From Molina failing to quickly pay providers to Centene settling with an 11th state over allegations it overbilled Medicaid programs, these are six recent fines levied against payers by states:
Centene agreed to pay $19 million to the state of Washington and $13 million to the federal government Aug. 24 to settle allegations it overcharged the state Medicaid program for pharmacy benefit management services.
John Hancock Life & Health Insurance will pay New York customers and their beneficiaries back nearly $21.6 million after a state investigation found the company prematurely terminated 156 long-term care policies. The state said Aug. 17 the company will also pay more than $2.2 million to the state's Medicaid program and a $2.5 million fine for violating state insurance law.
National Health Insurance Co. settled with California for $1.995 million Aug. 16 after the payer unlawfully failed to post its formulary online, sold drugs at incorrect prices and denied necessary care and coverage information to members.
Medova Healthcare Financial Group and its president and CEO, Daniel Whitney, were ordered by Washington state in August to halt all sales of illegal health insurance policies in the state after selling plans that were not clear about coverage details and what entity was responsible for paying claims. Washington issued a $310,000 fine to the company, and Medova and Mr. Whitney have surrendered their insurance licenses.
Anthem Blue Cross of California agreed to issue $9.2 million in reimbursements to members in June who were incorrectly required to pay office visit costs as part of their deductibles. The state also fined the payer $1.1 million for incorrectly applying office visit costs and failing to mail required explanation of benefits information to members.
Molina Healthcare of California was fined $1 million by the state in June for failure to quickly pay $80.3 million to providers. The payer paid the fine, the interest of $1.8 million and the original total owed to the providers. The payment delays, which violated state law, stemmed from software updates to Molina's data management systems in 2017.