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Centene subsidiary in Washington State fined $1.5 million over provider deficiencies

All but $500,000 of fine suspended if Coordinated Care Corp. ensures members have access to in-network providers.

Susan Morse, Senior Editor

Washington Office of the Insurance Commissioner Credit: Google Street ViewWashington Office of the Insurance Commissioner Credit: Google Street View

The insurance commissioner in Washington State has levied a $1.5 million fine against Centene subsidiary Coordinated Care Corporation and has ordered the HMO to fix deficiencies in provider access within its network.

The company was fined $1.5 million with $1 million suspended, pending no further violations over the next two years. Coordinated Care must also pay $500,000 by Jan. 15, 2018.

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Coordinated Care Corporation is a wholly-owned subsidiary of Indiana-based Centene that sells individual plans in Washington.

Insurance Commissioner Mike Kreidler said his office had received over 100 complaints about Coordinated Care's inadequate network, such as insufficient anesthesiologists and surprise medical bills from out-of-network charges, according to his December 15 order.

"Upon reviewing all of the materials submitted by the company, the insurance commissioner determined that the company had an insufficient network of providers in a number of its service areas, including its largest, such as King, Pierce, and Spokane Counties," Kreidler said.

The insurance commissioner has been working with Coordinated Care for months and three times rejected the insurer's alternative access delivery request, or AADR, in which Coordinated Care admitted it failed to offer an adequate network of providers.

Coordinated Care was briefly stopped from selling plans. The December 15 order rescinds the cease and desist order.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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