Coming from someone who has directly dealt with these Cigna audits in south Florida for many facilities,
Cigna is not directly "shutting down" facilities, but indirectly, facilities are shutting down because of this audit.
First off, there is nothing wrong with living in a halfway house and opening up a marketplace 792 policy (no linger available/active 2016). If you are now a resident of florida and living at a sober home, you qualify to open those policies when they were available through the marketplace. The first letter is "proof of residency" which the clients sends back in- then the 'real' letter comes...they send out to the insured ask them things such as "did you know you were going to an out of network facility" "did you know you were being billed at OON rates" "did you pay your deductible" "are you paying your co-insurance, (show us statements of payment)" "DID THE FACILITY PURCHASE YOUR POLICY FOR YOU?" They want to catch these facilities in "fee forgiving", not collecting DED and co-insurance. They are upset because these 792 policies are paid for (with a ACA premium), they pay out massive amounts of money for treatment, and then the policies term for non-payment, and they are left with a huge financial loss with no way to recoup. And Cigna is right for being mad, but frankly, they should also be mad at themselves. Who opens up a PPO in the capital of out of network substance abuse facilities? It was poor research on their end, they should never have chosen Florida to go on the marketplace as THE ONLY PPO, and now they are trying to clean up their mess.
As far as "shutting down" facilities, this is not true. At this point i know the Cigna SIU unit in Sunrise by first names. What they are doing is they are either sending audits or visiting facilities and auditing 35-40 patient medical records (primarily 792 but I've done audits containing U policies as well). For facilities that have good MR notes, they may pass the audit, Cigna lifts the payment ban, and they continue taking Cigna clients. But if the facility have bad medical records, that do not reflect the level of care authorized by Cigna/HealthSpring pre-cert team, they come back asking for every single cent since the facility opened their doors. This is causing facilities to shut their doors. So, I don't believe any one SIU Unit for an Insurance Company has the authority to shut down a facility. They can stop payment. They can ask for all payments back (causing the facility to be millions in debt and have to close their doors) or if they have information proving Kickbacks or Fee-forgiving, and provide that to the FBI, the FBI can come in and close a facility's doors. But shutting down a facility is out of their reach.
Facilities that do have good MR and can prove everything is in order 2 things happen; either Cigna lifts the ban, or Cigna just drags out the audit, "we are still in the process of reviewing the medical records" I have one lab that was opened and within 7 days the audit happened. There was only a week worth of claims and payments made, everything is perfect 100% per Cigna's Standards and Guidelines, and Cigna is still dragging their feet to lift the ban. But why would they? they don't want the OON lab being able to bill for UA samples tested. This was in July 2015. However, I have facilities that have had the ban lifted because they had impeccable notes showing medical necessity, and they are taking Cigna policies and receiving payment. And I have facilities that they have requested all the money back since they opened the doors because Cigna's "independent medical review specialists" deemed the notes insufficient. Cigna also claims to be outsourcing to an independent medical review team, but in actually, how independent can they be if they are being paid by Cigna?
Cigna is now trying to force their insured to only be able to do in-network treatment. Facilities that have all inclusive in-network SA/MH services, from detox to inpatient to php to IOP to OP. They have strategies in place for "pay-per-performance, and outcome based incentives" and are even trying to keep the clients in their home state. (This i personally disagree with, often an addict needs to change his persons, places, and things in order to maintain sobriety. Cigna is trying to say if you have a facility near your home, they don't want to cover you coming to Florida. I don't see them having a case for that, but this is based on my opinion, which I won't get into)
Cooperation with Cigna is your only option.