state regulators

UnitedHealthcare subsidiaries to pay $800K in fines

Anne Zieger — Fri, 25 Jul 2008 11:35:42 -0400

UnitedHealthcare subsidiaries have agreed to pay almost $800,000 in fines to settle allegations by the North Carolina Department of Insurance that they'd violated state law regarding claims payment and other issues. This is the second time UnitedHealthcare has settled with the state in the past five years, having paid $2.2 million in 2004 to settle with regulators over problems with claims processing.

The 2004 settlement led to a broader investigation and agreement with regulators in 39 states and the District of Columbia, all of whom settled with UnitedHealthcare earlier this year. In the larger settlement, UnitedHealthcare resolved concerns noted by state regulators in several areas, including claims processing, settlement and payment; coordination of benefits; appeals, grievances and complain resolution; explanation of benefits and provider networks.

To learn more about the settlement:
- read this N.C. Department of Insurance press release

Related Articles:
UnitedHealth settles securities suit for $895M
United Healthcare to pay $12M to settle complaints

Walgreens battles CVS for MA retail clinic market

Thu, 12 Jun 2008 06:59:58 -0400

Over the past year, drugstore chain CVS has engaged in a protracted battle to get permission to open its MinuteClinics in locations across the Boston metro area. The effort involved not only getting permission from state regulators, but also fighting the displeasure of Boston Mayor Thomas Menino, who opposes the retail clinic model. Despite the struggles CVS has faced, fellow drugstore giant Walgreens has decided that it, too, wants a piece of the Boston retail clinic market, seeking state approval to open such clinics inside 16 of its Massachusetts stores. Walgreens' Take Care Health Systems subsidiary has asked permission to build clinics stretching across a broad swath of the state. Its plans also include opening a clinic in Roxbury, a move which is likely to further upset Mayor Menino. Walgreens, which already operates 173 clinics in 14 states, hopes to open its first Massachusetts clinics in the fall. All told, it expects to have 400 clinics running across the U.S. by the end of this year.

To learn more about Walgreens' efforts:
- read this article from The Boston Globe

Related Articles:
MA sets retail clinic rules
SLIDESHOW: Common Retail Clinic Locations
Boston's mayor objects to retail clinic approval
Massachusetts opens door--a little--to retail clinic expansion

SPOTLIGHT: Providers fight self-insured plans for payments

Thu, 29 May 2008 06:59:52 -0400

Increasingly, self-insured insurance plans offered by large employers and labor unions have become a worry for employers, who say that these plans aren't paying their claims in a reasonable amount of time. While insurance companies must contend with state regulators if they're too tardy in settling claims, self-insured plans are regulated by federal ERISA rules, which give them a great deal of leeway. And the number of workers covered by self-funded plans has risen sharply in recent times from, 44 percent in 1999 to 55 percent to 2007, making this an increasingly important concern for physicians and hospitals. Article

FL may regulate faith-based healthcare coverage

Mon, 28 Apr 2008 06:59:56 -0400

In recent times, a handful of religious organizations have sprung up that offer to pay members' healthcare bills if they pay into a common fund. These groups, which include Samaritan Ministries, Christian Healthcare Ministries and Medi-Share, collect insurance-like contributions, but assert vigorously that they're not insurance companies but rather, "ministries." However, despite these claims, state regulators are increasingly wondering whether these are, in fact, health insurance companies that should be regulated as such.

Now, the Florida legislature is set to consider legislation that would exempt the plans from oversight by the state's Office of Insurance Regulation. It would exempt companies like Florida-based Christian Care, which takes in about $50 million a year in payments. If the exemption is approved, Florida would become one 10-odd states, including Pennsylvania, Wisconsin and Kentucky, which have approved such exemptions.

To learn more about faith-based healthcare groups:
- read this St. Petersburg Times article

Related Articles:
Patients cut costs with faith-based health plans
Health plan-like "bill sharing ministry" under fire

Health plan industry addressing policy cancellations

Thu, 28 Feb 2008 06:59:58 -0500

Hoping to get some control of a situation that is rapidly deteriorating into a series of regulatory fines, lawsuits and heinously bad PR, the health-insurance industry is mounting an initiative to deal with the issue of retroactive policy cancellations. Industry group America's Health Insurance Plans has begun pushing state regulators to adopt a draft bill giving consumers the right to appeal rescissions to an external panel. Decisions by the panel, which would be composed of independent healthcare professionals and lawyers, would be binding on all parties. Meanwhile, some individual insurance companies, such as Blue Cross of California, are preparing to roll out their own independent review programs.

The initiative comes in the wake of several legal actions that have slapped health plans engaging in these cancellations. Last week, for example, a California judge awarded $9.4 million to a hairdresser whose medical coverage was canceled by Health Net while she was being treated for breast cancer. Health Net also faces a suit filed against it by the Los Angeles city attorney, who contends that the plan engaged in a concerted campaign to cancel patients' policies when they became ill.

To learn more about the health insurance industry's plans:
- read this piece from The Wall Street Journal

Related Articles:
L.A. sues Health Net over cancellations. Report
Health Net set goals, bonuses based on policy cancellations. Report
CA regulators plan limits to health policy cancellations. Report
BC of California fined $1 million for cancellations. Report
CA agency mulls review of policy cancellations. Report
Kaiser forced to reinstate coverage. Report
Blue Cross of California settles plan-cancellation suits. Report
Kaiser pushes for policy cancellation rules. Report

L.A. sues Health Net over cancellations

Thu, 21 Feb 2008 06:59:58 -0500

The Los Angeles city attorney has filed suit against Health Net, one of the state of California's largest health insurers, contending it engaged in an illegal, secret campaign to drop patients with individual policies if they needed costly care. Meanwhile, the city attorney also is opening a separate criminal investigation into the health plan's practice of paying employee bonuses partly based on how often they could cancel policies for individually-insured members submitting large claims.

In the current suit, attorneys argue that Health Net defrauded thousands of policyholders, as the policies it sold them are of virtually no value if the plan cancels coverage when consumers need them. The suit contends that the company's business practices routinely violate more than 20 state laws, including a prohibition against canceling policyholders for making inadvertent mistakes on applications. If the city attorney succeeds in his suit, he could theoretically collect a fine for each of at least 100,000 individual policies the health plan has sold over the past four years, which could mount up into hundreds of millions of dollars. This is only the most recent legal tangle between Health Net and government regulators. Prior to this, Health Net was hit with a $1 million fine by state regulators when it lied twice to state investigators about the employee bonus program.

To learn more about the city's case against Health Net:
- read this Los Angeles Times article

Related Articles:
Health Net set goals, bonuses based on policy cancellations. Report
CA regulators plan limits to health policy cancellations. Report
BC of California fined $1 million for cancellations. Report
CA agency mulls review of policy cancellations. Report
Kaiser forced to reinstate coverage. Report
Blue Cross of California settles plan-cancellation suits. Report
Kaiser pushes for policy cancellation rules. Report

CO targets home healthcare for reforms

Thu, 21 Feb 2008 06:59:54 -0500

Shaken by a report revealing some horrific abuses by home caregivers, state lawmakers in Colorado have filed legislation that would require agencies providing nurses, physical therapists and home caregivers to be state-licensed. Right now, Colorado is one of only five states that doesn't license home healthcare providers. Because caregivers don't need a license, state regulators are powerless to set minimum care standards or perform routine inspections. Without such oversight, patients have suffered great harm, including one whose foot was amputated due to improper care, and another who died on the toilet and was left for a day.

If the new bill becomes law, the state health department will be able to make surprise inspections of home care agencies, whether or not they receive state funding through Medicaid. Regulators would have the ability to impose sanctions ranging from citations to de-licensure.

To learn more about the state's proposed changes:
- read this item in The Denver Post

Blue Cross asks MDs for info to cancel policies

Tue, 12 Feb 2008 06:59:58 -0500

Blue Cross of California has raised eyebrows around the state, and sparked protests from some physician groups, by sending medical groups applications filled out by beneficiaries and asking the doctors, in effect, if the patients lied about their health. With the applications, which went out to large medical groups who have capitation contracts with the health plan, Blue Cross advised doctors to narc on patients who had any conditions not listed on the applications. This is just the latest in the plan's attempts to aggressively weed out sick patients. Blue Cross has already faced the ire of regulators for issuing policies then canceling them when the patients incur big medical bills.

The letter and accompanying application "outraged" the California Medical Association, according to president Dr. Richard Frankenstein. He argues that with doctors in the role of police, patients may be afraid to share their whole medical history with doctors, putting their health at risk. The association has sent a letter to state regulators asking them to order Blue Cross to stop asking doctors for patient information. A spokesperson for the state insurance commissioner said that while their office hadn't gotten any complaints about the letter, they consider it "extremely troubling," in that it effectively places doctors in the role of underwriters.

To learn more about this story:
- read this Los Angeles Times article

Related Articles:
Calif. bars Blue Cross of CA from demanding fee confidentiality. Report
Blue Cross of California pays $31M in P4P bonuses. Report
Blue Cross of CA settles plan-cancellation suits. Report
Blue Cross of California settles another policy cancellation suit. Report
Blue Cross slapped with $200,000 fine. Report
Blue Cross makes changes in face of lawsuits. Report

Calif. rules on MD visits through HMOs still stalled

Tue, 05 Feb 2008 06:59:56 -0500

Six years ago, California passed a new law requiring that HMO patients get timely appointments with their doctors. State regulators thought they had licked the problem--but they were a bit too optimistic, to say the least. To date, the rules still aren't in force, a problem which won't be solved until at least late this year.

In 2007, the state's Department of Managed Health Care at least made a start, releasing proposed rules for HMO doctor access. They included a requirement that plans provide appointments for diagnostic testing within 24 hours, for urgent physical therapy within 72 hours and for preventive care with a specialist within 22 days.

However, HMOs and physician groups objected to the agency's proposal vigorously, arguing that it wasn't smart to further regulate physician relationships with consumers. Eventually, DMHC threw up its hands and decided to let health plans come up with their own proposal. Now, the health plans have until October of 2008 to issue their own compliance plan. The agency will then review the rules.

To learn more about this debate:
- read this piece from the Los Angeles Times

Related Articles:
California officials plan PPO "report card". Report
Illinois doctors fight Medicaid HMO plan. Report
State court makes CT Medicaid HMOs disclose doctor pay. Report

Cedars-Sinai cited for endangering pediatric patients

Thu, 10 Jan 2008 06:59:55 -0500

The recent case in which pediatric patients at Cedars-Sinai Medical Center got heparin overdoses has resulted in censure from the California Department of Public Health, which said the hospital had "deficient practices" in how it administered the drug. State regulators found that the hospital didn't educate the staff adequately about safe heparin use, and that nurses failed to read drug labels carefully enough.

Last November, three children, including actor Dennis Quaid's newborn twins, were given 1,000 times the intended dose of the drug. All three recovered, though two needed treatment for the overdose.

Since the incident occurred, the Los Angeles hospital has issued an apology to the families, provided more staff training and set a system in place requiring four pharmacy workers to verify "high-alert" medications like heparin before the drugs go to a patient care unit.

To find out more about the hospital's efforts to address the errors:
- read this piece from the Los Angeles Times

Related Article:
Third baby dies at IN hospital due to heparin overdose. Report