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Health Carrier Settles With Cornhusker State

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Units of a managed care giant have resolved a Nebraska investigation by agreeing to pay a $650,000 administrative fine and change some of their claims payment and grievance processes in the state.

The settlement agreement affects the Nebraska health insurance operations of UnitedHealth Group Inc., Minnetonka, Minn.

UnitedHealth is emphasizing that its Nebraska units are denying that they have violated any laws.

“The consent order includes no findings of intentional misconduct or general business practices in violation of the law,” the company says in a statement.

The UnitedHealth units are acknowledging that they made errors in “implementing certain technological efficiencies,” the company says.

“We are very glad to have this matter behind us so that we can concentrate on what we do best — improving access to high quality and affordable health care for Nebraska families,” William Tracy, chief executive of UnitedHealth’s UnitedHealthcare operations in Nebraska, says in the statement.

Regulators in the Nebraska Department of Insurance filed a petition listing concerns about the UnitedHealth units in December 2006.

Nebraska officials alleged that they had discovered a number of problems with processing of claims, appeals, and handling of grievances and notices at the UnitedHealth units during a market exam that covered the period starting July 1, 2003, and ending June 30, 2004.

The UnitedHealth units contested the allegations in the petition, Nebraska officials say in their announcement of the settlement agreement.

Since December 2006, UnitedHealth “has worked diligently to improve its service to customers,” Tim Wagner, director of the Nebraska department, says in the announcement. “I’m pleased with the changes UnitedHealthcare has made that have resulted in improved performance.”

One change will give UnitedHealth unit staffers in Nebraska the authority to final decisions on claims and grievances, Nebraska officials say.

The agreement affects United HealthCare Insurance Company, United HealthCare of the Midlands Inc., Midwest Security Life Insurance Company and United Behavioral Health, Nebraska officials report.

UnitedHealth managed care executives say the company has improved efficiency in recent years, pays 99% of claims within 30 days, and runs the only health plan in Nebraska that is accredited by the National Committee for Quality Assurance, Washington.


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