order to provide reimbursements to independent community pharmacies which provided prescription drugs to seniors.
“We find it particularly troubling that Fox is arguing in district court to have its contract reinstated while, according to CMS, the company continues to ignore its original fiduciary obligations for the period when the contract was in force,” the senators said. “Failure to pay these claims is in direct violation of the original contract and prompt-pay requirements.”