Insurer Fines in California

One of California’s largest health insurance providers has distinguished itself, and not in a good way! The following article dives into penalties and enforcement actions of ten California insurance providers. 

 

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Patient Residency Weaponized

The federal government is actively pursuing cases of fraud with respect to ACA/Obamacare policies within the substance use treatment industry. This case is about residency. Where did the patient actually live when treatment was being provided? Some insurers have begun verifying residency of virtually every substance use treatment patient often resulting in denial of the claims based upon their inability to verify the patient resided in a state. 

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PA fines UHC $1M for violations of mental-health law

The Pennsylvania Insurance Department has fined United Healthcare for violations of the Mental Health Parity and Addiction Equity Act. If you have outstanding claims from 2015 forward you should develop a strategy to appeal those claims based upon this news.

United Healthcare fined $1 million by Pennsylvania for violations of mental-health law

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Major Blues insurer sued for denying BH claims

Per Harris Meyer at Modern Healthcare:

The company that runs Blue Cross and Blue Shield plans in five states is unlawfully denying behavioral health benefits to members in violation of generally accepted medical standards, according to a federal lawsuit seeking class action status.

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New substance use privacy rules could hurt, not help addiction patients

Patient advocates cautioned HHS against loosening patient privacy protections surrounding substance use disorder records, warning it could lead people to avoid treatment.

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