The federal government has taken punitive action against Aetna, barring the carrier from enrolling new Medicare clients. The actual ban will not go into effect until the 21st of this month, giving Aetna time to initiate some sort of corrective action process. Beset with complaints regarding its handling of  beneficiaries’ appeals processing and application of fed subsidies in an efficient manner, the insurer’s major compliance deficits occurred in the scope of its prescription drug plans with beneficiaries — no doubt an important component of beneficiary recruitment and retention.

Although this sounds like a major issue, it will more than likely be a temporary period of reorganization for the insurance company, as greater federal oversight into compliance matters becomes keener under the healthcare overhaul. A similar fate fell upon insurer Wellpoint last year when that company was ordered to stop marketing to potential enrollees. Wellpoint quickly corrected deficiencies and has ramped up its efforts to enroll in 2010. Since open enrollment has already occurred for this year, Aetna (just like many other for-profits) has already probably enrolled the lions’ share of beneficiaries for this year — maintaining earnings potentials in the process. | LINK

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