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American Medical News

 
BUSINESS

News in brief - Sept. 10, 2001


Calif. takes over Los Angeles HMO - D.C. HMO closes - PacifiCare plans PPO launch - Mass. HMOs miss filing deadline - Hawaii plan founder pays part of fine

Calif. takes over Los Angeles HMO

California regulators have seized Watts Health Foundation, a Los Angeles-based HMO, saying the company's financial situation jeopardized its 96,000 mostly low-income patients.

The Dept. of Managed Care seized Watts Health Foundation, doing business as UHP Healthcare, in August after trying to work with the troubled HMO to correct its financial problems, state officials said. The department stepped in to ensure that claims by doctors and hospitals would be paid, said DMC Director Daniel Zingale.

Watts Health is a 34-year-old nonprofit with a history of being attentive to community health, Zingale said. But the HMO consistently fell behind in paying claims.

D.C. HMO closes

The George Washington University Health Plan will shut down next March, the HMO announced Aug. 22. The 77,000-member HMO could no longer compete against large managed care plans, stated CEO John F. Williams.

PacifiCare plans PPO launch

PacifiCare Health Systems Inc. will unroll a PPO health plan this fall in California, Oklahoma and Texas. Enrollment will begin in October for PPOs that start in January. The Santa Ana, Calif.-based managed care company, which traditionally has focused its business on HMOs, also announced that it would launch PPO plans in five other states by the third quarter of next year.

Mass. HMOs miss filing deadline

Three of the state's four biggest HMOs are months late in filing 2000 financial statements with the attorney general, as state law requires, to justify their charitable status.

The HMOs must submit the reports by May 15, but three -- Harvard Pilgrim Health Care, Tufts Health Plan and Fallon Community Health Care -- have asked for extensions to file their 2000 results.

But the health plans did manage to disclose second-quarter operating profits for 2001 to the insurance commissioner Aug. 14, the day before the deadline for both reports.

As Massachusetts-based charities, HMOs receive tax exemptions and can be sued for only $20,000 in damages if a court decides they're responsible for harming a patient.

Critics say the financial disclosure -- more extensive for the attorney general than for the insurance commissioner -- is necessary to make sure the health plans are fulfilling their charitable mission.

For example, the reports show top managers' salaries, diversion of money to for-profit subsidiaries and size of investment portfolios.

Spokeswomen for the plans called the extensions routine.

Hawaii plan founder pays part of fine

The founder of a now-defunct Hawaii health plan has paid $40,000 of a $50,000 fine imposed by the state Insurance Division. Darren Larson's Hawaii HealthCare Alliance was ordered to be liquidated in January after regulators found it was insolvent last fall.

The plan had been marketed to families of small-business owners and the self-employed.

Larson reached a settlement with the state in July on three administrative cases pending against him for his alleged part in several violations of insurance laws.

Under the settlement, his insurance licenses were revoked and he agreed to pay $50,000, with an initial payment of $40,000 and the remaining $10,000 in monthly installments of $500.

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Copyright 2001 American Medical Association. All rights reserved.
 
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