- Centene’s Coordinated Care unit was fined an additional $100,000 Thursday for not adhering to an agreed-upon compliance plan to fix its inadequate provider network in the state of Washington.
- The Washington Office of the Insurance Commissioner had already fined the unit $1.5 million last December as part of a consent order outlining steps the insurer must take to fix its provider network deficiencies.
- Centene has executed a business strategy aimed at boosting membership in low-cost Affordable Care Act individual health plans from 537,200 at the end of 2016 to more than 1.4 million in 2018.
Washington Insurance Commissioner Mike Kreidler first issued a cease and desist order Dec. 12, ordering the company to stop selling individual health plans in the state due to an inadequate network of providers. The action followed more than 140 complaints from enrollees who reported they had difficulty accessing in-network providers and received surprise medical bills.
The $100,000 fine represents the first additional amount of $1 million in suspended fines contingent on further violations over two years after the consent order was agreed to. Centene must pay the fine within 30 days or it may face revocation of its certificate of registration.
The insurance commissioner writes Centene failed to meet “several milestones and requirements” in the corrective action plan.
“These include but are not limited to filing of certain provider contracts for review, developing appropriate internal policies and procedures to ensure compliance, and developing an acceptable plan for remediating consumer harm resulting from the Company's inadequate network,” the new fine order states.
In addition, Centene’s inadequate network and other actions has led to several alternative access delivery requests that Washington says the state was unable to approve, leading to the additional fine. The insurer has submitted provider contracts with illegal arbitration clauses as well, according to the commissioner.
“If the company continues to violate the compliance plan it agreed to, some or all of the remaining $900,000 fine may be imposed,” his office said.
Centene’s rapid expansion of the plans has come under fire. The company faces a class-action lawsuit alleging that the plans are leaner than it advertised. Centene did not immediately respond to a phone call from Healthcare Dive seeking comment.