Lawmakers and regulators took aim at California health insurers Tuesday in efforts aimed at making sure they cover members' medical needs and pay physicians and hospitals what they owe them -- and on time, the Los Angeles Times reports.
A day after the state Senate killed Gov. Arnold Schwarzenegger's plan to expand healthcare coverage, Insurance Commissioner Steve Poizner vowed to make sure that current insurance laws were strictly enforced and ordered new audits of the state's largest health insurers.
Poizner acted after his department cited Cypress-based PacifiCare for 133,000 alleged violations of state laws and regulations, which carry fines of as much as $1.33 billion.
Separately, the Department of Managed Health Care alleged that 30% of the PacifiCare claims it examined were improperly denied. That agency is seeking a $3.5-million penalty. Related story.
The company said it was working hard with both regulators to fix problems that it said stemmed from its takeover in 2006 by insurance giant UnitedHealth Group Inc.
Poizner said he planned to complete the broad review of claims-paying practices by year-end. If his investigators find that insurers are failing to promptly pay what they owe physicians, hospitals and members, he vowed to "come down on them like a ton of bricks."
"Their business is to collect premiums and pay claims for legitimate healthcare expenses," Poizner said in an interview Tuesday. "We're talking about basic issues here. This is fundamental to their business."
The Department of Insurance declined to name which companies would be scrutinized.
Representatives of two of the state's largest insurers -- WellPoint Inc., which operates Blue Cross in California, and rival Blue Shield -- declined to comment on the prospect of a new audit.
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