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Centene fined again for failing to meet ACA provider standards

The Office of the Insurance Commission will impose some or all of a remaining $900,000 suspended fine if the insurer does not meet compliance plan.

Susan Morse, Senior Editor

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A Centene subsidiary, which had to pay $500,000 last year for not meeting provider access standards in the Affordable Care Act market, has again been financially penalized for not fully meeting the compliance plan, though this time the fine is $100,000.

The Office of the Insurance Commission in Washington State announced the $100,000 fine on Thursday, saying Coordinated Care failed to meet deadlines, submitted provider contracts with illegal arbitration clauses and did not meet state requirements to show its provider networks were adequate.

[Also: Centene subsidiary in Washington State fined $1.5 million over provider deficiencies]

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

The OIC said it was working with Coordinated Care to correct the issues and if the company continues to be in violation, would impose some or all of the remained $900,000 outstanding from last year's suspended fine.

[Also: Centene profits from Affordable Care Act business, Health Net acquisition]

On Dec. 15, 2017, the OIC fined Coordinated Care $1.5 million, with all but $1 million suspended, pending no further violations over the next two years.

Specifically, the ACA plan did not have enough anesthesiologists in certain Washington State counties.

Coordinated Care data showed its provider network was also seriously deficient in other categories of providers, including immunology, dermatology and rheumatology.

Centene has done well in the ACA market. Earlier this year, Centene expanded its ACA business into Kansas, Missouri and Nevada and also extended its footprint in six other states.

In its fourth quarter results released this year, Centene showed an 8 percent increase in revenues. Full year revenues of $48.4 billion, a 19 percent increase, were also attributed to a full year of results from the insurance plans of Health Net, a company acquired by Centene. 

Centene specializes in Medicare, Medicaid and the ACA market.

Uncertainty exists in the individual market as insurers begin to set premium rates for 2019 and decide whether to remain in the ACA business. The federal budget gave insurers no cost-sharing reduction payments, but insurers are still required by ACA law to help pay  deductibles and out-of-pocket costs for consumers who qualify. Insurers also did not get a proposed reinsurance program that would offset some of the cost for paying for coverage of high-risk beneficiaries.

Premiums in the individual market are expected to again rise for consumers.

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

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