Baucus, Grassley take on insurer over unpaid Part D claims

The bipartisan leaders of the Senate Finance committee are going after a New York-based insurance company for allegedly failing to pay claims under Medicare’s prescription drug benefit. 

The Fox Insurance Company was kicked out of the Part D drug program in March for violating a series of payment and appeals rules. But the company still received more than $33 million that month from Medicare — some of which the company is sitting on in lieu of paying out pharmacy claims, according to the Centers for Medicare and Medicaid Services (CMS).

Now, Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa) want to know why that’s the case. 

“We find it particularly troubling that Fox is arguing in district court to have its contract reinstated while, according to CMS, the Company continues to ignore its original fiduciary obligations for the period when the contract was in force,” the lawmakers wrote in a June 30 letter to Fox CEO Kary Shankar.

Baucus and Grassley posed four questions to Shankar: 

• “Medicare paid Fox more than $66 million to provide prescription drug benefits for February and March. How much of this amount was being held by Fox Insurance Company as of June 1, 2010, and why?”

• ”How many claims for services provided prior to the March 9th termination of your contract with Medicare have been received but remain unpaid as of the date of this letter?”

• ”Please provide details, including specific dates, on whether or not Fox intends to pay any and all appropriately filed outstanding pharmacy claims.”

• ”Please provide any other documents that you believe are relevant to any appropriately filed, unpaid claims.”

The lawmakers said they want a response by Friday.