Enforcement Actions
Itasca Medical Care
Stipulation and Order, June 2004. Deficiencies identified during quality assurance examination. Administrative penalty $5000
HealthPartners
Stipulation and Order, May 2004. Failure to notify the Department of Health about the impending termination of several providers that would significantly impact the remaining network. Corrective Action Plan required.
Stipulation and Order, December 2003. Deficiencies identified during quality assurance examination. Administrative penalty $10,000
Stipulation and Order, July 2003. Failure to handle enrollee’s phone calls as oral complaints. Enrollee denied protection of laws governing complaints, including the right to file a formal complaint, to receive written notice of the decision, the right to appeal an adverse decision, and the right to be given the phone number to contact the Department of Health. Administrative penalty $3000 with half going to the enrollee.
Blue Plus
Cease and Desist Order, December 2003. Failure to provide necessary pharmacy services to nursing home residents. Ordered to extend for 90 days its provider agreements with specified pharmacies. Also ordered to take other actions necessary to ensure that all of its enrollees who are residents of nursing homes have uninterrupted access to pharmaceutical services
Stipulation and Order, July 2003. Failure to provide an enrollee with notice of its decision on the enrollee’s complaint within 30 days, to provide notice of the right to appeal an adverse decision, and to provide the enrollee with the phone number to contact the Department of Health. Administrative penalty $3000 with half going to the enrollee.
Stipulation and Order, May 2005. Deficiencies identified during quality assurance examination. Administrative penalty $19,500.
Medica
Stipulation and Order, January 2003. Failure to promptly pay claims despite repeated assurance that the claims would be paid, causing the enrollee to set up payment plan with the provider to prevent adverse impact on enrollee’s credit rating. Administrative penalty $1000 with half going to the enrollee.
Stipulation and Order, June 2004. Deficiencies identified in quality assurance examination. Administrative penalty $5000.
Stipulation and Order, May 2005. Failure to pay for surgical assisting services provided by registered nurse first assistants. Administrative penalty $5000.
Metropolitan Health Plan
Stipulation and Order, July 2003. Deficiencies identified in quality assurance exam. Administrative penalty $16,000.
PreferredOne Community Health Plan
Stipulation and Order, July 2004. Deficiencies identified in quality assurance exam. Administrative penalty $9000.
Sioux Valley Health Plan of Minnesota
Stipulation and Order, March 2005. Deficiencies identified in quality assurance exam. Administrative penalty $1500.
UCare Minnesota
Stipulation and Order, October 2003. Deficiencies identified in a quality assurance exam. Administrative penalty $13,500.
For more information, or to file a complaint, contact the MCS at 651-201-5100 or 1 800-657-3916.