What We Are Reading

Some of you may have also seen last week’s NY Times front page, about the relapse rates for heroin across the country. Good news is that Florida is not alone in this fight. Bad news is the entire country clearly has been devastated as these “hot spots” know no borders or boundaries. If this was a virus, the CDC and the feds would declare a State of Emergency and people would likely be quarantined…..

Here is what we have been reading as of late, all of which points to positive news that your efforts are making a difference to people out there! Keep it up.

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  1. U.S. Government Suspends Enrollment in Cigna Medicare Advantage

    (Reuters) – The U.S. government has suspended new enrollment in Cigna Corp’s Medicare Advantage health insurance and prescription drug plans, saying Cigna had “widespread and systemic failures” that prevented patients from accessing medical services.

    The sanctions come after an October audit of the insurance giant, which is currently awaiting antitrust regulators’ approval of its planned merger with Anthem Inc. Cigna was ordered to stop enrolling Medicare beneficiaries in its medical service and prescription drug programs by the end of the day Thursday, according to a letter CMS sent Cigna-HealthSpring President Herb Fritch about the action.

    Cigna did not meet Medicare requirements in its handling of Medicare patients’ requests for coverage, questions about denials and coverage of prescription drugs, CMS found.

    As a result of these “widespread and systemic” failures, Cigna’s Medicare enrollees faced delays and denials in coverage for their treatment and medication, as well as increased out-of-pocket costs, CMS wrote in the letter.

    “The lack of a compliance infrastructure, coupled with serious deficiencies of Cigna’s administration of the Medicare Parts C and D requirements, resulted in enrollees being denied access to the medical services and drugs that they are entitled to receive,” according to the letter. “The nature of Cigna’s noncompliance provides sufficient basis for CMS to find the presence of a serious threat to enrollees’ health and safety, supporting the immediate suspension of Cigna’s enrollment and marketing activities.”

    This isn’t the first time Cigna has come under fire for its Medicare programs. Over the past several years, CMS has warned the insurer to fix many of the same problems it found in October, according to the letter.

    Cigna often did not reach out to health care providers to get more information before denying coverage, CMS found, and frequently skipped second or independent reviews of patients’ denied claims.

    During the 15-day audit period, nearly 64,000 provider claims were paid late or more than 60 days after they were submitted, CMS wrote in the letter.

    CMS also found problems with Cigna’s internal compliance policies, saying the insurer doesn’t have formal documentation of problems it encounters or proper communication between the company’s compliance officer and upper management.

    Cigna plans to be bought by Anthem Inc in a $45 billion deal, under review by antitrust regulators.

  2. Massachusetts Chief’s Tack in Drug War: Steer Addicts to Rehab, Not Jail

    In the area of “fee good” news, we continue to be impressed by the actions of a small police department in Gloucester, Mass. which has become the prototype of a national movement regarding restorative justice in the criminal justice system:

    “Any addict who walks into the police station with the remainder of their drug equipment (needles, etc.) or drugs and asks for help will NOT be charged,” he wrote. “Instead we will walk them through the system toward detox and recovery” and send them for treatment “on the spot.” That post from a small-town police chief was shared more than 30,000 times and viewed by 2.4 million people. By June, his Police Department had put his promise into action in what became known as Gloucester’s Angel program

    These law enforcement agencies are offering addicts referrals to treatment programs, either in lieu of arrest, as in Gloucester, Mass., or through direct outreach, according to the Police Assisted Addiction and Recovery Initiative.

    Also check out PAARI – The Police Assisted Addiction and Recovery Initiative.

    Call your local law enforcement agency and help them start a similar program as well.

About Jeffrey Lynne

Jeffrey C. Lynne is a South Florida native, representing individuals and business entities relating to licensing, accreditation, regulatory compliance, business structure, marketing, real estate, zoning and litigation pertaining to substance abuse treatment facilities and sober living residences. Mr. Lynne has been recognized across the region as a leader in progressive public dialogue about the role that substance abuse treatment has within our communities and the fundamental need and right to provide safe and affordable housing for those who are both in treatment for addiction and alcoholism as well as those who are established in their recovery.

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