North Carolina and Coventry HMO settle charges of claims violations
Coventry Health Care of the Carolinas Inc. has agreed to pay $14,300 in a settlement with North Carolina over allegations that it violated several state health insurance laws.
Insurance Commissioner Jim Long announced the agreement with Coventry on June 15. The settlement stems from a routine examination of the HMO's operations by insurance investigators in May 1999.
Investigators accuse the HMO of failing to properly monitor the availability to patients of its contracted doctors and other health care providers, failing to resolve patient appeals and grievances on time, failing to maintain proper credentialing files on its health care providers, and failing to include state-required provisions in its contracts with providers.
Per state law, the settlement money is earmarked for North Carolina public schools.
In the settlement order stipulating Coventry's agreement to the fine, the HMO neither admitted nor denied any wrongdoing. "There are no other oral or written agreements of any kind," the settlement says.
Since 1995, the North Carolina Department of Insurance has negotiated $2.6 million in settlements with 39 insurers in all lines of insurance.