NU Online News Service, April 3, 4:05 p.m. – Texas Insurance Commissioner Jose Montemayor is continuing to attack health insurers operating in his state.
Thirteen health insurers that do business in Texas have agreed to pay $2.8 million in fines and at least $7 million in restitution to resolve accusations that they violated the Texas prompt-payment law and related laws and regulations, according to Texas Insurance Commissioner Jose Montemayor.
Texas officials have accused the insurers of paying thousands of claims that were filed between Aug. 1, 2000, and Feb. 28, 2002, late, or not paying the claims at all.
The department notes that the insurers are paying the fines and restitution without admitting an violations of Texas laws or regulations. The department says it will post the names of the 13 insurers on its Web site, but, at press time, the names were not available.
Texas law requires that insurers pay claims that meet Texas Department of Insurance standards for clean claims within 45 days of receipt.
In addition to accusing the insurers of prompt-payment violations, the department has accused the insurers of failure to implement proper audit payment procedures, failure to monitor delegated entities that handled claims payment activities, failure to maintain an appropriate complaint record and failure to send timely deficiency notices.
The department has forced a total of 35 health insurers to pay at least $46 million in fines and restitution in connection with prompt-payment violations within the past eight months, the department says.
Montemayor announced agreements with 17 insurers and health maintenance organizations on August 1, 2001, and agreements with five more on November 1, 2001. In all cases, the companies agreed to the orders without admitting any violation of Texas laws and regulations, the Texas department says.
Montemayor said in a statement that the late-payment problems occurred despite ample warnings.
“We will not stand by and watch the law be ignored,” Montemayor said.
Montemayor said the department expects to announce additional enforcement actions in April.