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Oxendine Addresses Race and HMO Issues

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Georgia Insurance Commissioner John Oxendine discussed regulatory work on a settlement of a race-based investigation of ING Life Insurance Company of Georgia, Atlanta, as well as a separate investigation of Humana Employers Health Care of Georgia, Inc.’s fine for violating the prompt pay law.

Oxendine says that work on a settlement to resolve an investigation of ING Life of Georgia for charging black policyholders higher premiums than white policyholders is “real close” to a settlement. “It is measured in weeks,” he continues. Points that still must be addressed include attorneys fees and technical points, Oxendine adds.

A spokeswoman for ING Life of Georgia said that there were no new developments at press time.

Oxendine also spoke of a $400,000 fine levied against Humana today, the largest fine in Georgia history.

A total of 10 other managed care companies are under investigation for violation of prompt pay laws, he continues.

Oxendine says that after an initial examination, companies were given 1.5 years to come into compliance and make adjustments such as system changes to be in compliance with Georgia’s prompt pay law.

The action was the second time in as many years that Humana has been cited for delaying claims payment, the department said. Humana, based in Atlanta, has previously been fined $15,039, the department says. The latest fine is based on new reviews, the department adds.

The department is conducting a new round of examinations on all managed care plans and will impose additional fines if payments by managed care organizations are not made in a more timely manner, Oxendine says. Georgia law requires claims be paid within 15 working days or that a provider or policyholder be notified why a claim cannot be paid, the department says.

Since it started monitoring claims payments in fourth quarter 1999, the department says that no HMO reviewed has been 100 percent in compliance with the law.

Oxendine says that 10% of Humana’s claims did not meet the requirements of Georgia’s law and that the company’s experience had actually gotten worse. Other companies being examined, he says, vary in performance, with some getting better, and others, worse.

“I told Humana and other HMOs that in the very near future we will look at them again,” says Oxendine.

“I want the fine to get their attention. If $400,000 is not enough, I can make it more and I will,” he continues.

Oxendine says he believes that companies can be at 100% compliance because of technology. Additionally, he says that if companies are late and pay 18% interest, they are considered to be in compliance.

Humana consented to the fine, he continues.

Humana issued a statement saying that “Humana is committed to timely payment of claims with its contracted providers, as well as its employer groups and members. The company has taken strong measures to resolve claims payment timeliness issues. In 2001, the company tracked a consistent upward trend in compliance with the 15-day payment regulation in Georgia.”

Reproduced from National Underwriter Life & Health/Financial Services Edition, February 4, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.

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