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

June 24, 2012 Leave a comment
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=

Breaking News: Health Insurance Companies to Uphold Health Reform Provisions

June 14, 2012 Leave a comment

Breaking News…………………………………….

The for-profit health insurance companies of UnitedHealthcare, Aetna, and Humana have come out saying that they will uphold provisions in the Affordable Care Act regardless of how the U.S. Supreme Court rules later this month. Key provisions they especially will uphold include: keeping kids on parents insurance until age 26, covering preventive services,  maintaining independent process of claim denials, and no lifetime limits on coverage. The not-for-profit insurers are already planning to uphold provisions as well. The for-profit companies have decided to take this position only because they see the way this can greatly enhance profit for their shareholders and that they definitely do not want to miss out on anything that will  maximize profit.

Press Releases of the for-profits announcing their position on this matter can be read here:

http://press.humana.com/news/humana/20120611006392/en/Humana-Voluntarily-Preserve-Key-Health-Care-Reform

States dropping For-Profit Health Insurance Companies from Medicaid Programs

June 11, 2012 2 comments

As of today, The great state of Ohio has taken the right step and has kicked out private for -profit health insurance company Aetna from insuring people in Ohio’s Medicaid program. This comes only 2 months after Aetna received the green light to manage 1.7 million recipients. The contracts were supposed to go into effect January 1 of next year. It is unknown as to why Aetna was dropped (source 1).

Ohio is not the only state to have recently stopped awarding state Medicaid contracts to Aetna and other large 4-profit companies. In December 0f 2011, the great state of Connecticut made a great decision and kicked out UnitedHealthcare and Aetna from managing its Medicaid recipients as well. State officials are reported as saying to USA Today that the companies were dropped for “not fulfilling their promise to lower costs and provide better care.” (source 2). This whole thing of “not fulfilling their promise to lower costs and provide better care” is unfortunately becoming an epidemic in this country to when it comes to insurers. This goes ditto for the 4-profit ones. These especially are getting caught more and more by the federal government for defrauding Medicare and Medicaid on purpose in order to get profits for their shareholders. Sadly, this situation is turning into the “plague”.

According to research that I have done, I have found out that Aetna and UnitedHealthcare collectively have paid out over $596 million in settlements over the past 5 years for having been caught defrauding Medicare and Medicaid (actual amount defrauded before settlement to be posted on blog soon). Total amount by insurers over same time period is nearly $3,000,000,000 (source 3). This situation is clearly getting worse. State governments have finally “smelled the Starbucks” and have realized that the best prescription for curing this problem is to simply kick out the 4-profit companies from state Medicaid programs. Hopefully more states will follow suit and drop for-profit health insurance companies from their Medicaid programs.

Sources:

1. http://online.wsj.com/article/SB10001424052702303753904577452362620192458.html

2. ttp://www.kaiserhealthnews.org/Stories/2011/December/29/Connecticut-Drops-Insurers-From-Medicaid.aspx

3. https://medaccessforamerica.wordpress.com/2012/05/14/health-insurers-fined-4-3-billion-for-medicare-fraud-and-other-fraud-violations/

Health Insurance Companies Fined $5 Billion for Medicare Fraud and Other Fraud Violations!

May 14, 2012 3 comments

Health Insurance companies have been getting caught red-handed deliberately defrauding Medicare and Medicaid and other medical organizations for more than a decade. This is all due to insurance execs trying to get as much profit for their shareholders as possible. As a direct result of their felonious behavior,  insurance companies have been fined $2.694 billion for Medicare/Medicaid fraud and $2.435 billion for non-Medicare/Medicaid fraud (overcharging, not paying physicians, slow payments). This comes to a total $5 billion that health insurers have been fined for. The Department of Health and Human Services as well as the Office of Inspector General have officially declared “war” on health insurer fraud and are taking action to make sure this ceases.

Below is a listing of how much an insurer has been fined.

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Aetna

Q1 2012 Revenue: $8.92 billion    (cnbc.com)

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History of Non-Medicare Fraud:
Fined $750,000         – February 2010    (Source 12)
Fined $256,500         – November 2009  (Source 11)
Fined $20 million       – February  2009   (Source 24)
Fined $5.1 million      – February 2009    (Source 79)
Fined $6.25 million   – August 2003         (Source 10)
Fined $50,000            – June 2002           (Source 49)
Fined $1.4 million      – September 2001 (Source 7)
Fined $1.15 million   – November 2001  (Source 9)
Fined $1.9 million      – December 2000 (Source 8)
Fined $4.5 million       – December 1995  (Source 6)
Fined $89 million        – December 1994  (Source 6)
——————————————————————————————
 Medicare Fraud Fines:
Non-Medicare Fines:      $129,546, 500
Total Fraud Fines:        $129,546,500
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AmeriGroup
History of Medicaid Fraud
Fined $225 million        – July 2008  (Source 79)
Fined $144 million        – July 2006   (Source 79)
Fined $190 million       – July 2006   (Source 79)
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Total Fraud Fines:     $559 million
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Blue Cross Blue Shield
BCBS Illinois 2011 Revenue:  $1.1 billion
BCBS TN       2011 Revenue:  $5.2 billion
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History of Medicare Fraud:
Fined $25 million   – February 2011 (Source 21)
Fined $225,000     – August 2010 (Source 18)
Fined $131 million  – April 2007   (Source 3)
Fined $1.5 million   – August 2005 (Source 82)
Fined $40 million   –  June 2003  (Source 1)
Fined $9.3 million  – July 2002   (Source 83)
Fined $74 million   –  December 1999  (Source 1)
Fined $261 million  – July 1999      (Source 16)
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History of Non-Medicare Fraud:
Fined $480,000      – May 2012              (Source 43)
Fined $3.7 million – May 2012               (Source 78)
Fined $1.5 million   – March 2012          (Source 20)
Fined $1.6 million   – February 2012    (Source 14)
Fined $325,000       – April 2011           (Source 23)
Fined $5 million      – November 2010 (Source 13)
Fined $20 million   – September 2010 (Source 77)
Fined $95,000    – January 2010     (Source 22)
Fined $1 million      –  February  2009  (Source 19)
Fined $542,000      – August 2008        (Source 15)
Fined $2.1 million  – August 2008        (Source 50)
Fined $2.8 million   – March 2008         (Source 31)
Fined $1.25 million  – September 2006   (Source 85)
Fined $128 million  – May 2006            (Source 17)
Fined $23.7 million  – November 2005 (Source 85)
Fined $1.5 million      – August 2005     (Source 86)
Fined $150,000       – July 2005            (Source 47)
Fined $1.8 million   –  December 2003 (Source 48)
Fined $135,000      – June 2002            (Source 49)
 ———————————————————————————————
 Medicare Fraud Fines:                   $542,025,000
Non-Medicare Fraud Fines:          $194,327,000
 Total Fraud Fines:                          $736,952,000
 ——————————————————————————————————————————————
CareMark  Advantage
 Q1 2012 Revenue:  $30.8 billion   (cnbc.com)
 ———————————————————————
 History of Medicare Fraud:
 Fined $5 million         – May 2012 (Source 68)
Fined $7.5 million      –  February 2003  (Source 1)
 ———————————————————————–
Total Fraud Fines:                $12.5 million
 ——————————————————————————————————————————————
Cigna
Q1 2012 Revenue:  $6.9 billion (cnbc.com)
—————————————————————————-
History of Medicare Fraud:
Fined $24.5 million  – December 2002 (Source 25)
Fined $9 million       – March 2000         (Source 63)
 ————————————————————————–
History of Non-Medicare Fraud:
Fined $1.2 million  –     April 2011             (Source 62)
Fined $20 million    –    February 2009    (Source 24)
Fined $97 million    –    July 2007             (Source 26)
Fined $150,000      –    January 2006      (Source 61)
Fined $540 million  –    September 2003 (Source 27)
Fined $80,000         –    June 2002            (Source 49)
—————————————————————————–
Medicare Fraud Fines:            $33.5 million
Non-Medicare Fraud Fines:   $657, 200,000 million
 Total Fraud Fines:                    $690,700,000 million
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First Health Services Corporation
 ————————————————–
History of Medicaid Fraud:
 Fined $13 million  –  April 2004   (Source 1)
 —————————————————–
History of Non-Medicare Fraud
Fined $150 million   –  June 2011 (Source 69)
 —————————————————-
Total Fraud Fines:         $163 million
——————————————————————————————————————————————-

HighMark Inc
————————————————–
History of Medicare Fraud:
Fined $1.5 million   – April 2004  (Source 1)
 ————————————————-
History of Non-Medicare Fraud
Fined $10 million   – October 2007 (Source 70)
 —————————————————–
Total Fraud Fines:       $11.5 million
 ——————————————————————————————————————————————
 Humana
Q1 2012 Revenue: $10.2 billion
———————————————-
Breaking News:
 Dept of Justice probing Humana for Fraud –   May 2012  (http://www.fiercehealthpayer.com/story/feds-probe-humana-claims-doc-loans/2012-05-04)
 Physician Exposes Humana Scam:   http://www.wejonesmd.com/Pages/Ins/humana.html
 ———————————————————————————————————
 History of Medicare Fraud:
Fined $3.4 million    –  August 2011  (Source 29)
Fined $133 million  – October 2005 (Source 4)
Fined $8 million       – June   2001 (Source 1)
Fined $14.5 million  –  June 2000 (Source 1)
Fined $8 million        – November 1999 (Source 28)
 ————————————————————–
 History of Non-Medicare Fraud:
Fined $45,000,000  – May 2012 (Source 84)
Fined $314,000     – June 2011  (Source 60)
Fined $299,000     –  June 2011 (Source 30)
Fined $100,000     –  January 2011 (Source 32)
Fined $55,800       – October 2010  (Source 60)
Fined $2.8 million  – March 2008 (Source 31)
Fined $500,000      – January 2008 ( Source 60)
Fined $500,000     – August 2007   (Source 60)
Fined $4,190,000 million – July 2005 (Source 60)
Fined $1,013,259 million – July 2005 (Source 60)
Fined $3.5 million   – May 2005    (Source 60)
Fined $10.2 million – November 2003 (Source 60)
Fined $106 million – October 2003 (Source 60)
Fined $78.5 million – January 2000 (Source 33)
Fined $10 million    – July 1999     (Source 33)
 ——————————————————————–
Medicare Fraud Fines:               $166,900,000 million
Non-Medicare Fraud Fines:      $264,740,859 million
Total  Fraud Fines:                      $431,640,859 million
 ———————————————————————
——————————————————————————————————————————————-
Lovelace Health Plan
—————————
History of Medicare Fraud:
Fined $24.5 million  – December 2002 (Source 1)
 ——————————————————-
Total Fraud Fines:                    $24.5 million
 ——————————————————————————————————————————————
Medco Health Solutions
 ———————————
History of Medicare Fraud:
Fined $29 million  –  April 2004  (Source 1)
Fined $115 million – October 2006  (Source 1, Source 2)
—————————————————————
History of Non-Medicare Fraud
Fined $2.75 million  – March 2012 (Source 71)
Fined $29.3 million  – April 2004 (Source 72)
——————————————————–
Medicare Fraud Fines:            $144 million
Non-Medicare Fraud Fines:   $32,050,000
 Total Fraud Fines:                    $176,050,000 million
 ——————————————————————————————————————————————
 Rocky Mountain Health Plans
 ———————————–
Fined $1.5 million    –  August 1999 (Source 1)
—————————————————
Total Fraud Fines:     –  $1.5 million
 ——————————————————————————————————————————————
Tenet Choices Inc
———————-
History of Medicare Fraud:
Fined $8.25 million –  March 2004  (Source 1)
Fined $54 million    –  August 2003 (Source 1)
Fined $4 million    –  February 2003 (Source 1)
Fined $115 million  –  January 2003 (Source 1)
—————————————————–
Total Fines:               $177,650,000 million
 ————————————————-
——————————————————————————————————————————————-
 UnitedHealthcare
Q1 2012 Revenue: $27.23 billion (cnbc.com)
 —————————————————-
History of Medicare Fraud:
Fined $3.5 million –  December 2004 (Source 34)
Fined $4 million   –   September 2002  (Source 1)
Fined $2.9 million –  November 2000   (Source 36)
———————————————————
History of Non-Medicare Fraud:
Fined $1.3 million  – May 2012           (Source 42)
Fined $20 million    – May 2012          (Source 39)
Fined $350 million  – October 2010  (Source 35)
Fined $457,000       – October 2010   (Source 38)
Fined $750,000      – November 2009 (Source 54)
Fined $500,000       – August 2009     (Source 40)
Fined $50 million    – January 2009   (Source 37)
Fined $250,000       – July 2008          (Source 41)
June $50,000          – June 2008         (Source 74)
Fined $2.8 million   – March 2008      (Source 44)
Fined $3.5 million   – January 2008  (Source
Fined $4.4 million   – December 2007  (Source 51)
Fined $12 million    – September 2007 (Source 45)
Fined $650,000      – May 2007              (Source 55)
Fined $59,500         – February 2007 (Source 43)
Fined $364,750       – March 2006      (Source 46)
Fined $350,000      – March 2006       (Source 52)
Fined $5,000          – January 2005    (Source 53)
Fined $2.8 million – January 2005    (Source 54)
Fined $150,000     –  May 2002         (Source 56)
Fined $87.3 million   –  April 2002 (Source 1)
Fined $35,900       – November 2000 (Source 59)
Fined $175,000     – April 2000         (Source 57)
Fined $127,400     – March 2000      (Source 58)
 ————————————————————
Medicare Fraud Fines:            $10,400,000
Non-Medicare Fraud Fines:   $538,024,550 million
 Total Fraud Fines:                    $548,424,550
 ——————————————————————————————————————————————
 WellCare
 —————————-
History of Medicare Fraud:
Fined $138 million            March 2012   (Source 75)
Fined $80 million             May 2009       ( Source 80)
——————————————————–
History of Non-Medicare Fraud
Fined $120,000   –  August 2009  (Source 76)
 ——————————————-
Total Fraud Fines:    $218,120,000
——————————————————————————————————————————————-
 WellPoint
Q1 2012 Revenue: $15.42 billion  (cnbc.com)
 —————————————————-
History of Medicare Fraud:
Fined $6 million       –  October 2005 (Source 81)
Fined $198 million  –  July 2005  (Source 5)
————————————————–
History of Non-Medicare Fraud:
Fined $100,000    – August 2008 (Source 64)
Fined $1 million   – March 2007    (Source 66)
Fined $80 million    – May 2005    (Source 67)
Fined $448 million  – July 2005      (Source 65)
 ——————————————————
Medicare Fraud Fines:             $204,000,000 million
Non-Medicare Fraud Fines:    $529,100,000 million
 Total Fraud Fines:                    $733,100,000
 ——————————————————————————————————————————————
 Total Medicare Fraud Fines:                    $2,694,475,000 billion
Total Non-Medicare Fraud Fines:           $2,506,958,859 billion
Grand Total Fraud Fines:                           $5,219,493,859 billion
——————————————————————————
Sources:
10. http://articles.latimes.com/2003/aug/20/business/fi-rup20.4

25. http://articles.latimes.com/2002/dec/05/business/fi-cigna5

U.S. Debt Committee Proposes 20-30% Cuts to Medicare and Medicaid

November 17, 2011 Leave a comment

The U.S. Congressional Joint Committee on Deficit Reduction has proposed a 20-30% combined cut to Medicare/Medicaid. The committee specifically plans to cut $300 billion from Medicare/Medicaid over the next 10 years. Senators on the U.S. Senate Finance Committee have said that the cuts are necessary and have to be done to get rid of all of the fraud committed by UnitedHealthcare, Humana, Cigna, Aetna, and Blue Cross/Blue Shield. Even if the Committee fails to reach a deal next week, automatic 2% cuts to Medicare/Medicaid will still have a major affect on physician practices and hospitals. Tennessee Hospital Association CEO Craig Becker says “if you’re looking at a 2o percent to 30 percent cut in medicare and medicaid funding, there’s no way some of them can take that.” Mr. Becker is absolutely right. Non-profit facilities will suffer and for-profits will suffer just as much. Tenet has publicly said that the sequestration would result in a $40-$54 million loss on EBITDA (cash flow). United Health Systems has said sequestration would reduce EBITDA  by $36.6 million over the next year. For insurers, they are expecting an impact as well. Even though they are being investigated by the U.S. Senate and DOJ for fraud, they plan to use the cuts as an opportunity to continue their attack on physician reimbursement. UnitedHealthcare, Humana, Aetna, Cigna, Blue Cross/Blue Shield specifically plan to withhold as much reimbursement as possible from physicians in order to preserve profits for their shareholders as a result of the cuts.

In addition, CMS plans to cut physician reimbursement by an additional 27.4% starting January 2012. In October of 2012, CMS will also withhold reimbursement for those physicians and hospitals who have “poor” patient satisfaction survey scores (HCAHPS).

Source: http://www.cnbc.com/id/45325955

Source: http://cms.gov/

U.S. Senate Investigating United Healthcare, Cigna, Aetna for Medicare and Medicaid Fraud

November 10, 2011 3 comments

BREAKING NEWS……………………..

The U.S. Senate is now officially investigating United Healthcare, Cigna, and Aetna for one of the largest fraud schemes yet against the Medicare and Medicaid programs. The amount of fraud is said to be in the hundreds of billions of dollars. The fraud was done on purpose as to rake in billions of profits for the insurers at the demand of company executives and shareholders, according to the U.S. Senate.

In addition, FierceHealthcare is reporting that United Healthcare, Cigna, and Aetna have also been caught in a multi-billion dollar pull-through scheme involving Quest Diagnostics and LabCorp. This scheme specifically involves Quest and LabCorp offering contracts for discounted or below-cost pricing in exchange for in-network physician referrals for lab testing business. The companies have clearly violated the U.S. federal anti-kickback law which protects patients and Medicare/Medicaid beneficiaries from potential influence of financial arrangements on care decisions. (Source: http://www.fiercehealthcare.com/story/senate-probe-aetna-cigna-united-healthcare-quest-lab-corp-alleged-billion-d/2011-11-09?utm_medium=nl&utm_source=internal)

This is only the tip of the iceberg. It has also been reported that Blue Cross/Blue Shield and Humana are also being investigated for a very very similar multi-billion dollar fraud scheme as well.

Stay tuned to here for more on this BREAKING NEWS story.

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