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Medicare lifts Citrus’ suspension

Carol Gentry
11/24/2009 © Health News Florida

Citrus Health Care, which was under Medicare suspension all year, has been granted a reprieve for 2010 – in the nick of time.

The Tampa-based company, which has over 54,000 customers in Central and South Florida, received the good news in a letter on Friday from the Centers for Medicare and Medicaid Services (CMS). Open-enrollment season for 2010 Medicare sign-up began Nov. 15, so Citrus will have to hustle to catch up with competitors.

The HMO won’t be participating in Medicare’s prescription-drug program next year, only the Medicare Advantage (MA) program. MA plans replace traditional Medicare coverage for both hospital and outpatient care, including doctor's visits.

Citrus aims to offer eight plans, said Lisa Brock, a spokeswoman for the company. One of those plans, the “Citrus Advantage,” will be available in all 20 counties that the company serves, she said.

“Employees at Citrus Health Care have worked extremely hard to address the concerns of CMS and we are gratified that they have recognized our effort,” CEO Bruce Carpenter said via Brock.

The letter from Brenda Tranchida, director of CMS’ Program Compliance and Oversight Group, said the agency “determined that Citrus has satisfactorily addressed the deficiencies that formed the basis for the sanction.”

The suspension was based on “serious deficiencies” in operations, such as failing to process members’ enrollments and resignations, pay bills and refunds on time, and check doctors’ credentials. 

The problems in Citrus’ prescription-drug plan were so serious that CMS rescinded its previous decision to “auto-assign” low-income beneficiaries to the company’s plan, which would have been a quick and easy source of new members.

Tranchida said in her letter that the agency will monitor Citrus throughout MA enrollment season, which ends March 31.

The letter was similar to the one sent to WellCare Health Plans, which was under a similar suspension until early this month.

Many of Citrus’ problems appeared to stem from cash-flow problems, according to records at the state Office of Insurance Regulation. Last year the company reported a loss of $14 million.

Such problems are common among start-up HMOs, which often find it hard to meet the state’s required 2-percent margin to show financial stability. Citrus was founded in 2003 and expanded rapidly, both in geography and variety of programs.

Even while Citrus was under suspension from Medicare, the state of Florida allowed the company to continue enrolling Medicaid beneficiaries in its HMOs, so that they now account for 38,700 of its members. While the federal CMS provides funding for both Medicare and Medicaid, which covers low-income young, old and disabled, states make the decisions in Medicaid.

(Editor's note: Tampa’s Citrus Health Care is not affiliated with Hialeah-based Citrus Health Network, which offers primary care and mental health services.)