KAISER: GOVERNMENT SETTLES WITH HMO ON FEHBP PAYMENT CLAIM
The U.S. Office of Personnel Management (OPM) has agreed toThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
pay Kaiser Foundation Health Plans of Northern California $25.7
million plus interest to settle a claim that it underpaid Kaiser
between 1987 and 1996 for premiums to cover workers in the
Federal Employees Health Benefits Program (FEHBP), according to
MANAGED CARE WEEK. David Mlawsky, editor of the newsletter,
said, "The settlement appears to be the largest in a string of
recent similar deals the government has struck with several other
HMOs that contract to cover federal employees."
BAD DEALS: For several years, managed care plans
participating in the FEHBP program have complained that the
government does not keep accurate records of the number of
federal workers and retirees in participating health plans. As a
result, many HMOs contend that they are being "gypped out of
FEHBP premium dollars." According to MANAGED CARE WEEK, at least
three other HMOs have reached similar settlements. In September,
OPM agreed to pay $8.25 million to NYLCare Health Plan to settle
claims that FEHBP underpaid premiums for government workers.
Last year, the government agreed to pay an HMO run by Rockville,
MD-based Mid Atlantic Medical Services Inc. $3.3 million in
premium underpayments. And in 1994, the government settled with
the Kaiser Foundation Health Plans of the Mid-Atlantic States on
$6.8 million in premium underpayments (Atlantic Information
Services, Inc. release, 12/11).