SANTA ANA, Calif., July 30, 2018 /PRNewswire-PRWeb/ --áDrug overdoses cause more deaths in America than either car accidents
According to court documents, on July 24, 2018, the CDI served HealthNet with an Order to Show Cause and Notice of Noncompliance (OSC) after receiving hundreds of complaints from substance use disorder providers that alleged HealthNet had either denied claims or grossly underpaid claims for treatment rendered in late 2015 and 2016. The CDI concluded that in January 2016, HealthNet began accusing substance use disorder providers of insurance fraud and referred their claims to its Special Investigations Unit (SIU) before even performing a reasonable review of the claims. The claims were held in a "pending" status while the health care providers were forced to submit extensive documentation and comply with unreasonable requests for information, resulting in illegitimate denials and delayed payment of claims for pre-authorized and covered treatment. (CDI File No. UPA-2016-00005.)
For those providers who were able to be cleared from the SIU, their claims were allegedly paid at a fraction of the amount owed under the HealthNet PPO policies. The CDI noted that the HealthNet PPO policy language in 2015/2016 required payment at 75% of the provider's billed rate, but that HealthNet was paying the providers "a bundled per diem Medicare rate for an entirely different service furnished by an entirely different type of facility." The OSC states that HealthNet has engaged in unfair and deceptive insurance practices under California Insurance Code section 790.03, and failed to comply with the Federal Mental Health Parity and Addiction Equity Act of 2008, and seeks the imposition of monetary penalties of up to $10,000 for each willful act of unfair competition, potential amounting to hundreds of millions of dollars, court documents allege.
*Steinley v. Health Net, United States District Court Case No. 2:18-cv-05458-R-SK *Mitchell v. Health Net, United States District Court Case No. 2:18-cv-05499-R-SK
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