California regulators probe Health Net over stopped payments

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California insurance regulators are investigating claims that Health Net Inc. has stopped payments to addiction treatment providers following concerns of fraudulent claims, according to Kaiser Health News.

Officials at the California Department of Insurance and the California Department of Managed Health Care are reviewing complaints from treatment providers who claim they haven't received payment for services from the insurer since January. Similar allegations have been levied against the company by providers in Arizona.

The investigation stems from a letter, obtained by KHN, that was sent to addiction treatment providers in January by Matthew Ciganek, Health Net's director of special investigations, indicating Health Net was investigating claims for out-of-state patients and concerns that providers were waiving deductibles and copays.  

The allegation that Health Net has stopped payments to providers entirely raises concerns that the insurer is overstepping its authority, and threatens to put some providers out of business. In some instances, addiction treatment facilities are refusing patients with Health Net coverage.

In recent months, the addiction treatment industry has been overrun by marketers and kickback schemes that ply addicts with cash to enroll in rehab programs, leading insurers to intensify audits with more comprehensive records requests. Last year, Cigna pulled out of the Florida marketplace, citing an increase of fraudulent addiction treatment claims.

To learn more:
- read the KHN article
- here's the Health Net letter

Related Articles:
Kickbacks, marketers infiltrate addiction treatment industry
Payers are ramping up addiction treatment audits
Addiction providers look to alter the industry's growing reputation for fraud

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