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Posts Tagged ‘health plan’

U.S. House Votes to Repeal Healthcare Reform 244-185

July 11, 2012 1 comment

The U.S. House today voted to repeal the Affordable Care Act 244-185.  Five Democrats voted FOR repeal and they are:
Dan Boren (D-OK 02), Larry Kissell (D-NC 08), Jim Matheson (D-UT 02), Mike McIntyre (D-NC 07), Mike Ross (D-AR 04). You can see how each member of the House voted by going here: http://clerk.house.gov/evs/2012/roll460.xml. The bill the House approved (H.R. 6079) can be read here: http://www.gpo.gov/fdsys/pkg/BILLS-112hr6079ih/pdf/BILLS-112hr6079ih.pdf.

Keywords:  health care insurance, health care, health plan, health policy, U.S. Congress, health care reform

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Health Insurance Companies Raise Premiums by 181.4% Since Health Care Reform Passage

July 5, 2012 Leave a comment
We are barely 7 months into 2012 and already health insurers are dramatically hiking premium rates. Specifically, they are raising premiums in order to get as much profit as possible. The insurers themselves refuse to justify their rate hikes publicly because they claim they would be giving away “trade secrets” (Source 1).  As you will see in the data below, the country’s largest  insurers have raised premiums by 181.4% (16.5% average) since health care reform officially passed in 2010. Approximately 787,000 policy holders were effected. The insurers were fined a whopping total of $116,750,000 as a result of their deed. The Affordable Care Act (ACA) is supposed to curb this unethical act but the consumer will not see significant relief from this until 2014.                                                            R74BG8W84C8B
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Rate Hikes By Insurer
——————————–
Aetna
8% increase   – April 2012 (Source 3)
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Blue Cross Blue Shield
20% Increase  – July 2012
7% increase   –  May 2012 (Source 2)
9.35%  increase  – January 2012 (Source 5)
12.9% increase   – September 2011 (Source 6)
22% increase     – May 2011 (Source 8)
59% increase     – January 2011 (Source 9)
12.4% increase small group  – May 2010 (Source 10)
13.4% increase large group – May 2010 (Source 10)
———————————————————————–
Kaiser Permamente
10% increase – June 2011 (Source 7)
———————————————————
United Healthcare
11.8% increase on businesses of fewer than 50 employees  – May 2010 (Source 10)
15.5% increase on business of greater than 50 employees  – May 2010 (Source 10)
—————————————————————————————————————–

Members Effected by Rate Increase
————————————————
Aetna
73,000 members   – April 2012  (Source 3)

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Blue Cross Blue Shield
90,000  – July 2012
31,000   – April 2012     (Source 2)
86,000    – January 2012 (Source 5)
45,000   –  September 2011 (Source 6)
59,000   – May 2011  (Source 8)
193,000  – January 2011 (Source 9)
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Kaiser
300,000   – June 2011  (Source 7)
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Impact on Profit
———————–
Aetna
Profit UP 27.7% due to 8% premium increase  (Source 4)
————————————————————————
Fines for Rate Increases
———————————–
Assurant fined $2,750,000 for unapproved rate increase  – May 2012 (Source 11)
11 insurers (United Healthcare, Aetna, Blue Cross Blue Shield) fined $114,000,000  -January 2012 (Source 12)
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Sources:
——————————————-
1. http://www.nytimes.com/2011/10/12/nyregion/health-insurers-ask-to-keep-rate-increase-data-secret.html?_r=1&scp=1&sq=health%20insurers%20ask%20to%20keep%20rate%20increase%20data%20secret&st=cse
2. http://www.elpasotimes.com/ci_20733206/blue-cross-raising-rates-31-000?source=most_emailed
3. http://articles.latimes.com/2012/apr/05/business/la-fi-mo-aetna-raises-rates-20120405
4. http://www.fiercehealthpayer.com/story/aetna-ignores-regulator-implement-8-rate-hike/2012-04-09
5. http://www.kcrg.com/news/local/State-Approves-Wellmarks-Health-Insurance-Premium-Hike-136611573.html
6. http://www.ctmirror.org/story/13806/anthem-proposes-129-percent-rate-increase
7. http://www.sfgate.com/business/article/Kaiser-raising-rates-for-300-000-subscribers-2366454.php
8. http://www.oregonlive.com/health/index.ssf/2011/05/oregons_largest_health_insurer.html
9. http://latimesblogs.latimes.com/money_co/2011/01/rate-increase-by-blue-shield-of-california-prompts-criticism.html
10. http://www.fiercehealthpayer.com/story/insurance-premiums-more-double-digit-hikes-sought-ri-mi-and-ct/2010-05-24
11. http://www.in.gov/idoi/files/Assurant_Press_Release_5-16-2012%281%29.pdf
12. http://www.governor.ny.gov/press/110911health
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Keywords: health care insurance, insurance premium, blue cross blue shield, health insurance company, united healthcare, health care reform

Health Insurance Companies to Pay $1.3 Billion in Rebates for Violating Medical Loss Ratio Rule

July 5, 2012 Leave a comment

There is finally some good news coming out of the ACA in regards to the fact that the Medical Loss Ratio is in full effect. Under this rule, large plan insurers (Humana, United, BCBS, etc) must PAY 85% of premiums towards providing actual medical care(not profits). In addition, small plans must PAY 80% of premiums towards providing actual medical care as well. These money-loving insurers should thank God that this rule was not in place back in 2010 because if it had been, they would have had to cough up $2,000,000,000 for violating the rule (Source 1). According to a report done by the Commonwealth Fund, Individual market insurance companies in Texas and Florida would have had to pay rebates back to consumers totaling $281,000,000. Large group Insurers in Maryland and Florida would have had to pay $40,000,000 in rebates back to consumers (Source 1).

Insurers are already off to a brilliant start this year at violating the MLR. The National Journal reports that Insurers could cough up $1,300,000,000 in rebates by the end of the year. This will account for $426,000,000 in rebates to the individual plan market and $541,000,000 to the large group plan market (Source 2).  An estimated 4,900,000 in the individual market  will be getting rebates this year totaling $377,000,000. Alaska, Alabama, Oregon, Louisiana, and Massachusetts are expected to receive an average of $256.50 per enrollee. An estimated 7,500,000 in the large group market will be getting rebates this year totaling $541,000,000. Vermont, Nebraska, Minnesota, New York, and North Carolina are expected to receive an average of $208.60 per enrollee (Source 3). If the MLR had been in effect in 2010, the total amount in rebates that could have been paid out by the end of this year could have totaled $3,300,000,000.
The following insurers (so far) have had to pay out rebates back to consumers for violating the MLR rule.
———————–
Aetna
$11,495,614     – November 2011 (Source 6)
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Blue Cross Blue Shield
$82,507,470       – November 2011       (Source 6)
$283,000,000  – October 2011            (Source 5)
$167,000,000  – September 2011        (Source 4)
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CD PHP
$487,768    – November 2011 (Source 6)
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ConnectiCare
$15,462      – November 2011 (Source 6)
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Group Health
$4,168,935   – November 2011  (Source 6)
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Health Net
$5,052,467    – November 2011 (Source 6)
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Health Now
$4,492,327   – November 2011 (Source 6)
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HIP Health Plan
$182,194    – November 2011  (Source 6)
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Humana
$5,144,676  – November 2011
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MVP
$1,319,640
——————————————————
United Healthcare
$4,838,675  – November 2011 (Source 6)
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Keywords: health care, affordable health insurance, medical loss ratio, insurance rebate, blue cross blue shield, united healthcare, health care reform

Health Insurance Company Scheme Alert: Downcoding

June 28, 2012 Leave a comment

Physicians are finally beginning to drop insurance carriers due to the downcoding “scam” that insurers are using in order to greatly enhance their profits. Downcoding specifically is when an insurer unilaterally decides after services have been rendered to reduce the amount of reimbursements a physician (even hospital) can receive. According to the American Medical Association, most physicians believe this practice is a scam aimed directly at giving insurers as much profit as possible and this specific issue is what physicians complain to the AMA the most about.
_____________________________________________________________________________________

CPT Codes Most Downcoded by Insurance Company:
Code:                                                    Medicare Rate:                                         Usual Downcoding Amount
99205 (new pt office visit)               $213.60
99204 (level 4 new office visit)       $170.47                                                      $43.13
99203 (leve 3 new office visit)         $110.92                                                       $59.55
99202 (level 2 new office visit)        $76.88                                                        $34.04
99201  (level 1 new office visit)        $44.77                                                         $32.11
99215  (level 5 established patient)  $149.60
99214  (level 4 established patient)  $111.39                                                      $38.21
99213  (level 3 established patient)   $74.46                                                      $36.93
99212  (level 2 established patient)   $44.77                                                      $29.69
99211 (level 1 established patient)     $22.39
9234 (outpatient observation)            $142.68
99233 (level 3 hospital progress note)   $108.67                                                $34.01
99232 (level 2 hospital progress note)   $75.78                                                  $32.89
99231 (level 1 hospital follow up)            $42.12                                                  $33.66

Average % difference between usual downcoding amount and normal Medicare rate is 49%.
( Source 2)
—————————————————————————————————————————————— Aetna
————-

– Paid $6,270,000 settlement for downcoding dentist claims  (Source 3)
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Blue Cross Blue Shield
————————–
– downcoded Anesthesiologist claims (Source 4)
-downcoded Urologist claims in Kansas (Source 4)
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Humana
———————————-
Physician exposes massive  “scam” run by Humana (Source 1)
– Humana underpaid by $108.47 on code 99215 when should have paid $149.60
-Humana underpaid by  $27.13 on code 99213 when should have paid $74.46
————————————————————————————————————

Sources:

1. http://www.wejonesmd.com/Pages/Ins/humana.html
2. http://www.mtbc.com/learningcenter/index.php/steps-your-practice-can-take-to-prevent-downcoding-on-medical-claims/
3. http://articles.baltimoresun.com/2003-08-20/business/0308200151_1_aetna-dentists-dental-association
4. http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center/case-summaries-topic/managed-care-payments.page

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Keywords: medical coding, medical billing, health care insurance, health plan, united healthcare, humana, blue cross blue shield

Health Insurance Companies Fined $88.8 Million for Overcharging Federal Employee Health Benefit Plan

June 27, 2012 1 comment

Over the past decade, health insurers have been fined $88,800,000 for overcharging the Federal Employee Health Benefit Plan on purpose. Blue Cross Blue Shield was fined $1,500,000 (Source 1) and United Healthcare (Source 2) was fined $87,300,000 for their deeds.

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Sources:
1. http://www.govexec.com/federal-news/2005/08/fehbp-contractor-agrees-to-pay-15-million-settlement/19982/  2. http://www.californiahealthline.org/articles/2002/4/15/pacificare-pays-87m-to-settle-fehbp-overcharges-case.aspx

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Keywords: health care, health insurance, employee health, health benefits, federal government, blue cross blue shield, united healthcare

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
————————————————————————————————————————-
Affinity
# of State Fines:   5
Total State Fines:  $30,900  (Source 1
—————————————————————————————————————————————
Alameda Alliance
# of State Fines:    1
Total State Fines:  $333,229    (Source 1
—————————————————————————————————————————————-
Blue Cross Blue Shield
# of Fines:   43
Total State Fines:  $54,645,878  (Source 1
—————————————————————————————————————————————
Capital District Health Plan
# of State Fines:    6
Total State Fines: $55,700  (Source 1
—————————————————————————————————————————————–
Centercare
# of State Fines:  3
Total State Fines: $8,200  (Source 1
——————————————————————————————————————————————-
Community Choice
# of State Fines:  2
Total State Fines:  $10,300   (Source 1
——————————————————————————————————————————————-
Community First Health Plans
# of State Fines:    1
Total State Fines:  $200,000    (Source 1
——————————————————————————————————————————————-
Community Health Plans of NY, Washington
# of State Fines:    4
Total State Fines:  $1,005,200  (Source 1
——————————————————————————————————————————————-
Community Premier Plus
# of State Fines:    1
Total State Fines:  $1,200    (Source 1
——————————————————————————————————————————————-
Fidelis
# of State Fines:    5
Total State Fines:  $10,100  (Source 1
——————————————————————————————————————————————-
FreeState
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
——————————————————————————————————————————————-
HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
——————————————————————————————————————————————-
Group Health Cooperative
# of State Fines:    15
Total State Fines:  $57,050 (Source 1
——————————————————————————————————————————————-
Health Services Med Corp
# of State Fines:    1
Total State Fines:  $7,300 (Source 1
——————————————————————————————————————————————-
Healthcare Underwriters Mutual
# of State Fines:    1
Total State Fines:  $9,750  (Source 1
——————————————————————————————————————————————-
HealthNow (Medicare Advantage)
# of State Fines:    12
Total State Fines:  $1,170,300 (Source 1
——————————————————————————————————————————————-
Health Plus
# of State Fines:    3
Total State Fines:  $75,200  (Source 1
——————————————————————————————————————————————-
Healthsource plan of NY/NJ
# of State Fines:    2
Total State Fines:  2,200 (Source 1
——————————————————————————————————————————————-
Heritage Provider Network
# of State Fines:    2
Total State Fines:  $294,000  (Source 1
——————————————————————————————————————————————-
HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
——————————————————————————————————————————————-
Hometown Health Plan
# of State Fines:    1
Total State Fines:   $25,000 (Source 1
——————————————————————————————————————————————-
Indemnity Insurance Company
# of State Fines:    1
Total State Fines:  $1,800 (Source 1
——————————————————————————————————————————————-
Independent Health Association
# of State Fines:   5
Total State Fines:  $49,775 (Source 1
——————————————————————————————————————————————
Inland Empire
# of State Fines:    1
Total State Fines:  $2,500  (Source 1
——————————————————————————————————————————————-
Inter Valley
# of State Fines:    1
Total State Fines: $7,500   (Source 1
——————————————————————————————————————————————-
JMH Health Plan
# of State Fines:    1
Total State Fines:  $25,000 (Source 1
——————————————————————————————————————————————-
Kaiser Foundation Health Plans
# of State Fines:    13
Total State Fines:  $792,800 (Source 1
——————————————————————————————————————————————-
Lifewise Health Plan
# of State Fines:    1
Total State Fines:  $1,250 (Source 1
——————————————————————————————————————————————-
Managed Health Network
# of State Fines:    2
Total State Fines:  90,000  (Source 1
——————————————————————————————————————————————-
Mayo Health Plan
# of State Fines:    1
Total State Fines: $25,000  (Source 1
——————————————————————————————————————————————-
Med Mutual of Ohio
# of State Fines:    1
Total State Fines:  $100,000 (Source 1
——————————————————————————————————————————————-
Mercy Health Plans
# of State Fines:    1
Total State Fines:  $100,600 (Source 1
——————————————————————————————————————————————-
Molina
# of State Fines:    1
Total State Fines:  $5,000 (Source 1
——————————————————————————————————————————————-
MVP Health Plan
# of State Fines:    3
Total State Fines: $35,000  (Source 1
——————————————————————————————————————————————-
Promina Health Plan
# of State Fines:    1
Total State Fines: $81,635  (Source 1
——————————————————————————————————————————————-
Providence Health Plan
# of State Fines:    2
Total State Fines:  $3,750 (Source 1
——————————————————————————————————————————————-
Sharp Health Plan
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
——————————————————————————————————————————————-
Sloans Lake
# of State Fines:    1
Total State Fines:  $156,750 (Source 1
——————————————————————————————————————————————-
St. Barnabus (Partners in Health)
# of State Fines:    1
Total State Fines:   $1,300 (Source 1
——————————————————————————————————————————————-
St. Joseph’s Care Management
# of State Fines:    1
Total State Fines:  $33,538 (Source 1
——————————————————————————————————————————————-
SummaCare
# of State Fines:    1
Total State Fines:   $125,000 (Source 1
——————————————————————————————————————————————-
Unicare Life
# of State Fines:    6
Total State Fines:  $1,533,426 (Source 1
——————————————————————————————————————————————-
Univera / Health Plan Inc (NY)     NP
# of State Fines:    2
Total State Fines:  $24,550 (Source 1
——————————————————————————————————————————————-
Vytra
# of State Fines:   9
Total State Fines:  $483,800 (Source 1
——————————————————————————————————————————————-
For-Profit
—————————————————————————————————————-
Aetna  (Public Traded)
# of  State Fines:     31
Total State Fines:  $8,262,982  (Source 1
——————————————————————————————————————————————-
American Heritage Life (AllState, Publicly Traded)
# of State Fines:  2
Total State Fines: Fined $264,765  (Source 1
——————————————————————————————————————————————-
American Medical Life
# of State Fines:     1
Total State Fines $1,000       (Source 1
——————————————————————————————————————————————-
Amil International Insurance Company
# of State Fines:   2
Total State Fines  $196,543  (Source 1
——————————————————————————————————————————————-
Alta Health and Life
# of State Fines    1
Total State Fines: $250  (Source 1
——————————————————————————————————————————————-
Avemco Insurance
# of State Fines:   2
Total State Fines: $269, 729  (Source 1
——————————————————————————————————————————————-
Beacon Health Plan
# of State Fines: 1
Total State Fines: $50,000    (Source 1
——————————————————————————————————————————————-
Capitol American Life
ERISA Settlement:  $6,826,000 (Source 6
——————————————————————————————————————————————-
Careplus
# of State Fines: 4
Total State Fines:  $28,345  (Source 1
——————————————————————————————————————————————-
Central Reserve Life
# of State Fines:  2
Total State Fines:   $811,513 (Source 1
——————————————————————————————————————————————-
CHA HMO
# of State Fines:  1
Total State Fines:  $43,750   (Source 1
——————————————————————————————————————————————-
Cigna (Publicly Traded)
# of State Fines:    26
Total State Fines:  $4,954,534 (Source 1
ERISA Settlement:  $954,000  (Source 6
——————————————————————————————————————————————-
Combined Insurance Company of America of Illinois
# of State Fines:  1
Total State Fines:  $30,000   (Source 1
——————————————————————————————————————————————-
Conseco Medical Insurance Company
# of State Fines:    3
Total State Fines:    $1,820,610  (Source 1
ERISA Settlement: $9,975,000   (Source 6
——————————————————————————————————————————————-
Continental Assurance
# of State Fines:    3
Total State Fines:   $161,212   (Source 1
——————————————————————————————————————————————-
Coventry
# of State Fines:  1
Total State Fines:  $10,000  (Source 1
——————————————————————————————————————————————-
CVS
ERISA Settlement: $3,000,000  (Source 6
——————————————————————————————————————————————-
Dental Benefit Providers Maryland
# of State Fines:    2
Total State Fines:   $80,000  (Source 1
——————————————————————————————————————————————-
Excellus
# of State Fines:    8
Total State Fines:   $36,400  (Source 1
——————————————————————————————————————————————-
Florida 1st Health Plan
# of State Fines:    1
Total State Fines:  $25,000  (Source 1
——————————————————————————————————————————————-
Fortis Insurance
# of State Fines:   3
Total State Fines:  $1,410,055  (Source 1
——————————————————————————————————————————————-
Foundation Health
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
——————————————————————————————————————————————-
FreeState
# of State Fines:    1
Total State Fines:   $75,000 (Source 1
——————————————————————————————————————————————-
Great West Healthcare
# of State Fines:    4
Total State Fines:  $2,323,669  (Source 1
——————————————————————————————————————————————-
Guardian Life
# of State Fines:    6
Total State Fines:  $1,440,305 (Source 1
——————————————————————————————————————————————-
Hartford Casualty Insurance Company
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
——————————————————————————————————————————————-
Health Care Plan of NY
# of State Fines:    1
Total State Fines:   $20,500 (Source 1
——————————————————————————————————————————————-
Health Insurance Plan of NY
# of State Fines:    10
Total State Fines:  $351,350 (Source 1
——————————————————————————————————————————————-
Health Net
# of State Fines:    9
Total State Fines:  $521,700 (Source 1
ERISA Settlement: $215,000,000  (Source 6)
——————————————————————————————————————————————-
Health Options
# of State Fines:    1
Total State Fines:  $50,000  (Source 1
——————————————————————————————————————————————-
Healthplan Southeast
# of State Fines:    1
Total State Fines: $50,000   (Source 1
——————————————————————————————————————————————-
HMO Colorado
# of State Fines:  1
Total State Fines:  $252,500  (Source 1
————————————————————————————————————————————–
Human Affairs
# of State Fines:    1
Total State Fines:  $5,500 (Source 1
————————————————————————————————————————————-
Humana (Publicly Traded)
# of State Fines:    9
Total State Fines:  $2,879,113 (Source 1
ERISA Settlement:  $58,000,000  (Source 8
—————————————————————————————————————————————
LifeGuard
# of State Fines:    1
Total State Fines:  $40,000 (Source 1
——————————————————————————————————————————————-
Magellan
# of State Fines:    2
Total State Fines:  $450,000 (Source 1
——————————————————————————————————————————————-
Meco Health Solutions
ERISA Settlement: $42.5 million
——————————————————————————————————————————————-
Med Insurance Company of Ohio
# of State Fines:    1
Total State Fines:  $60,000 (Source 1
——————————————————————————————————————————————-
Mega Life and Health Insurance Company
# of State Fines:    3
Total State Fines:  $875,000  (Source 1
——————————————————————————————————————————————-
MetLife Insurance Company
# of State Fines:   5
Total State Fines: $1,343,428  (Source 1
——————————————————————————————————————————————-
MDNY
# of State Fines:    9
Total State Fines:  $185,650  (Source 1
——————————————————————————————————————————————-
Merit  Behavioral
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
——————————————————————————————————————————————-
Mid-South Insurance Company
# of State Fines:  1
Total State Fines:  $51,850 (Source 1
——————————————————————————————————————————————-
Mid-West National Life
# of State Fines:    2
Total State Fines:  $140,500  (Source 1
——————————————————————————————————————————————-
New England Life
# of State Fines:    1
Total State Fines:  $41,500 (Source 1
——————————————————————————————————————————————-
New York Life Insurance
ERISA Settlement: $14,000,000  (Source 6)
——————————————————————————————————————————————-
NYL Care
# of State Fines:   5
Total State Fines:  $1,092,050 (Source 1
——————————————————————————————————————————————-
Oriska Insurance
# of State Fines:    1
Total State Fines:  $3,900 (Source 1
——————————————————————————————————————————————-
Oxford Health Plans
# of State Fines:    13
Total State Fines:  $5,046,674 (Source 1
——————————————————————————————————————————————-
Pacific Life and Annuity Company
# of State Fines:    3
Total State Fines: $3,530,579  (Source 1
——————————————————————————————————————————————-
Physicians Healthcare Plans
# of State Fines:    2
Total State Fines:  $78,300 (Source 1
——————————————————————————————————————————————-
Principal Life Insurance Company
# of State Fines:    2
Total State Fines:  $704,856 (Source 1
——————————————————————————————————————————————-
Protective Life Insurance Company
# of State Fines:    2
Total State Fines:  $152,780 (Source 1
——————————————————————————————————————————————-
Prudential
# of State Fines:    6
Total State Fines:  $216,000  (Source 1
——————————————————————————————————————————————-
Qualmed Washington
# of State Fines:    1
Total State Fines:  $250,000 (Source 1
——————————————————————————————————————————————-
Renaissance Health and Life
# of State Fines:   1
Total State Fines:  $1,750 (Source 1
——————————————————————————————————————————————-
Rite Aid
ERISA Settlement: $67,600,000 (Source 6)
——————————————————————————————————————————————-
Safeguard Health Plans
# of State Fines:    3
Total State Fines:  $239,339 (Source 1
——————————————————————————————————————————————-
Sierra Health / Texas Health Choice Companies
# of State Fines:    3
Total State Fines:  $1,437,450 (Source 1
——————————————————————————————————————————————-
Systemas Medicos
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
——————————————————————————————————————————————-
Trustmark Insurance Company
# of State Fines:    2
Total State Fines: $595,676  (Source 1
——————————————————————————————————————————————-
United American Insurance Company of McKinney
# of State Fines:   1
Total State Fines:   $190,000 (Source 1
——————————————————————————————————————————————-
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
——————————————————————————————————————————————-
Vista Health Plan
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
——————————————————————————————————————————————-
Well Care
# of State Fines:    6
Total State Fines:  $147,100 (Source 1
————————————————————————————————————
 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=

Health Insurance Companies Should Pay $4.3 Billion for Defrauding Medicare/Medicaid

June 19, 2012 1 comment
The total amount that health insurance companies should pay for defrauding Medicare and Medicaid is $4,319,180,879 billion. The insurers have settled with the government for only $1,502,300,000 billion (34% of total fraud amount). The government settled at an average rate of 45% of the total amount defrauded. Total amount that was pocketed by the insurers (unrecovered) is $2,816,880,879 billion.  This is all found via public records. The amount of money in some recent cases that has been unreported (sealed by Judge) is probably a high amount as well and probably would greatly inflate the total amount I was able to find.
Amerigroup
—————-
Actual amount of Fraud:      $524,700,000
Settlements:                           $225,000,000    (Source 1)
% Settled for                           42%
—————————————————————-
 Blue Cross Blue Shield
Actual Amount of Fraud        $522,180,879     (Source 2, 3, 4, 5, 23)
Settlements:                            $302,100,000        (Source 6,7, 8, 9, 10, 23, 26)
% Settled for                            57%
 ———————————————————————————–
CareMark
Actual Amount of Fraud:        $110,000,000 million
Settlements:                           $54,200,000 million     (Source 26, 27,28)
 % Settled for                         49%
 —————————————————————————–
Cigna
Actual Amount of Fraud       $74,500,000
Settlements:                           $58,000,000   (Source 19)
% Settled for                           77%
 ————————————————————————–
 Humana
Actual Amount of Fraud       $311,800,000
Settlements:                           $155,500,000    (Source 13, 14, 15, 16)
% Settled for                           50%
——————————————————————————–
 Medco
Actual Amount of Fraud:       $430,000,000 million
Settlements:                            $155,000,000 million  (Source 24, 25)
% Settled for                            36%
 —————————————————————————-
 UnitedHealthcare /Pacificare
Actual Amount of Fraud       $1,300,000,000 billion (Source 17)
Settlements:                                  $97,500,000 million (Source 18, 19)
% Settled for                          7%
 —————————————————————————-
WellCare
Actual Amount of Fraud:         $1,046,000,000 billion (Source 20)
Settlements:                              $455,000,000 million  (Source 21, 22)
% Settled for                              43%
—————————————————————————
————————————————————————————————————————–
Total Fraud                                                               $ 4,319,180,879
Settlements                                                               $1,502,300,000
Average % of total fraud amount Settled for:  45%
Insurers Pocketed:                                                  $2,816,880,879
———————————————————————————————————————–
Sources:

22. http://www.ama-assn.org/amednews/2010/07/12/bisa0712.htm

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