Friday, March 9, 2007

CMS investigates Humana on Part D channelling

Federal officials are investigating whether one health-insurance company that sells prescription-drug coverage to Medicare beneficiaries inappropriately diverted its most expensive customers to a competitor.  Sierra Health Services, which offers Medicare Part D prescription-drug plans under the brand name SierraRx, alleges that Humana Inc. telephoned its highest-cost customers and recommended they purchase coverage from Sierra instead.  Humana counters that it merely passed along information to its customers about a competing product that might better suit their needs, and said federal regulators approved its actions. The dispute between the two companies, and the involvement of the Centers for Medicare and Medicaid Services (CMS), highlights the difficulty of offering comprehensive prescription-drug coverage to the oldest, sickest and costliest Medicare participants.  Sierra executives met with CMS officials at the agency’s headquarters in Baltimore last Wednesday. CMS spokesman Jeff Nelligan would only comment: “We’re aware of this issue and reviewing it.”  Sierra made its accusations during a hastily arranged conference call with investment analysts last Tuesday. The company had looked in January at its drug claims and did not like what it saw.

Source/more:  The Hill

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