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Life Health > Health Insurance > Your Practice

Illinois Fines Health Carrier

By Staff Writer

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The Illinois Division of Insurance has negotiated a consent order with a managed care company over allegations that the company sold products to Illinois residents through agents not licensed in Illinois.

The company, a unit of Humana Inc., Louisville, Ky., has agreed to pay a $500,000 fine to resolve allegations that it failed to check agent licenses properly by selling some Medicare Advantage and Medicare Part D prescription plans to Illinois residents, Illinois officials say.

Illinois also has received some complaints from consumers about the cost of Humana coverage and duplication of other benefits, officials say.

Illinois officials reviewed records for about 54,000 Humana Medicare product enrollments completed from September 2005 to September 2006.

Humana now has about 140,000 Medicare Advantage and Medicare drug plan customers in Illinois, and the settlement agreement will not affect their coverage, Humana spokesman Mark Mathis says.

Mathis notes that the agent licensing violations officials discovered involved only 84 of the 2,200 agents who submitted Medicare product applications during the period reviewed and only abut 350 of the 54,000 enrollments completed.

Humana believes the violations happened because “we were focused on getting people enrolled,” Mathis says.

Since learning about the violations, Humana has taken the opportunity to introduce a new, automated agent licensing system and to emphasize the importance of licensing in agent training programs, Mathis says.

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