From software glitches to COVID-19 rule violations, these payers faced monetary fines from a state over the last year:
Georgia fined BCBS $5 million: The payer was fined March 29 following improper claims settlement practices, violations of the Prompt Pay Act, failure to reply to consumer complaints in a timely manner, inaccurate provider directories and significant delays in loading provider contracts.
Illinois fined BCBS $339,000: The payer was fined March 21 for failing to provide the state with updated network adequacy documents following the termination of its contract with Springfield Clinic.
California fined L.A. Care $55 million: The public plan was fined March 4 for failing to authorize members' needed care, ensure timely access to care and address patient complaints. State regulators also found a backlog of 67,000 unresolved grievances against the payer.
New York fined Aetna, Oscar Health and Wellfleet $3.1 million: The three payers were fined in December after state regulators found they had policies that required members to illegally pay copays or coinsurance for mental health and substance use disorder benefits. The payers owed $2.6 million in penalties and had to return $473,565 to members.
North Carolina fined Humana $630,000: The payer was fined in July for subjecting members to out-of-network costs when in-network providers were not available and failing to pay for emergency services. The payer was also required to pay $227,205.94 back to members.
Rhode Island fined UnitedHealthcare $100,000: The payer was fined this month for breaking state law through denial of substance use disorder treatment claims.
Pennsylvania fined UPMC Health Plan $250,000: The payer was fined in January for failing to notify members about delayed or denied claims, pay and interest delays, mental health parity coverage issues, and rate miscalculations.
Michigan fined BCBS $7,000: The payer was fined in April for failure to follow COVID-19 regulations after not allowing nonunion employees to work from home when possible and failure to require social distancing in the office.
Florida fined Sunshine State Health Plan $9.1 million: The Centene Medicaid vendor was fined in March for software issues that led to delayed payments for nearly three months.