DFS Fines Mvp Companies $200,000 for Improperly Denying Health Insurance Claims and for Charging Co-Pays and Deductibles for Preventative Services

ALBANY, N.Y., Aug. 22 -- The New York State Department of Financial Services issued the following news release:

Financial Services Superintendent Maria T. Vullo today announced the Department of Financial Services (DFS) has fined MVP Health Plan Inc. and MVP Health Insurance Company $200,000 for incorrectly applying cost-sharing to members' claims and improperly denying some claims for preventive healthcare services. The companies agreed to pay the fine and to correct claims processing procedures in a consent order reached with DFS. The companies have agreed to make restitution, including interest, to 356 of its members.

"Health insurance companies must provide necessary preventative services without co-pays and deductibles as the law requires," Superintendent Vullo said. "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 companies have agreed to make restitution, including interest, totaling approximately $9,000 to 356 of its members. MVP Health Plan Inc. is a not-for-profit health maintenance organization; MVP Health Insurance Company is a for-profit insurer that sells small group policies and policies to individuals. The two companies insure approximately 100,000 members in New York's individual and small group markets.

The violations, which occurred between 2011 and 2013, were uncovered in a DFS examination of the insurers. The DFS examination found that some members' claims were improperly denied by the insurers. In other cases, members were erroneously charged cost-sharing expenses, such as improper co-payments or deductible charges. The violations involved instances of improperly processing claims involving more than a dozen kinds of healthcare screening or preventive services. These included screening for breast, cervical and colorectal cancer, depression, hearing loss and obesity in children and adults.

In addition to restitution and the fine, the consent order directs the companies to update their claims processing system, provide training for claims examiners, and explain to providers how to handle certain mandated services under the federal Affordable Care Act and New York law.

The DFS consent order requires the companies to provide DFS with documentation to verify that they have complied with the terms of the order.