The Texas Department of Insurance (TDI) has fined an insurer whose inability to pay claims on time kept physicians waiting on millions of dollars.
TDI dealt Molina Healthcare of Texas an administrative penalty of $500,000 – on top of almost $8 million combined that the insurer paid in penalties and interest to TDI, and to affected physicians and other health care providers.
“In 2018 Molina discovered programming errors that resulted in miscalculating the amount due to providers in penalty and interest on clean claims paid late, which also resulted in inaccurate prompt pay reports to TDI,” the order states. “Molina voluntarily self-disclosed the calculation errors to TDI and has corrected the programming errors.”
Also in 2018, Molina reconciled and corrected prompt-pay reports from 2014 to 2017, paying TDI more than $4 million in penalties and interest for those years, the order states. It also paid nearly $3.8 million in penalties and interest to “any providers who were underpaid in these years,” according to the order.
The cover story in the March 2019 edition of Texas Medicine outlines the millions of dollars in physicians’ unpaid Molina claims that led the Texas Medical Association and Harris County Medical Society to file a complaint with TDI.
TDI previously fined Molina in December 2016 for violations that included late processing of claims, failure to pay prompt-pay penalties, and inadequate networks. The latest order, issued Feb. 28, 2019, says Molina failed to timely file an access plan demonstrating “corrections of the deficiencies found during the 2016 examination. This was similar to issues TDI previously identified in a 2014 examination of Molina.”
The February order also notes, “Molina received a number of complaints from contracted providers in 2017-2018 pertaining to loading issues affecting providers that had multiple locations. Most of these complaints have been resolved, and Molina represents that it will resolve the remaining known complaints by March 11, 2019.”
TMA helps resolve prompt-pay and other complaints against health plans by acting as an intermediary between a practice and TDI once a complaint has been filed to the agency. If you’ve filed a complaint with TDI against a health plan and are waiting to hear from the department, email Genevieve Davis, TMA’s associate vice president of payment advocacy.