State investigates insurer, provider for marketing misconduct

The New Mexico insurance commissioner is investigating the marketing practices of insurer Lovelace Health Plan and doctor practice ABQ Health Partners after the payer and provider accused each other of illegal marketing tactics, reported the New Mexico Business Weekly.

Lovelace and ABQ HP have been involved in testy contract negotiations, with ABQ HP terminating its contract effective Nov. 8. After the failed contact talks, Albuquerque, N.M.-based Lovelace sued the 184-doctor practice, claiming ABQ HP is trying to guide patients to leave Lovelace for other insurers, FierceHealthPayer previously reported.

"We are beginning an investigation on the marketing techniques and the steering procedures that we feel could be against the Division of Insurance's regulations," New Mexico Superintendent of Insurance John Franchini told Business Weekly. "I feel we need to look at both of them to ensure they are not violating the ability of the public to get a fair break and make a choice."

Franchini decided to investigate Lovelace and ABQ HP after representatives from both companies appeared before the Public Regulation Commission to explain their actions since contract negotiations ended Oct. 9. For instance, ABQ HP filed a complaint against Lovelace Health Plan with federal officials, claiming it improperly markets itself to patients and it even ordered Lovelace representatives out of 10 of its facilities, claiming they were soliciting patients in waiting rooms, clinical areas and pharmacies, Business Weekly reported.

If Franchini determines either firm has violated state regulations, he said he can issue cease-and-desist orders.

To learn more:
- read the New Mexico Business Weekly articles on the department's investigation and the ABQ HP complaint