When it comes to legal issues, Health Net is having a very bad year. First, it spent several long, tense months wrangling with state investigators over the way it handled policy cancellations. Now it's being investigated on charges that it violated federal laws regarding Medicare and Medicaid, and attempted to defraud the Medicaid system.
Health Net is accused of making automated calls to senior citizens that would connect them to sales agents. The sales agents allegedly then gave the seniors false or misleading information about the plan restrictions, enrollment deadlines, and even whether or not they would be eligible for Medicaid or lose Medicare drug benefits.
Furthermore, the company may have broken a federal law preventing anyone from being enrolled during an outbound call. And the report also cites instances in which Health Net agents apparently posed as beneficiaries in order to retrieve Medicaid identification numbers.
These accusations come in a year in which Health Net has already had a temporary marketing suspension placed on it by CMS. It also comes after executives were caught rescinding members' policies when they made expensive claims. Health Net was eventually forced to restore the coverage for affected members.
To read more about this case:
- Read this Modern Healthcare piece (reg. req.)