CMS investigates Humana on Part D channelling
Federal officials are investigating whether one health-insurancecompany that sells prescription-drug coverage to Medicare beneficiariesinappropriately diverted its most expensive customers to a competitor. Sierra Health Services, which offers Medicare Part D prescription-drugplans under the brand name SierraRx, alleges that Humana Inc.telephoned its highest-cost customers and recommended they purchasecoverage from Sierra instead. Humana counters that it merelypassed along information to its customers about a competing productthat might better suit their needs, and said federal regulatorsapproved 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 comprehensiveprescription-drug coverage to the oldest, sickest and costliestMedicare participants. Sierra executives met with CMSofficials at the agency’s headquarters in Baltimore last Wednesday. CMSspokesman Jeff Nelligan would only comment: “We’re aware of this issueand reviewing it.” Sierra made its accusations during ahastily arranged conference call with investment analysts last Tuesday.The company had looked in January at its drug claims and did not likewhat it saw.