Just a little over a week after it suspended a prescription benefit provider for 21 states, the U.S. Centers for Medicare & Medicaid Services has terminated the company’s contract, effective immediately.

New York-based Fox Insurance Co., through its spokesman, said it “anticipates” reinstatement of its rights through CMS by working with the federal agency and its attorneys.

CMS announced that following an onsite review of Fox, it found “significant deficiencies” with the plan in not meeting Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care. These deficiencies, CMS added “jeopardized the health and safety of Fox enrollees.”

The Fox Medicare plan is available in Arkansas, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Missouri, North Carolina, New Jersey, New York, Nevada, Ohio, Pennsylvania, South Carolina, Texas and West Virginia.

CMS said it found that Fox had committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer and seizure medications.

“The immediate termination of Fox as a Medicare prescription drug plan demonstrates our commitment to protecting the health of some of their most vulnerable enrollees from getting necessary drugs, in some cases life-sustaining medicines,” said Jonathan Blum, acting director of CMS’ Center for Drug and Health Plan Choices, in a statement.  “CMS’s immediate action was essential to protect members’ health and safety – an integral part of our contract with all Medicare beneficiaries.”

Jules Abraham, a spokesman for Fox, told IFAwebnews.com the company is working with CMS and its attorneys “to resolve this situation as quickly as possible” and working to reinstate its Medicare contract.

Relief for clients

Federal officials said the immediate termination will not limit or delay access to drugs for the more than 123,000 Medicare beneficiaries currently enrolled in Fox plans. As of March 10, enrollees will obtain their prescription drugs through LI-NET, a program run by Medicare and administered by Humana, ensuring distribution of enrollee drugs.

Those currently enrolled in the Fox plan will be able to choose a new Medicare prescription drug plan through May 1, 2010, and those who do not choose a plan will be enrolled in one selected by Medicare.

On Feb. 26, CMS suspended the marketing and enrollment activities of Fox for not following Medicare’s rules for providing prescription drug coverage to its enrollees.

A subsequent onsite audit, conducted between March 2 and March 4, led CMS to discover “Fox’s problems persisted and it continued to subject its enrollees to obstacles in getting needed and, in many cases, life–sustaining medicines,” according to the federal agency. Because it was unable to satisfactorily address these compliance concerns and furnish medicines to its Medicare enrollees, the company had its contract terminated.

“We take our oversight role of Medicare prescription drug plans seriously,” Blum said.  “We review and take action on all complaints received about Medicare health and drug plans and will take appropriate and immediate actions wherever necessary.”

The website for Fox Insurance Co. showed a “currently unavailable” message when accessed March 10.