Sat, Jul 04, 2009

Business

United Healthcare fined $364,750

Penalty largest ever by Dept. of Insurance
By Scott Simonson
arizona daily Star
Tucson, Arizona | Published: 03.11.2006
The Arizona Department of Insurance on Friday ordered United Healthcare to pay civil penalties totaling $364,750 — the largest fine in the department's history — for violations of state insurance laws.
State regulators said United Healthcare illegally denied more than 63,000 claims by doctors without receiving all of the information needed to accept or deny a claim.
The company also failed to follow state laws for promptly notifying doctors and patients about about decisions and appeals, the state said.
United also violated a 2002 agreement to correct previous violations, the state said.
The fines resulted from violations by United Healthcare of Arizona Inc., the state's sixth-largest HMO; and United Healthcare Insurance Co., a preferred provider organization, or PPO. United Healthcare's health plans have about 660,000 members in Arizona.
State regulators found the violations from mid-2001 through mid-2003. .
State insurance laws say that if a doctor submits a claim with incomplete information, a health-insurance company must seek more information before it decides to accept or deny.
But in about 63,000 claims — or 52 percent of claims examined by regulators — United Healthcare denied doctors' claims without asking for more information.
The investigation also found about 22,900 claims where United failed to follow state rules that require interest to be added to claims that are paid late.
A United Healthcare representative said in a statement that the company has corrected a number of administrative issues, and that customers, doctors and hospitals are satisfied with service.
"We have implemented new systems that improve our claims-processing and appeals efficiency and accuracy," said Tyler Mason, United Healthcare spokesman.
Friday's fine, which goes to the state general fund, broke the previous Department of Insurance record by more than $130,000, said Erin Klug, department spokeswoman.
● Contact reporter Scott Simonson at 573-4176 or at simonson@azstarnet.com.