Home > Health Insurance Company: Fraud, Denials and Other Issues > Health Insurance Companies Fined $940 Million for Failing to Reimburse Physicians

Health Insurance Companies Fined $940 Million for Failing to Reimburse Physicians

Health insurance companies  routinely do not reimburse physicians on purpose in order to protect company profits. This problem has skyrocketed over the past decade alone. During this particular time period, One hundred nine companies were fined $940,445,363 for failing to pay physicians in a timely manner.  States gave 104 companies 455 fines totaling $156,951,581.   Forty four are non-profit and they were fined 170 times totaling $62,030,981.  Sixty five are for-profit and they were fined 285 times totaling $94,920,600.  Ten for-profit companies had federal ERISA settlements against them which totaled $784,855,000. Blue Cross Blue Shield had the most fines of the non-profit sector which totaled $54,645,878. UnitedHealthcare was fined the most of the for-profit sector which totaled $417,514,675.
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Not-for-Profit
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Affinity
# of State Fines:   5
Total State Fines:  $30,900  (Source 1
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Alameda Alliance
# of State Fines:    1
Total State Fines:  $333,229    (Source 1
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Blue Cross Blue Shield
# of Fines:   43
Total State Fines:  $54,645,878  (Source 1
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Capital District Health Plan
# of State Fines:    6
Total State Fines: $55,700  (Source 1
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Centercare
# of State Fines:  3
Total State Fines: $8,200  (Source 1
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Community Choice
# of State Fines:  2
Total State Fines:  $10,300   (Source 1
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Community First Health Plans
# of State Fines:    1
Total State Fines:  $200,000    (Source 1
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Community Health Plans of NY, Washington
# of State Fines:    4
Total State Fines:  $1,005,200  (Source 1
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Community Premier Plus
# of State Fines:    1
Total State Fines:  $1,200    (Source 1
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Fidelis
# of State Fines:    5
Total State Fines:  $10,100  (Source 1
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FreeState
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
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HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
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Group Health Cooperative
# of State Fines:    15
Total State Fines:  $57,050 (Source 1
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Health Services Med Corp
# of State Fines:    1
Total State Fines:  $7,300 (Source 1
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Healthcare Underwriters Mutual
# of State Fines:    1
Total State Fines:  $9,750  (Source 1
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HealthNow (Medicare Advantage)
# of State Fines:    12
Total State Fines:  $1,170,300 (Source 1
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Health Plus
# of State Fines:    3
Total State Fines:  $75,200  (Source 1
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Healthsource plan of NY/NJ
# of State Fines:    2
Total State Fines:  2,200 (Source 1
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Heritage Provider Network
# of State Fines:    2
Total State Fines:  $294,000  (Source 1
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HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
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Hometown Health Plan
# of State Fines:    1
Total State Fines:   $25,000 (Source 1
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Indemnity Insurance Company
# of State Fines:    1
Total State Fines:  $1,800 (Source 1
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Independent Health Association
# of State Fines:   5
Total State Fines:  $49,775 (Source 1
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Inland Empire
# of State Fines:    1
Total State Fines:  $2,500  (Source 1
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Inter Valley
# of State Fines:    1
Total State Fines: $7,500   (Source 1
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JMH Health Plan
# of State Fines:    1
Total State Fines:  $25,000 (Source 1
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Kaiser Foundation Health Plans
# of State Fines:    13
Total State Fines:  $792,800 (Source 1
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Lifewise Health Plan
# of State Fines:    1
Total State Fines:  $1,250 (Source 1
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Managed Health Network
# of State Fines:    2
Total State Fines:  90,000  (Source 1
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Mayo Health Plan
# of State Fines:    1
Total State Fines: $25,000  (Source 1
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Med Mutual of Ohio
# of State Fines:    1
Total State Fines:  $100,000 (Source 1
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Mercy Health Plans
# of State Fines:    1
Total State Fines:  $100,600 (Source 1
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Molina
# of State Fines:    1
Total State Fines:  $5,000 (Source 1
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MVP Health Plan
# of State Fines:    3
Total State Fines: $35,000  (Source 1
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Promina Health Plan
# of State Fines:    1
Total State Fines: $81,635  (Source 1
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Providence Health Plan
# of State Fines:    2
Total State Fines:  $3,750 (Source 1
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Sharp Health Plan
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
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Sloans Lake
# of State Fines:    1
Total State Fines:  $156,750 (Source 1
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St. Barnabus (Partners in Health)
# of State Fines:    1
Total State Fines:   $1,300 (Source 1
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St. Joseph’s Care Management
# of State Fines:    1
Total State Fines:  $33,538 (Source 1
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SummaCare
# of State Fines:    1
Total State Fines:   $125,000 (Source 1
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Unicare Life
# of State Fines:    6
Total State Fines:  $1,533,426 (Source 1
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Univera / Health Plan Inc (NY)     NP
# of State Fines:    2
Total State Fines:  $24,550 (Source 1
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Vytra
# of State Fines:   9
Total State Fines:  $483,800 (Source 1
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For-Profit
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Aetna  (Public Traded)
# of  State Fines:     31
Total State Fines:  $8,262,982  (Source 1
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American Heritage Life (AllState, Publicly Traded)
# of State Fines:  2
Total State Fines: Fined $264,765  (Source 1
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American Medical Life
# of State Fines:     1
Total State Fines $1,000       (Source 1
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Amil International Insurance Company
# of State Fines:   2
Total State Fines  $196,543  (Source 1
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Alta Health and Life
# of State Fines    1
Total State Fines: $250  (Source 1
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Avemco Insurance
# of State Fines:   2
Total State Fines: $269, 729  (Source 1
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Beacon Health Plan
# of State Fines: 1
Total State Fines: $50,000    (Source 1
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Capitol American Life
ERISA Settlement:  $6,826,000 (Source 6
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Careplus
# of State Fines: 4
Total State Fines:  $28,345  (Source 1
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Central Reserve Life
# of State Fines:  2
Total State Fines:   $811,513 (Source 1
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CHA HMO
# of State Fines:  1
Total State Fines:  $43,750   (Source 1
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Cigna (Publicly Traded)
# of State Fines:    26
Total State Fines:  $4,954,534 (Source 1
ERISA Settlement:  $954,000  (Source 6
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Combined Insurance Company of America of Illinois
# of State Fines:  1
Total State Fines:  $30,000   (Source 1
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Conseco Medical Insurance Company
# of State Fines:    3
Total State Fines:    $1,820,610  (Source 1
ERISA Settlement: $9,975,000   (Source 6
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Continental Assurance
# of State Fines:    3
Total State Fines:   $161,212   (Source 1
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Coventry
# of State Fines:  1
Total State Fines:  $10,000  (Source 1
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CVS
ERISA Settlement: $3,000,000  (Source 6
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Dental Benefit Providers Maryland
# of State Fines:    2
Total State Fines:   $80,000  (Source 1
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Excellus
# of State Fines:    8
Total State Fines:   $36,400  (Source 1
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Florida 1st Health Plan
# of State Fines:    1
Total State Fines:  $25,000  (Source 1
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Fortis Insurance
# of State Fines:   3
Total State Fines:  $1,410,055  (Source 1
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Foundation Health
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
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FreeState
# of State Fines:    1
Total State Fines:   $75,000 (Source 1
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Great West Healthcare
# of State Fines:    4
Total State Fines:  $2,323,669  (Source 1
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Guardian Life
# of State Fines:    6
Total State Fines:  $1,440,305 (Source 1
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Hartford Casualty Insurance Company
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
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Health Care Plan of NY
# of State Fines:    1
Total State Fines:   $20,500 (Source 1
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Health Insurance Plan of NY
# of State Fines:    10
Total State Fines:  $351,350 (Source 1
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Health Net
# of State Fines:    9
Total State Fines:  $521,700 (Source 1
ERISA Settlement: $215,000,000  (Source 6)
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Health Options
# of State Fines:    1
Total State Fines:  $50,000  (Source 1
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Healthplan Southeast
# of State Fines:    1
Total State Fines: $50,000   (Source 1
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HMO Colorado
# of State Fines:  1
Total State Fines:  $252,500  (Source 1
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Human Affairs
# of State Fines:    1
Total State Fines:  $5,500 (Source 1
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Humana (Publicly Traded)
# of State Fines:    9
Total State Fines:  $2,879,113 (Source 1
ERISA Settlement:  $58,000,000  (Source 8
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LifeGuard
# of State Fines:    1
Total State Fines:  $40,000 (Source 1
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Magellan
# of State Fines:    2
Total State Fines:  $450,000 (Source 1
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Meco Health Solutions
ERISA Settlement: $42.5 million
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Med Insurance Company of Ohio
# of State Fines:    1
Total State Fines:  $60,000 (Source 1
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Mega Life and Health Insurance Company
# of State Fines:    3
Total State Fines:  $875,000  (Source 1
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MetLife Insurance Company
# of State Fines:   5
Total State Fines: $1,343,428  (Source 1
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MDNY
# of State Fines:    9
Total State Fines:  $185,650  (Source 1
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Merit  Behavioral
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
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Mid-South Insurance Company
# of State Fines:  1
Total State Fines:  $51,850 (Source 1
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Mid-West National Life
# of State Fines:    2
Total State Fines:  $140,500  (Source 1
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New England Life
# of State Fines:    1
Total State Fines:  $41,500 (Source 1
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New York Life Insurance
ERISA Settlement: $14,000,000  (Source 6)
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NYL Care
# of State Fines:   5
Total State Fines:  $1,092,050 (Source 1
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Oriska Insurance
# of State Fines:    1
Total State Fines:  $3,900 (Source 1
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Oxford Health Plans
# of State Fines:    13
Total State Fines:  $5,046,674 (Source 1
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Pacific Life and Annuity Company
# of State Fines:    3
Total State Fines: $3,530,579  (Source 1
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Physicians Healthcare Plans
# of State Fines:    2
Total State Fines:  $78,300 (Source 1
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Principal Life Insurance Company
# of State Fines:    2
Total State Fines:  $704,856 (Source 1
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Protective Life Insurance Company
# of State Fines:    2
Total State Fines:  $152,780 (Source 1
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Prudential
# of State Fines:    6
Total State Fines:  $216,000  (Source 1
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Qualmed Washington
# of State Fines:    1
Total State Fines:  $250,000 (Source 1
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Renaissance Health and Life
# of State Fines:   1
Total State Fines:  $1,750 (Source 1
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Rite Aid
ERISA Settlement: $67,600,000 (Source 6)
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Safeguard Health Plans
# of State Fines:    3
Total State Fines:  $239,339 (Source 1
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Sierra Health / Texas Health Choice Companies
# of State Fines:    3
Total State Fines:  $1,437,450 (Source 1
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Systemas Medicos
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
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Trustmark Insurance Company
# of State Fines:    2
Total State Fines: $595,676  (Source 1
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United American Insurance Company of McKinney
# of State Fines:   1
Total State Fines:   $190,000 (Source 1
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United Healthcare
# of State Fines:    59
Total State Fines:  $50,514,675  (Source 1, 2, 3,4, 5
ERISA Settlement: $17,000,000 (Source 6
ERISA Settlement: $350,000,000 (Source 7
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Vista Health Plan
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
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Well Care
# of State Fines:    6
Total State Fines:  $147,100 (Source 1
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 Sources:
2. http://americustimesrecorder.com/local/local_story_%20003234020.html
3. www.texmed.org/Template.aspx?id=6325
4. http://www.newsobserver%20.com/news/stor%20y/1152663.html
5. http://azstarnet.com/all-headlines/119565/
6. http://www.erisasettlements.com/press/ERISA-Chart.pdf

7. http://www.healthdatamanagement.com/news/ama-unitedhealth-insurance-lawsuit-ingenix-database-43997-1.html

8. http://www.bizjournals.com/milwaukee/stories/2005/10/17/daily14.html?from_rss=
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