About POGO's Federal Contractor Misconduct Database (FCMD)
The government awards contracts to companies with histories of misconduct such as contract fraud and environmental, ethics, and labor violations. In the absence of a centralized federal database listing instances of misconduct, the Project On Government Oversight (POGO) is providing such data. We believe that it will lead to improved contracting decisions and public access to information about how the government spends hundreds of billions of taxpayer money each year on goods and services. Report an instance of misconduct »
Health Net, Inc.
Using an Outdated Schedule for Reimbursements
Date: 04/13/2004 (Date of Settlement Agreement)
Misconduct Type: Cost/Labor Mischarge
Enforcement Agency: State/Local
Contracting Party: None
Court Type: Civil
Synopsis: On April 13, 2004, the New York State Insurance Department and Health Net reached an agreement that stated that Health Net would "refund policyholders $4.99 million for claims and interest for medical services. Also, Health Net will create an appeals process for claims that had been partially or fully denied and will offer new appeals on certain emergency room claims that had been denied. The Department’s recent Report on Examination revealed that Health Net utilized an outdated schedule to determine certain reimbursements for out-of-network physicians and other medical providers between July 1999 and December 2002." Along with the $4.99 million refund, Health Net paid a $500,000 fine.