The Rise And Fall Of Physicians United Plan
|By Jim Ross, Ocala Star-Banner, Fla.|
|McClatchy-Tribune Information Services|
The state took receivership of the
Court records and documents from the state and federal governments show Physicians United, known as PUP for short, has been doing battle in multiple forums for the past seven years.
On the administrative front, the federal
CMS alleged that PUP failed to comply with federal requirements "governing the processing of Part C grievances, organization determinations and appeals," an agency record shows.
Two years ago, in a federal lawsuit, PUP and other medical and medical-related companies were accused of
In May, the plaintiff removed PUP's owner,
In a court filing earlier this year, PUP said it is a privately held company whose majority owner is IDJB.
According to the
Multiple efforts to reach Sattaur, Bajaj or anyone from PUP were unsuccessful.
Last year, a former PUP saleswoman targeted the company in a federal "whistleblower" lawsuit.
Illegally shut out potential policy holders who were blind because they were more likely to have or develop medical conditions that are expensive to treat;
Prevented her from selling in
Gave her a list of "preferred" doctors who had financial incentive based on medical loss ratio;
Eventually fired her for complaining.
PUP, through its attorney, has denied the charges. The lawsuit remains pending.
Earlier this year a former nurse care coordinator sued PUP alleging failure to pay overtime. The company has denied wrongdoing. That suit also remains pending.
That number jumped to 3,205 by the end of 2007. The balance sheet, however, wasn't progressing as well.
At the end of 2007, PUP's capital and surplus registered at negative
To comply with state rules, PUP issued additional private stock and a
The state was back two years later and once again found trouble in PUP's books. At the end of 2009, the company counted 18,574 enrollees but again had insufficient capital and surplus, the state reported.
State law only requires a financial examination every five years, and there were no reports after the 2009 version.
By the end of last year PUP had more than 38,000 enrollees. In retiree-rich
State experts dove back into PUP's books in April. As in the past, PUP reported financial data indicating it was properly capitalized. And as in the past, the state differed.
Only this time, regulators uncovered accounting problems so significant that the state decided to step in once and for all.
At issue was a newly discovered sale/lease-back agreement between PUP and Pacific Western Equipment Finance, according to an affidavit from an official with the
The company's financial statement for March showed
By the state's accounting, the
There was similar trouble on the receivables part of the ledger. According to the state,
The result: Instead of standing at a capital and surplus of
In light of this, on
The cash infusion never materialized. That's when the
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