California Regulators Seeking up to 10 Billion in Fines Against United HealthCare With Over 1 Million Violations After The Purchase of Pacificare HMO

Victor
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This is a large number of violations stacked up here by the State, 992,936 with a fine of 10k for each violation.  This could stand to be the largest fine in US history against a health insurance company.  United Health Group is appealing the process of course.  image

When United took over Pacificare they stated they would maintain PacifiCare's workforce and relationships with providers.  Providers soon complained after the take over as claims were not paid timely, customer service suffered big time. I heard those complaints personally from office where I was consulting.  Seriously offices could not get answers and I over heard offices on the phone with their offices all the time.  United even came out and said they were going to get to be more user friendly. In Orange County, many employers are looking for new HMO contracts for their employees as the rate went up when converting over to a United policy from the old Pacificare and some hospitals won’t take Pacificare/United employer plans. 

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

I think in all honesty their problems were data related in combining the systems which is really not an excuse but this happens and is still happening all over the place. As sick patients, we don’t get any exceptions.  We also had the Ingenix Inquisition too with United and most all other major carriers using the Ingenix data base to pay doctors and consumers short on out of network charges, and this is only one case there’s a lot more filed all over the US.  Pacificare was part of this before and under United.  image

AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)

During the last 15 years most of the major health insurance carriers paid Ingenix to license the data base used for out of network charges so United made money both from consumers and other health insurance companies with the data base that “low balled”

Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana

Headlines from 2008:

State intervenes in PacifiCare coverage dispute

United/PacifiCare fined record $3.5 million

With all of this said, there’s room for some fines for not taking care of business how much and what is up to the courts. 

IT’S ALL ABOUT THOSE COST EFFICIENCY ALGOIRITHMS THAT MAKE DECISIONS TO DRIVE PROFITS. 

Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

Insurers live and die by the algorithms and United owns Ingenix who can develop some whenever needed. 

I think the stuff that really works on public impressions too are what happens at board meetings with no holding a limit on what executives are paid and no concern over how much they want to spend on lobbying as the board says go for it.  image

UnitedHealth Shareholders Say We Don’t Care What Executives Earn and What Is Spent on Lobbying – Go For It

It is important to pay attention to their subsidiary actions too as this is shaping many of the directions where the company is headed to ensure profits and expand upon if possible.  The link below summarizes some of this in a prior post.  BD

UnitedHealth Group 2nd Quarter Profits for 2010 Rose 31% – Expects Revenues of 93 Billion for the Year

The health insurer violated state law nearly 1 million times from 2006 to 2008 after it was bought by UnitedHealth Group, the Department of Insurance says.

California regulators are seeking fines of up to $10 billion from health insurer PacifiCare over allegations that it repeatedly mismanaged medical claims, lost thousands of patient documents, failed to pay doctors what they were owed and ignored calls to fix the problems.
In court filings and other documents, the California Department of Insurance says PacifiCare violated state law nearly 1 million times from 2006 to 2008 after it was purchased by UnitedHealth Group Inc., the nation's largest health insurance company by revenue.

The state's accusations are spelled out in documents filed with a state administrative law judge who has been hearing testimony intermittently since last December. At the conclusion of the Oakland hearing, the judge will decide whether to recommend penalties.

California regulators seek up to $10 billion in fines from PacifiCare - latimes.com

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