Politics > Politics-Economics > Laissez-faire free market health care meltdown, UnitedHealth GroupInc. could face fines of up to $1.3 billion because its PacifiCare unitallegedly handled claims unfairly, Regulators investigated and uncovered atleast 130,000 alleged violations of st
| Topic: |
Politics > Politics-Economics |
| User: |
"" |
| Date: |
05 Feb 2008 08:49:26 PM |
| Object: |
Laissez-faire free market health care meltdown, UnitedHealth GroupInc. could face fines of up to $1.3 billion because its PacifiCare unitallegedly handled claims unfairly, Regulators investigated and uncovered atleast 130,000 alleged violations of st |
http://www.twincities.com/ci_8113027?nclick_check=1
Calif. roasts health insurer
Claims meltdown hits UnitedHealth
BY MARCUS WOHLSEN
Associated Press
Article Last Updated: 01/29/2008 09:01:15 PM CST
SAN FRANCISCO - UnitedHealth Group Inc. could face fines of up to $1.3
billion because its PacifiCare unit allegedly handled claims unfairly
after it was taken over by the nation's second-largest health insurer,
California officials said Tuesday.
Regulators investigated and uncovered at least 130,000 alleged
violations of state laws and regulations regarding payments for
medical care, California Insurance Commissioner Steve Poizner said in
a statement.
"After years of broken promises to California regulators, it became
crystal clear that PacifiCare simply could not or would not fix the
meltdown in its claims-paying process," Poizner said.
A maximum penalty of $10,000 applies to each violation, which include
wrongful denials of covered claims, incorrect payments, lost documents
and delays in handling claims. The maximum fine will apply only if
authorities prove all the violations and show they were committed as
part of a deliberate scheme.
A final decision on the amount of the fine likely was months away
pending the outcome of further hearings and the company's response, a
Department of Insurance spokesman said.
In a statement, Minnetonka-based UnitedHealth officials said the
company was cooperating with the department and believed it would not
face the "theoretical maximum penalty."
The problems stem from the $9.2 billion purchase of PacifiCare by
UnitedHealth in January 2006. More than 3 million Californians were
added to UnitedHealth in the deal.
Advertisement
The company now has about 27 million enrollees nationwide.
UnitedHealth officials said problems occurred when the company tried
to make too many changes too quickly.
"The pace of the transition may have resulted in some physicians and
other care providers experiencing inconsistent service in the past,"
spokesman Tyler Mason said.
Cypress, Calif.-based PacifiCare already had disclosed many of the
issues raised by regulators prior to the investigation and was taking
"aggressive steps" to make improvements, Mason said.
PacifiCare already has been fined $3.5 million by California's
Department of Managed Health Care over the alleged violations.
Department of Insurance investigators reviewed PacifiCare claims
processed between July 2005 and May 2007 following complaints from
patients and doctors, Poizner said.
UnitedHealth's regional chief executive David Hansen said the "vast
majority" of the alleged violations were administrative errors that
did not harm PacifiCare members. More than 80,000 of the violations,
he said, stemmed from not sending health care providers letters
acknowledging that claims were received, even though most of those
claims were paid on time, he said.
The president of the California Medical Association, the state's
largest physicians' group, praised the action against UnitedHealth,
saying patients and doctors have faced "chaos" since the merger.
"If they weren't prepared to manage that business from day one, they
shouldn't have done it," Dr. Richard Frankenstein said.
Also Tuesday, insurance rating agency A.M. Best Company Inc. said it
had downgraded UnitedHealth's credit and debt ratings over
expectations the firm's debt-to-capital ratio would increase in 2008.
The downgrade did not appear to stem directly from the investigation
announcement.
UnitedHealth's stock shed $1.22, or 2.3 percent, to close at $50.78
Tuesday.
.
|
|
|
Related Articles |
FOR UN-AMERICAN LIBERALS AT Earthlink ISP, Harry Hope ==> Dems, Jackson to Pay $200,000 in Fines
FOR PATHETIC LIBERALS AT Earthlink ISP, Harry Hope ==> Dems, Jackson to Pay $200,000 in Fines
Liberalism Is a Mental Disorder. ==> Dems, Jackson to Pay $200,000 in Fines
Another 430,000 join the jobless lines!
Fund campaigners close in on $80,000 goal
Defense Secretary Donald Rumsfeld should offer $100,000 reward to the person who finds WMD
2,000 Pages of Army Report on Abuse Missing
3,000 see Fahrenheit 9/11 in Li'l Georgie's hometown
| Jobless claims increase. 345,000 more Americans join jobless lines. Wages stagnate.
$50,000 for proof Li'l Georgie wasn't AWOL
*** >>> TCS to hire 12,000 for Gujarat centre in India <<< ***
Bush protected by warplanes, battleships, 15,000 troops because of....somethin'
Xansa to up headcount to 10,000
Unions Have No Answers to Outsourcing; Exports of Jobs in '04 Will Top 400,000
Brigade to up headcount to 4,000
|
|
|
