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Category: Health Insurance

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HMOs Fined Millions for Failure to Pay Claims

Wed Dec 15th, 2010 on     Health Insurance,    

Insurance regulators in Florida could not ignore the recent fines imposed on seven health maintenance organizations in California. The organizations were the targets of that state’s Department of Managed Health Care investigation into complaints from doctors and other health care providers about insurance claim payment practices. The fines totaling $5 million were just part of the decision: The seven HMOs must also pay restitution to the providers, and that could add up to tens of millions of dollars.

Health Insurer’s ‘Most Favored Nation’ Clauses Challenged

Wed Oct 20th, 2010 on     Health Insurance,    

Both the federal government and the State of Michigan filed suit this week against Blue Cross & Blue Shield of Michigan, alleging that the insurer’s “most favored nation” clauses with hospitals violate the Sherman Antitrust Act and the Michigan Antitrust Reform Act. The Justice Department did not indicate if there are plans either to investigate or to take legal action against health plans in other states; the outcome of the suit, however, will likely affect how the Blues and other health insurance companies contract with hospitals throughout the nation.

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