UPMC hit with $250K claims notification penalty

After receiving an audit from the Pennsylvania Insurance Department, UPMC must pay out $250,000 for claims and notification violations, the Pittsburgh Post-Gazette reported Dec. 30. 

During a routine audit, the department found several alleged violations — between Jan. 1, 2015, and March 31, 2016 — including failures in notifying members of delayed or denied claims, pay and interest delays, mental health parity coverage issues and rate miscalculations.

In addition to the fine, UPMC must take corrective action to shore up communication with its members and pay unjustly denied claims, according to the Post-Gazette

State Insurance Commissioner Jessica Altman said UPMC was "extremely cooperative and thorough" in their compliance with the audit, according to a Dec. 30 news release.

A UPMC spokesperson told Becker's that it appreciated the department's collaboration and commitment to quality for its members. 

"Many of the concerns identified by the Department were corrected even prior to the conclusion of the audit and while we were disappointed to receive even a single violation, we note that our findings are consistent with all of the insurers whose exams have been completed to date," the spokesperson said. "We have not only incorporated the changes recommended by the Department's findings but will continue striving to offer the high quality products and services that our members and consumers deserve."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months