A health insurer based in the Albany area has been fined $200,000 for “improperly” denying health insurance claims and charging members for copays and deductibles for preventive services, the Department of Financial Services announced Tuesday.
In a consent order, MVP Health Plan Inc. and MVP Health Insurance Co. have agreed to pay a $200,000 fine and correct their claims processing procedures. The insurer, which has roughly 100,000 members, also has agreed to make approximately $9,000 in restitution to 356 of its members.
“Health insurance companies must provide necessary preventative services without copays and deductibles as the law requires,” Superintendent Maria Vullo said in a statement. “DFS will continue to hold companies accountable if they do not process all claims accurately, in a timely manner and to the letter of the law. DFS appreciates MVP’s cooperation in recognizing the importance of making sure its claims examiners and systems process claims correctly for all of its members.”
The DFS found the violations during an examination that occurred between January 2011 and December 2013. As part of the consent order, MVP—through its in-house counsel—has agreed to update its claims payment system, train their claims examiners on the appropriate claims adjudication procedures and update providers on Affordable Care Act mandates. The consent order also requires MVP to show the department that it has taken the corrective steps within 90 days.
“Although the cost share at issue totaled less than $10,000 and related to less than 1 percent of claims, DFS imposed a $200,000 fine. We have addressed the operational issues that caused the error and all affected members were reimbursed for their copays, with interest,” said Ted Herman, the vice president of communications at MVP.