Wednesday, March 27, 2002

Oxendine fines HMO $200,000 over prompt pay

Georgia Insurance Commissioner John W. Oxendine today fined One Health Plan of Georgia, Inc., $200,000 for violating Georgia's prompt pay law.

The fine is the latest in a series of fines against health maintenance organizations and other healthcare plans resulting from ongoing reviews by Commissioner Oxendine's office of claims data that the plans are required to submit quarterly.

"It is unfortunate that fines must be imposed to encourage compliance. Consumers and doctors deserve prompt payment," Commissioner Oxendine said. "While some plans have improved since our last review, I will continue to aggressively pursue those who do not comply with the law."

A dozen plans were collectively fined more than $1 million following initial reviews in 2000 and 2001. The purpose of the reviews is to ensure that managed care plans are paying claims within 15 working days, or notifying the provider or policyholder why a claim can't be paid, as Georgia law requires. The fine announced today against One Health Plan is the second HMO fine based on the latest round of reviews of managed care plans.

To ensure managed care plans were complying with Georgia law, Oxendine issued a directive in August 1999 that all healthcare plans licensed in Georgia would be required to submit claims data every quarter, beginning with the third quarter of 1999. Since then, no HMO reviewed has been in100 percent compliance with the law. The Commissioner has repeatedly warned healthcare plans that strict compliance with the law is expected.

Consumers having difficulty with their HMO or with any insurer should contact Commissioner Oxendine's Consumer Services Division at 404-656-2070 or 1-800-656-2298 from 8 a.m. to 7 p.m., Monday through Friday, or they may visit the Department's Web site at www.gainsurance.org to obtain a complaint form and instructions for submitting it.