California public hospitals provide emergency care, and the job becomes more manageable with the cooperation of insurers. However, Health Net and other companies decided to disrupt this critical service by attempts to delay payment or underpay. They now face the full wrath of the law.
The city of San Francisco filed a lawsuit against Health Net and other defendants identified as Blue Cross, Anthem Blue Cross Life, and Health Insurance Company. According to the court filing, Health Net and its co-accused made deliberate efforts to hold off payments to the San Francisco General Hospital (SFGH) and similar institutions.
The insurers’ actions unnecessarily interrupted the operations of the named public hospitals and endangered the lives of many patients, per the filing by city attorney Dennis Herrera. The lawyer said Health Net and co. had carried out a scheme to cut down costs and enrich themselves.
Disruption Of Public Service
Public hospitals like the SFGH are mandated to accommodate emergency cases, and the cost of such undertaking is passed on to insurers. Herrera said these companies are duty-bound to make full payment, especially in patients who are policyholders.
It turned out that Health Net and the other accused insurers were unwilling to provide the coverage they promised to customers. They made arbitrary Usual and Customary Rate (UCR) rate reductions on the bills sent out by public hospitals.
The decision harmed these institutions, and as the lawsuit stated, several ER facilities in California were forced to close due to a lack of funding. Health Net’s scheme only added to the already serious financial woes these hospitals had been made to deal with.
In pursuing the case, Herrera said he wants the court to order Health Net and other insurers to stop their unfair business practice immediately. The city of San Francisco also seeks full restitution for all cited underpayment made by the erring companies, plus the interest incurred.
Herrera is also looking to secure the payment of penalties and the cost of the litigation. He is optimistic that the court will rule favorably considering a similar case in 2011 that also involved Health Net. In that successful lawsuit, the court found the company guilty of wrongdoing and ordered the compensation of nearly $1 million.
A Serial Crook Exposed
As of writing, a decision on the case is yet to be handed down. But the lawsuit serves as another proof of Health Net’s long-standing practice of violating the law to achieve a financial advantage. Also in California, the company is facing complaints of wrongdoing from a group of mental treatment centers.
Per the information gathered from these cases, Health Net either denied payment claims from these healthcare providers or reduced the money due to them. The insurer’s action triggered a domino effect – the care facilities stopped their operations, and then patients found themselves lacking adequate medical help.
