Washington Insurance Commissioner Mike Kreidler fined Molina Healthcare of Washington $100,000 on Tuesday for errors in the company’s enrollment and billing system.
Kreidler’s office opened a review of Molina’s enrollment and billing system in 2021 after a significant increase in consumer complaints against the company. That included two complaints about claims for pre-authorized services being denied, according to Kreidler’s office.
Molina transitioned to a third-party enrollment and premium billing platform in April of 2021 to address an increase in enrollment through the Washington State Health Benefits Exchange. Prior to the change, Molina identified several issues with its billing system — including sending incorrect invoices to nearly 2,000 people and incorrectly terminating coverage for 22 members.
The company continued to experience issues with enrollment and billing after the change; 2,309 members’ account balances were lower than the amount shown on their invoices; 55 members were erroneously terminated for non-payment; 259 transactions weren’t fully loaded into the system, which led to incorrect premium balances, according to Kreidler’s office.
After the OIC’s examination, Molina identified another 42 claims for pre-approved services that were denied due to issues with the claims processing system.
Molina has been operating as a health maintenance organization in Washington since 1985.
Kreidler has assessed more than $40 million in fines, which are directed to the state’s general fund to pay for state services.
Topics Washington
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