Health Insurer PacifiCare Faces Up To $9.9 Billion In Fines For Nearly A Million Alleged Health Care Violations

Los Angeles Times:

California regulators are seeking fines of up to $9.9 billion from health insurer PacifiCare over allegations that it repeatedly mismanaged medical claims, lost thousands of patient documents, failed to pay doctors what they were owed and ignored calls to fix the problems.

In court filings and other documents, the California Department of Insurance says PacifiCare violated state law nearly 1 million times from 2006 to 2008 after it was purchased by UnitedHealth Group Inc., the nation's largest health insurance company by revenue.

Regulators said the companies broke promises to maintain smooth operations for 130,000 of PacifiCare's customers, resulting in what insurance officials nationwide believe is the largest fine ever sought against a U.S. health insurer.

Read the whole story: Los Angeles Times

Comments

[Bryan Kauffman]

10:39 AM on 09/10/2010

So the gov't fines them 9.9 billion then gives them a tax break. Do the patients ever get their monies back for being overcharged?

[Pediego]

06:36 PM on 09/09/2010

We're so advanced in the USA

[FaceReality2]

01:16 PM on 09/09/2010

Who ends up paying the fines? The corporate officers who make multi-million dollar salaries and have multi-million dollar retirement plans? Or will the fines ultimately be born by the policy holders through premium increases?

[blinkthink]

05:57 PM on 09/09/2010

You have judged correctly. They will file it under Administrative costs-oh, look they went up to we can charge more, again.

[Actraiser]

11:35 PM on 09/09/2010

Why even bother to file it under administrative costs when they can just file them straight under medical expenses to boost their medical loss ratio?

http://commerce.senate.gov/public/index.cfm?p=PressReleases&ContentRecord_id=c9a3b9b4-175f-4b71-9086-a080e2b08480

[pfrogger]

01:03 AM on 09/10/2010

"american capitalism" at its finest.
all industries do it. they call it innovation. anyone with half a brain calls it a racket. the whole things a scam. everything gets passed down to the consumer, the taxpayer, or both. so what's the benefit of the corporation to the people? banking innovations include more fees for the consumer. energy industry innovation involves more pollution of the air, land, and water. the list goes on. they provide no benefit. the government could do the same job for less because 1. they are so big they have leverage power, and 2. no CEO/mob boss taking home millions in bonuses, most from laying people off, or as they like to call it, streamlining operations. there are no innovations in certain industries. banking doesn't need it. wind and solar have been around for decades. this is NOT innovation, this is a con job.
cut out the parasite. they will bleed us dry until we are dead, and then they will move on.

[FaceReality2]

12:54 PM on 09/09/2010

Fines for theft by corporations. Prison terms for theft by people.

Unlimited corporate contributions to politicians are ruled the exercise of "free speech" by the Supreme Court.

Is there any question who really runs this country?

[blinkthink]

08:40 AM on 09/10/2010

We should start a petition to re-name the country-the United Corpocracies of America. But then some in Congress are working so hard to make this country an oligarchy, it's quite the conundrum.

[fatback65]

12:45 PM on 09/09/2010

This is why we need to take health care away from the for-profits. They are not interested in providing health care, but only in making $$$ at your expense. If I stole someones money, would I get a fine or would I go to jail. This country is a mess.

[Peter007]

09:05 AM on 09/09/2010

So the customers got screwed and the Government gets the 10 billion.

Yep, thats fair.

[blinkthink]

08:33 AM on 09/10/2010

True, if we remain silent, it will go on-contact the WH, Congress and your Reps, especially the GOP.
At the very least, the 10 billion should fund Medicare, or some facet of healthcare.

[changling]

07:34 AM on 09/09/2010

No more fines for criminals! Jail time and close them down. Keep the workers, have the govt. take over their accounts and then go after the other healthcare companies who obviously have been robbing people for years. When healthcare company CEOs make millions or billions of personal dollars while cutting healthcare to people who need it we sit helplessly as our costs keep escalating. Healthcare should be a not for profit industry since it is a necessity. This could be the first step toward single-payer healthcare.

[fatback65]

12:47 PM on 09/09/2010

Fanned. I just commented what you basically said. We would get jail if we stole.

[JC Wilmore]

08:01 PM on 09/08/2010

Well, this probably won't surprise anyone:

http://shockoe-lit-mess.blogspot.com/2010/02/unitedhealth-group-and-al-qaeda.html

[lvdragonlady]

07:26 PM on 09/08/2010

Forget the fines, because they do not care in the first place. What the government needs to do is take it over completely and then use it as a stepping stone for the health care reform bill.
Think outside the box for a change people!!!

[Actraiser]

11:38 PM on 09/09/2010

Why should the government even touch this dirty filthy business? Just allow everyone to have medicare if they want it, and if the teabaggers and centrists want to give their money to the insurance companies, let them. A fool and their money are soon parted.

[blinkthink]

08:20 AM on 09/10/2010

Fanned for great idea. But the government oversight would have to increase on Medicare. Here's
why:

http://www.opensecrets.org/orgs/summary.php?id=D000000109

[tangerinesong]

05:59 PM on 09/08/2010

We just had a client leave our offices that is a top 3 manufacturer of sundries for the hospitality industry, shampoos, lotions, etc. She was co-founder of her first company called Sea and Ski. Her healthcare expenses increased 8 percent last year with a 33 percent increase this quarter. She decided the company will offer to contribute 50 percent of all premiums to employee policies. Only 10 percent have taken the program which has resulted in yet another rate increase of 18 percent due to lack of enrollment. Out of 2800 employees only 268 signed by the expiration timeline. Interesting times indeed.

[redstateblues69]

04:24 PM on 09/08/2010

Violated the law 1 million times from 2006-2008. Which administration enabled that? Too bad this administration enacted insurance reform.

[Peter007]

09:03 AM on 09/09/2010

The state of California regulates that insurance company.
Plenty of people making $150,000/ year were sitting on their butts in Sacramento.

[ajwriter]

12:04 AM on 09/10/2010

States have neither the resources nor the will to properly regulate insurance products of all kinds.

[KDog76A]

03:17 PM on 09/08/2010

...and when the Feds run the show, hardly anyone will be able to sue, because Universal Healthcare will be "too big to fail"

this is exactly why should not have a single payer plan... you will have no recourse against the government

[Dennis]

03:23 PM on 09/08/2010

You might get a surprise if you read the fine print in your health insurance policy. Insurers often include a clause that staqtes that disputes will be resolved by arbitration.

[Name Not In Use]

04:38 AM on 09/09/2010

You cannot sue your insurance company.
SURPRISE!!!!!!!
It's called ERISA.

http://en.wikipedia.org/wiki/ERISA#ERISA_pre-emption

http://www.opednews.com/articles/The-Insurance-Companies--by-Douglas-Drenkow-091027-632.html

"Even if benefits are improperly denied, the insurance company cannot be sued for any resulting injury or wrongful death, regardless of whether it acted in bad faith in denying benefits. Insurers operating ERISA plans enjoy several immunities not available to other types of insurance companies. ERISA preempts all conflicting state laws, including state statutes prohibiting unfair claims practices and causes of action arising under state common law for insurance bad faith. There is no right to a jury trial in ERISA benefits actions. Although Americans normally take for granted the right to testify on their behalf, plaintiffs have no right to present live testimony in ERISA bench trials, in which the judge simply reads through the documents which formed the record originally before the ERISA plan administrator and performs de novo review. Finally, punitive damages are not allowed in actions for ERISA benefits. - Wikipedia

[redstateblues69]

04:30 PM on 09/08/2010

When did we have a recourse against a government that endorses denial of preexisting conditions? Or a government that is complacent about US citizens' bankruptcy, disability and early demise? The only recourse is this administration's health care reform.  Although it equates to insurance reform, it was sorely needed. A public option is coming. Like when Ma Bell was trust busted, insurance companies need competition.

[callinguonit]

05:57 PM on 09/08/2010

Touche'

[Dennis]

03:15 PM on 09/08/2010

In light of this and similar horror stories over the years the GOP threat to repeal HCR has to be seen as egregious posturing: HCR is the biggest windfall that the health care industry has seen since Medicare Part D.  What you will see, should the GOP retake Congress, is the removal of any of the provisions in HCR that that the health care industry finds to be too onerous.

[aflyinyoursoup]

04:32 PM on 09/11/2010

Bingo....
Fanned...

[sheila]

03:09 PM on 09/08/2010

This is the face of Commercial Health "Care." We in California have been subjected to ENDLESS FRAUD, WASTE, ABUSE AND RIP-OFFS for decades, and the pathetic "reforms" enacted by our pathetic congress will only make matters worse, because they traded away the ONLY leverage we had "mandatory coverage" and got NOTHING in exchange.

Employer-based healthcare is a crappy system, invasion of privacy and a severe restriction on free market opportunities for individuals who are trapped in jobs they don't want just to keep insurance. We need to completely eliminate it, put EVERYONE on the individual market, and offer Medicare for All as an option that the Big Insurers have to compete with. At the same time, WAGES should pay for employees, not benefits, which, again, will mean apples to apples when applying for jobs.

Entrepreneurs are unfairly in the crosshairs of the insurance industry, which is enforcing all of us into the "dead end cubicle traps" for it's Big Corporate buddies. Time to start innovating, which means individuals should NOT be discriminated against because they want to work outside the Corporate Machine.

[BarryS]

02:46 PM on 09/08/2010

And, if anyone died because of this, then pre-meditated murder indictments. That will quicken the pace of true reform.

[redstateblues69]

04:37 PM on 09/08/2010

If only that were the case.