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Thread: Clean Claims' Restitution
06-05-2008, 05:17 AM #1
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Clean Claims' Restitution
The Texas Department of Insurance reported the restitution payments and fines announced by the Insurance Commissioner Jose Montemayor in agreement with 17 insurance carriers and health maintenance organizations operating in Texas are primarily the result of numerous justified complaints from healthcare providers about thousands of clean claims that were paid after the statutory 45-day period.
In a statement, Montemayor said the penalized company has been given enough time to correct their delinquent payments. The restitution payment will be effected along with $9.25 million in fines for failing to act on clean claims.
TMA President Dr. Tom B. Hancher called the action "a good first step" but said TMA believes that the fines and restitution represent only the tip of the iceberg about the money still owed to Texas physicians.
Mr Montemayor said that those insurance carriers failed to pay doctors and other providers on time, even after passage of legislation, the revision of this agency's regulations and strong warnings by the department.
Dick Weekley, Co-Founder, Chairman and CEO of Texans for Lawsuit Reform, a statewide organization dedicated to bringing fairness and balance back to Texasí civil justice system praised the action, giving credit to Gov. Rick Perry (R), who has been under fire from individual doctors and the Texas Medical Association for vetoing legislation passed by the 77th Legislature that would have strengthened prompt- payment requirements.
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