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.
