The Centers for Medicare and Medicaid Services has ordered the insurance company to stop marketing efforts to enroll Medicare patients. The move follows an 11-day audit in June that found 38 instances of SummaCare failing to comply with the requirements for drug and supplemental Medicare coverage.
In a letter to the insurer this week, the federal agency said the violations stem from a lack of internal controls.
Elizabeth Schinderle with CMS said the suspension is in place until SummaCare has corrected the issues.
“We're taking action against an insurance company that delayed or denied beneficiaries’ access to prescription drugs and Medicare covered services and inappropriately charged additional costs for Medicare covered services and prescription drugs,” Schinderle said.
Patients currently enrolled in SummaCare should not be affected, but anyone having difficulty getting benefits should call 1-800-MEDICARE.
SummaCare has until Monday to submit a Corrective Action Plan, and until Wednesday, August 27 to request a hearing. Calls to Summa were not returned.
Due to an editing error, an earlier version of this story misspelled "suspend" in the headline.
