TEXAS: AG Charges Kaiser With Emergency Care Violations
Texas Attorney General Dan Morales (D) yesterday charged Kaiser Foundation Health Plan with violating the state's Deceptive Trade Practices Act by denying and delaying payments for emergency care. After more than a year of gathering information from parent company Kaiser Permanente, Morales is asking a district court judge to order repayments for denied claims and fines of $10,000 per violation, the Fort Worth Star-Telegram reports. The lawsuit alleges that "Kaiser has improperly denied emergency care claims of its members based on Kaiser's own inability to verify membership." "We're surprised and disappointed that the attorney general's office has chosen to file a lawsuit at this time," said Kelly Smith, spokesperson for Kaiser. "Any valid concern could readily have been addressed without resorting to this court action," she added. The lawsuit comes little more than a year after Kaiser settled a dispute with the Texas Department of Insurance over emergency care by paying $1 million (Sanchez, 7/14).
Aetna vs. Genesis
A group of doctors carried out their threatened contract termination with Aetna U.S. Healthcare Sunday, leaving 38,000 Texas enrollees without coverage. The doctors of the Genesis Physicians Practice Association, which is affiliated with the Presbyterian Healthcare System, are obliged to see their patients through Oct. 10. If the contract dispute is not settled by that date, policyholders will be forced to find new doctors. In the meantime, Aetna will attempt to sign contracts with the individual doctors. The Dallas Morning News reports that the "dispute between Aetna and Genesis centers around access to financial information and patient data." The doctors want more data than the insurer is willing to release (Ornstein, 7/14).