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California Department of Insurance v. Pacificare Life & Health Insurance Co.

HEALTH PLAN REGULATION: California Department of Insurance v. Pacificare Life & Health Insurance Co. (California State Insurance Commissioner) CMA has provided information and witnesses in the Department of Insurance's (DOI) administrative action against Pacificare. 

In 2006, CMA presented a lengthy complaint to the DOI from 20 physician members concerning a variety of problems they encountered with Pacificare. Subsequently, the DOI conducted a year-long investigation that resulted in findings of hundreds of thousands of violations of the Insurance Code by Pacificare. In the fall of 2009, the DOI commenced a formal administrative action to prove Pacificare committed approximately 993,000 violations of the insurance laws and regulations. In June 2014, DOI issued a decision to impose penalties of more than $173 million against Pacificare. United Healthcare, which acquired Pacificare in 2005, has appealed the decision to the Orange County Superior Court. The matter continues to be litigated and CMA will continue to stay involved as necessary to ensure that United Healthcare is held accountable for its violations.

Status

In June 2013, DOI imposed penalties of more than $173 million against Pacificare. United Healthcare, which acquired Pacificare in 2005, has appealed the devision

CMA Staff: Francisco Silva, Long Do