Oxendine Addresses Race And HMO Issues

The Georgia department will impose more fines if payments by managed care organizations are not made in a more timely manner, Oxendine says.

Since the department started monitoring claims payments in the fourth quarter of 1999, it has not found 100% compliance at any HMO reviewed.

At Humana, claims handlers have been violating Georgia prompt-pay requirements 10% of the time, and the statistics are actually getting worse, Oxendine says.

The performance of other companies varies, with some getting better, and others worse, Oxendine says.

"I told Humana and other HMOs that in the very near future we will look at them again," Oxendine says. "I want the fine to get their attention. If $400,000 is not enough, I can make it more and I will."

Oxendine says he believes that companies can be at 100% compliance because of technology.

He notes that his department treats a late payment as if it were made on time as long as the company includes 18% interest.

Humana consented to the fine, Oxendine says.

Humana issued a statement emphasizing that it has improved its operations since the problems reported by the Georgia department occurred.

"Humana is committed to timely payment of claims with its contracted providers, as well as its employer groups and members," Humana says. "The company has taken strong measures to resolve claims payment timeliness issues. In 2001, the company tracked a consistent upward trend in compliance with the 15-day payment regulation in Georgia."