Delaware Blues fined $325K for denying cardiac tests

Blue Cross Blue Shield of Delaware must pay a $325,000 fine for "deficiencies" in its nuclear cardiac imaging testing pre-authorization process, reports Insurance and Financial Advisor.

The insurer violated state law when it signed a contract with MedSolutions that guaranteed savings by denying high-tech imaging tests, such as nuclear cardiac exams. Separate state and federal investigations determined that Blue Cross inappropriately denied 73 physician orders for cardiac nuclear imaging studies for various reasons, including insufficient information or a scan ordered without a doctor having seen the patient in more than 30 days.

As a result of the illegal contract clause and denials, Blue Cross entered into a settlement agreement and consent order with Delaware Insurance Commissioner Karen Weldin Stewart. The settlement also orders Blue Cross to work with the American College of Cardiology on a pilot program that aims to reduce inappropriate testing. Blue Cross will underwrite the program, which is set to begin this fall, The News Journal reports.

If Blue Cross doesn't commit to the program for at least three years, it faces an additional $300,000 fine, according to the Newark Post.

To learn more:
- read the Blue Cross consent order (.pdf)
- read the Insurance and Financial Advisor article
- see The News Journal article
- check out the Newark Post article

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