Re: PacifiCare failed to make timely payments on thousands of claims
From: Charlie Chambers (cchamber@embarqmail.com)
Thu Jan 31 15:34:22 2008
No, that's Frank-un-steen'.
This article made me smile. Nothing like sticking it to the man.
On Jan 31, 2008, at 1:25 PM, Meenan, Anna wrote:
> Well, it's about time they make those weasels pay. Hey did anybody
> catch the fact that the president of the California Medical
> Association is named Dr. Frankenstein? Poor guy.
>
> Anna Meenan, MD
>
>> http://www.latimes.com/business/la-fi-
>> insure29jan29,1,2413322.story?ctrack=1&cset=true
>> From the Los Angeles Times
>> INSURANCE
>> Health plan faces fines of $1.33 billion
>> UnitedHealth Group's PacifiCare failed to make timely payments on
>> thousands of claims, state regulators say. | DISCUSS
>> By Lisa Girion
>> Los Angeles Times Staff Writer
>>
>> January 29, 2008
>>
>> California regulators are expected to announce today that they are
>> seeking as much as $1.33 billion in penalties from Cypress-based
>> PacifiCare as a result of widespread problems stemming from its
>> takeover two years ago by healthcare giant UnitedHealth Group Inc.
>>
>> In an investigation prompted by widespread complaints, the state
>> Department of Insurance uncovered 133,000 alleged violations of
>> state laws and regulations regarding payments for medical care.
>> Each violation carries a maximum penalty of $10,000 for a possible
>> total of $1.33 billion.
>>
>> Separately, the state Department of Managed Health Care alleged
>> that 30% of the medical claims it reviewed were improperly denied.
>> That agency is seeking an additional $3.5 million in fines.
>>
>> "These were very serious violations," said Cindy Ehnes, executive
>> director of the Department of Managed Health Care. "The most
>> fundamental promise of insurance is that they will pay when you
>> are sick, and they will pay those physicians and hospitals in a
>> fair manner."
>>
>> Insurance Commissioner Steve Poizner expressed frustration at
>> efforts to get the company to make changes.
>>
>> "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," he said. "We're
>> going to put an end to that. If PacifiCare can't understand the
>> ABCs of basic claims payment, maybe it will understand the dollars
>> and cents of regulatory action."
>>
>> The problems stem from the $9.2-billion purchase of PacifiCare by
>> Minneapolis-based UnitedHealth in January 2006. The deal added
>> more than 3 million Californians to UnitedHealth, which now has
>> about 27 million enrollees nationwide.
>>
>> The company's regional executives acknowledged that the merger was
>> bungled in many ways. In a meeting with Times reporters and
>> editors Monday, David Hansen, UnitedHealth's regional chief
>> executive, apologized for the problems that the transition caused
>> physicians, hospitals and patients.
>>
>> Hansen said the company made a mistake in attempting to make too
>> many changes too quickly, and also was tripped up by unforeseen
>> problems such as the loss of a 9,000-member physicians network
>> contract.
>>
>> "Our integration issues and challenges shouldn't affect our
>> providers, and they shouldn't affect our members," he said. "We're
>> very regretful about that."
>>
>> At the same time, UnitedHealth executives downplayed the effect on
>> members and patient care, characterizing the problems largely as
>> administrative errors. Still, they said, the company was taking
>> the allegations seriously.
>>
>> "We have conducted a top-to-bottom review of PacifiCare of
>> California's operations, procedures and policies and are working
>> closely with state regulators to ensure that we resolve any
>> outstanding performance issues," spokesman Tyler Mason said.
>>
>> The potential fines are the latest black eye for UnitedHealth.
>> Longtime Chief Executive William McGuire resigned in 2006. Last
>> month, in the first settlement of its kind under post-Enron
>> corporate reforms, he agreed to pay $468 million to avoid trial on
>> charges that he secretly padded his paycheck by manipulating stock
>> options.
>>
>> The company stressed Monday that most PacifiCare members were in
>> health maintenance organization plans, which were largely
>> unaffected by the problems uncovered by state regulators.
>>
>> Regulators said they found problems primarily in preferred-
>> provider and point-of-service type plans, which serve about
>> 200,000 members.
>>
>> The two regulators planned to make an unprecedented joint
>> announcement of their findings today in an effort to underscore
>> the import they attach to the alleged problems.
>>
>> UnitedHealth executives stressed their cooperation with regulators
>> and said they expected the final amount due to be substantially less.
>>
>> Physician and hospital groups praised the action. Richard
>> Frankenstein, president of the California Medical Assn., the
>> state's largest physicians organization, said many doctors were
>> still having to fight to get paid on time and what they are owed.
>>
>> UnitedHealth "may claim this is an administrative issue," he said.
>> "But that doesn't help someone who needs their heart surgery
>> approved in a hurry."
>>
>> Regulators said some patients faced delays in getting in to see
>> physicians who were supposed to be available to PacifiCare members
>> but who were incorrectly dropped from computerized network lists
>> maintained by the parent company.
>>
>> They also said some patients were forced to pay out of pocket for
>> all or part of such visits. And some physicians and hospitals
>> considered dropping PacifiCare patients after the merger because
>> it was too difficult to collect payments from UnitedHealth.
>>
>> Dr. Ted Mazer, a San Diego ear, nose and throat specialist, said
>> the time he and colleagues spend fighting for fair and timely
>> payment from UnitedHealth had cut into the time they spent with
>> patients.
>>
>> "This really all boils down to access to care for everybody by
>> maintaining the infrastructure of a medical delivery system, which
>> is falling apart under government underpayment, health plan
>> underpayment and health plan profiteering," Mazer said.
>>
>> The slow payments caused big problems for the hospitals operated
>> by the University of California. "Our ability to care for our
>> patients rests on our ability to be paid timely and accurately,"
>> said Santiago Munoz, a UC associate vice president.
>>
>> UnitedHealth spokesman Mason said many of the problems were
>> identified and brought to the attention of regulators by the
>> company. In addition, he said, the company, which announced plans
>> to lay off more than 500 Orange County employees in late 2005 and
>> 2006, was hiring 50 people to help correct payment problems and
>> improve physician services.
>>
>> Mason also noted that both PacifiCare and UnitedHealth continue to
>> earn good marks from members in surveys and from a private
>> oversight organization.
>>
>> Hansen said some employers had dropped PacifiCare from their
>> benefit offerings as a result of the payment problems. They are
>> among a host of service problems affecting membership nationwide
>> that UnitedHealth executives recently discussed with Wall Street
>> analysts.
>>
>> lisa.girion@latimes.com
>>
>> Start the year off right. Easy ways to stay in shape in the new year.
>
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Charlie Chambers
--
Hood River, OR
cchamber@alumni.rice.edu
"Almost anything you do will seem insignificant but it is very important
that you do it....You must be the change you wish to see in the world"
-- Mahatma Ghandi.
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