Florida suspends Centene’s Medicaid registration, fines insurer for technical error

Florida suspends Centene’s Medicaid registration, fines insurer for technical error

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Florida’s health care agency immediately suspended Centene subsidiary’s Medicaid and long-term care enrollment and fined insurers nearly $9.1 million after a computer glitch caused Sunshine State Health Plan to wrongly deny more than 121,100 low-income adults and children’s medical claims.

The $125.9 billion insurer must pay the fine within 30 days, according to a letter Wednesday sent by the state Health Care Administration to the CEO of the Sunshine State Health Plan. Centene’s Florida branch must also submit a plan for how all provider and patient claims will be reprocessed within 21 days, certify future claims are paid in a timely manner within 30 days, and communicate with the agency’s senior management on a weekly basis Call to see how the process is going.

After all requirements are met, the state will begin re-enrolling individuals into Centene’s Medicaid and long-term care plans. Insurers have 21 days to appeal the fines and registration freeze.

Centene did not immediately respond to an interview request.

The insurer, which claims to be one of the largest Medicaid managed care plans in Florida, has reportedly signed a multi-year contract with the agency worth $31.6 billion. The letter states that Sunshine admitted “an internal system error” that led to the incorrect claim denial.

Centene attributed the payment issues to a glitch in its integration of WellCare, which the insurer bought for $17.3 billion in 2020. Other Centene subsidiaries have recently run into similar troubles with state regulators.

In January, the insurer’s recently acquired Magellan subsidiary took over the administration of California’s Medicaid prescription drug program. worker shortage Frustrated by the thousands of patients awaiting approval for prior authorization, some were put on hold for eight hours at a time in the company’s call center.California health care agencies will reportedly detained Two-thirds of Magellan’s January contract payments. The insurer said it still plans to submit a bid to run the state’s Medicaid program.

As of March 10, California regulators received 47 complaints from suppliers about Centene and its subsidiaries in 2022. Last year, the California Department of Managed Health Care received 279 complaints about the insurer.

former CEO Michael Nedorf said the company encountered a shortage of workers during its third-quarter earnings call in September. In response, insurance companies are automating their call centers. The company has called for the implementation of artificial intelligence in this and other aspects of its business as part of its value creation plan, championed by activist investor Politan Capital Management.

“Relative to staffing, yes, we feel the pressure,” Nedorf told investors. “We have solutions that we think will work for us, and we’re working on them.”

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