Pennsylvania Department of Insurance Discovers Violation Against Geisinger

HARRISBURG, Pennsylvania (WTAJ) – A hospital with multiple medical centers in Pennsylvania has breached a pending medical claim, the Pennsylvania Department of Insurance (PID) has announced.

In a news release issued Wednesday, acting insurance commissioner Michael Humphries said Geisinger’s violations were found during a “comprehensive Affordable Care Act (ACA) market conduct examination.” . According to PID, Geisinger said he was cooperative in trials from January 1, 2015 to March 31, 2016 and from January 1, 2017 to March 31, 2018.

Geisinger replied to the WTAJ on Thursday and said in an emailed statement that the trial helped the hospital’s primary focus on facilitating access to health care services in the community. .

We appreciate the opportunity to partner with the insurance sector on opportunities for improvement. This is very much in line with Geisinger’s mission to make the health of the communities we serve easier: the review period for this latest market conduct trial dates back to his January 2015. Violations mentioned in the report have already been remedied or are being addressed.

Geisinger

A state investigation found that claims should have been paid, but were in fact denied by vendors of behavioral health services, the release said. Geisinger indicated that from 2016 he made system changes to 2018, including an all-new processing system for medical claims. In 2019, all behavioral issues were handled in-house.

As punishment, Geisinger was ordered by PID to reprocess the erroneous claim and pay the person who submitted the claim with the applicable interest. The report also found unfair insurance practice law violations, including “unclear communication with members, miscalculation of maximum out-of-pocket costs, and incomplete claim files,” the report said. Geisinger must show proof of return and pay a penalty of $125,000.

“The insurance sector’s top priority is consumer protection in the marketplace and these investigations give the sector an opportunity to ensure that companies are maintaining high standards and that consumers are enjoying their rights.” said Humphreys. “The results of the trial will not only allow some consumers to receive compensation, but also to improve their internal processes.”

About 60,000 Pennsylvanians have been awarded more than $5.8 million in compensation through Affordable Care Act inspections, according to PID. A full copy of the report can be read online at the PID website.