New York has fined five Medicaid managed care plans a total of $2.6 million following an examination of their reimbursement of behavioral health claims that found "repeatedly and inappropriately denied claims" or failure to pay for services at rates required by law.
The denials were most frequently for care provided by assertive community treatment; personalized recovery oriented services; comprehensive psychiatric emergency program, partial hospitalization; and adult behavioral health home and community based services, according to a Nov. 9 news release.
The five penalized health plans:
Affinity Health Plan (Molina): fined $349,500 for failing to provide adequate oversight of management functions and failing to reimburse at required rates.
Amida Care: fined $232,000 for inappropriate claims denials and failing to quickly pay.
EmblemHealth: fined $422,000 for failing to correct inappropriate claims denials and failing to pay claims at required rates.
MetroPlus HealthPlan: fined $584,000 for failing to pay claims at required rates and failing to reimburse providers at required rates.
MVP HealthPlan: fined $1 million for failing to pay claims at required rates and failing to reimburse providers at required rates.