PacifiCare Agrees to Pay Fine for Late Claims Payment
PacifiCare Health Systems yesterday said it has reached an agreement with the California Department of Managed Health Care to pay penalties and interest on delinquent payments to thousands of doctors and hospitals, the Los Angeles Times reports. In agreeing to the deal, PacifiCare acknowledged that it violated state law by failing to pay 7,000 claims within 45 working days. The Santa Ana, Calif.-based managed care company blamed the delinquent payments on the company's "rapid shift" from a capitation payment system to a fee-for-service system. PacifiCare said it has begun to correct problems with its claims processing system, including upgrading its information system and hiring 72 claims processors. The company said it plans to pay the penalties plus interest by the end of the month. Saying that Pacificare is not the only California managed care company failing to pay claims promptly, Jan Emerson, spokesperson for the California Healthcare Association, which represents the state's hospitals, said, "Hopefully, this action against PacifiCare will be a significant statement to the health care industry" (Ballon, Los Angeles Times, 3/2).