DOI Enters Settlement Agreement with United HealthCare

DOI Enters Settlement Agreement with United HealthCare
Companies Fined Nearly $800,000 for Alleged Violations of State Law
RALEIGH -- Insurance Commissioner Jim Long today announced that the Department of Insurance has entered into a settlement agreement with United HealthCare Insurance Company and UnitedHealthCare of North Carolina, Inc. The agreement resolves an investigation into allegations that the two companies violated state law in areas of claims payment and other issues. As part of the settlement, the companies agreed to pay a fine of $786,655.87.
Problems with claims settlement and claims payment first came to light in 2003 and 2004, when complaints from North Carolina consumers and healthcare providers led the North Carolina Department of Insurance (NCDOI) to scrutinize the two companies. At that time, the Department identified numerous and systematic problems with the claims handling process, and fined both companies as part of a settlement agreement in 2004.
The NCDOI's work in 2003 and 2004 proved to be of interest to regulators in other states. After the 2004 NCDOI settlement agreement, a multi-state agreement was entered to resolve concerns in the following areas:
  • claims processing, settlement and payment;
  • coordination of benefits;
  • appeals, grievances and complaint resolution;
  • explanation of benefits;
  • provider networks;
  • operations and management; and others.
Thirty-nine states and the District of Columbia signed a multi-state agreement over these alleged violations earlier this year. North Carolina did not participate in this agreement, citing concerns over restrictions placed on future regulatory examinations and activities of the NCDOI. This week's agreement includes most of the major provisions from the multi-state agreement and provides that NCDOI plans to participate in the ongoing multi-state examination activities arising out of the multi-state agreement. While this week's agreement mirrors much of the multi-state agreement, this agreement also gives NCDOI the flexibility to address future issues as they arise.
As required by state law, the monetary penalty collected will be distributed to the state public school system.
-- NCDOI --