Two MVP companies, MVP Health Plan Inc. and MVP Health Insurance Company, have been fined a total of $200,000 by the Department of Financial Services due to improper denial of claims and incorrectly applying cost shares.
The cases, which affected 356 members between 2011 and 2013, involved denying claims for preventative procedures, as well as incorrectly charging cost-sharing services to clients, a statement from the Department of Financial Services (DFS) said. The procedures mentioned in the claims included screenings for breast, cervical and colorectal cancer, as well as claims related to depression, hearing loss and obesity.
“Health insurance companies must provide necessary preventative services without co-pays and deductibles as the law requires,” DFS superintendent Maria Vullo said, in the statement. “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 agreed to pay the fine, which amounts to approximately $9,000 per member affected, including interest. Additionally, the DFS has mandated an update to processing systems for claims, better training for claim examiners and explanations to care providers on how to handle mandatory services. A consent order placed by the DFS obligates MVP to provide documentation as proof of these adjustments.