In what could be the first of a number of fines against health insurance companies, the Georgia insurance commissioner fined UnitedHealthcare and three related companies a combined $750,000 for allegedly not paying thousands of health claims promptly.
The fines involve the parent company UnitedHealth Group, Inc., as well as UnitedHealthcare of Georgia, Inc., American Medical Security Life Insurance Company, and Golden Rule Insurance Company.
According to Commissioner John W. Oxendine's office, the insurance commissioner issued a directive in 1999 that all healthcare plans licensed in Georgia are to submit claims data every quarter. Based on data submitted through March 31, 2009 by UnitedHealth and its sister companies, the Georgia insurance commissioner determined that the companies were in violation of state law that required prompt payment of claims.
"It is unfortunate that fines must be imposed to encourage compliance," Oxendine said. "Consumers and doctors deserve prompt payment. I will continue to aggressively pursue those companies who do not comply with the law."
Oxendine said in a statement that his office is reviewing data from other insurance companies and he expects more fines "in the near future."
UnitedHealth responded to the fine today with this statement: "UnitedHealthcare currently processes 97 percent of its claims within 15 days in Georgia. This settlement involves only the small percentage of claims not processed within 15 days. Timely and accurate payment is important and UnitedHealthcare processes 99 percent of claims for its Georgia customers within 30 days."
This is not the first time UnitedHealth has needed to pay a state this year. This fine is mere chump change compared to the $400 million settlements UnitedHealth made with the New York Attorney General's office in January. Those settlements involved UnitedHealth's subsidiary, Ingenix, which most insurers used to determine "prevailing" and "usual, customary and reasonable charges" for out-of-network physician services.
Critics of Ingenix complained the database did not provide the correct charges for out-of-network services and charged that a health insurer-owned company should not have overseen the databases.
The agreement required UnitedHealth to shell out $400 million, cease two databases run by Ingenix, and help fund a new independent database that will collect price information. A number of other health insurers that used Ingenix to find out-of-network costs also agreed to pay to help create the new independent database that will be run by a nonprofit company, FAIR Health, which will work with Syracuse University and a group of other state universities.
UnitedHealth Group did not acknowledge any wrongdoing in the settlements.