State Levies Fine Against L.A. Care Health Plan for Claims Mismanagement
The state Department of Managed Health Care has issued a $25,000 fine to L.A. Care Health Plan for mismanaging claims and failing to pay appropriate interest and penalties when submitting late payments to health care providers, Payers & Providers reports.
The health plan provides coverage for about 750,000 Medi-Cal and Healthy Families beneficiaries in Los Angeles County. Medi-Cal is California's Medicaid program and Healthy Families is the state's Children's Health Insurance Program.
According to a letter from DMHC, the claims problems surfaced during a 2008 audit. The agency said L.A. Care Health Plan "failed to forward misdirected claims (to the appropriate party) in a timely manner ... and failed to pay penalties and interest for late claims."
State law requires HMOs to pay claims within 45 business days of receipt.
L.A. Care Health Plan said in a statement that it accepted the judgment by DMHC. The plan said it "recognizes the importance of submitting timely and accurate payments to providers," adding that it has "made substantial changes" to its claims management system (Payers & Providers, 7/7).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.