CA regulators seek $10 billion from PacifiCare

The health insurer is accused of mismanaging medical claims, losing thousands of patient documents, and failing to pay doctors what they were owed. All told, PacifiCare, now part of UnitedHealth Group, is alleged to have violated state law one million times from 2006 to 2008, according to the state Department of Insurance. Regulators have been going after the Cypress-based insurer for several years, but the $10 billion fine is much higher than what I've seen in earlier stories. It's believed to be the largest fine ever sought against a U.S. health insurer. From the LAT:

"This is about intentional disregard for the interests of doctors, hospitals and patients in California, and the pursuit of cutting costs at any means possible," said Adam Cole, the insurance department's general counsel. "It's a story of intense corporate greed." PacifiCare and UnitedHealth Group have rejected the state's assertions, and they are fighting the proposed fines in a lengthy legal hearing that began 10 months ago in Oakland and could conclude as early as next month.

The insurers maintain that the state's case largely involves administrative errors that did little harm to anyone. They point out that three-quarters of the allegations relate to PacifiCare's alleged failure during a short period in 2007 to inform doctors and patients in correspondence of their right to appeal coverage decisions. "The allegations concerning claims processing by PacifiCare are simply not true," spokeswoman Cheryl Randolph said. "By all objective measures, PacifiCare pays its claims timely and accurately."