Regulators Taking Fewer Actions Against Insurers, but Levying Higher Fines
The number of enforcement actions taken by the California Department of Managed Health Care has decreased this year compared with 2009, but the amount of financial penalties imposed appears to have increased dramatically, Payers & Providers reports.
So far this year, DMHC has reported 95 enforcement actions totaling $2.25 million against health insurers and brokers, the lowest number of actions taken in one year since 2003. In 2009, the department took 367 enforcement actions totaling about $3.5 million.
Yet To Factor in Latest Fines
However, this year's total has yet to factor in the $4.85 million in fines that DMHC announced last month against seven major health plans. The fines were imposed because of inaccuracies in claims payments to hospitals and physicians.
After officials finalize the agreements between DMHC and the penalized health plans, the department will have levied more than $7.1 million in fines this year, which is about twice the dollar amount of fines imposed in 2009.
Shift in Focus
Lynne Randolph, DMHC spokesperson, said the increase in financial penalties is part of DMHC's shift in focus toward health plan problems that affect thousands of enrollees. She said, "There may not be as many individual actions, but these settlements may have much more of an impact."
However, some consumer advocates have expressed concern that DMHC's new focus might lead it to disregard more minor infractions committed by health insurers (Payers & Providers, 12/9).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.