ARCHIVED  February 1, 1997

Insurance Division cites HSI for violations of regs

FORT COLLINS – The Colorado Division of Insurance has cited HSI Health Plans Inc. of Fort Collins with 34 findings of noncompliance with Colorado insurance laws or regulations.The findings, detailed in the division’s “Market Conduct Examination Report,” range from concerns related to HSI’s policy forms to the company’s implementation of Small Group Health Insurance Reform.The Examination Report was only the second ever conducted by the Insurance Division and reflects a much greater level of inquiry than is found in the division’s typical triannual reviews of insurance companies.
A separate examination of Mutual of Omaha and Primera Inc. elicited 35 notices of violations, in the division’s first such audit.
Chuck Mabry, president of HSI, said the insurer started out by contesting some of the findings of the auditors but eventually agreed to all 34 findings and recommendations.
“It was either that or have our license put on hold,” Mabry said. “You don’t have much choice unless you want to go to court.
“It just wasn’t worth the time, the effort, the cost to fight the battle over one word, for example,” he added.
Despite the newness of the audit, Mabry said he didn’t believe the division was trying to make an example of HSI.
“I think that they were genuinely attempting to assess what we were doing and the way we were doing it,” he said. “The problem is always one of interpretation.
“A lot of where we found ourselves at odds with the Division auditors were areas of genuine interpretation,” he added.
As an example, Mabry pointed to an HSI form that referred to a “legally married spouse.” The division’s auditor’s objected to the word “legally,” so HSI eventually acquiesced and agreed to remove the word from all forms.
Additionally, some HSI policies hadn’t been updated, even though the company was complying with new laws and regulations in practice, Mabry said.
He added that he conducted an audit on every one of the issues raised by the Insurance Division that could have had an effect on a policyholder. He said the company found “absolutely no real impact on any single, solitary member of the company.
“They pointed out so many things that added up to no substance,” he added.
Mabry said the company might have to pay some level of a fine for the violations but that the amount and likelihood of a fine is unknown.
He said he was most surprised not by the extensiveness of the audit but by the fact that Colorado had no certified examiners to conduct the audit. Instead, the state brought in an examiner from the East Coast. HSI had to pay for the lodging, rental car, transportation, etc. for the duration of the audit, which took six to eight weeks. For most of the time, two auditors were in place at HSI’s expense, but a third was there for part of the process, he said.Gov. shakes up health department
CHEYENNE – Wyoming Gov. Jim Geringer has shaken up the state Health Department by removing its director and the head of the state’s Health Care Financing Division after a state audit revealing the department was lax in pursuing Medicaid overpayments.
Geringer accepted the resignation of Director Ken Kamis and removed Cheryl McVay as head of the state’s Medicaid program after investigation by state officials determined the state didn’t try to recover more than $600,000 in Medicaid overpayments to doctors, hospitals and other medical providers.
The governor said Kamis started and McVay continued a state Medicaid policy to educate Medicaid providers regarding overpayments while not always trying to collect them. He praised Kamis for his record as Health Department chief under both Geringer and former Gov. Mike Sullivan, but he said a policy of disregarding Medicaid overpayments was an error that could not be overlooked.
Kamis said he tried to educate Medicaid providers on how to improve their billing practices and thought that was within his discretion. He noted that his policy led to Wyoming having the highest provider participation rate in the nation, with virtually every doctor and hospital providing health care for Medicaid patients, and he said his policy helped stem an exodus of doctors from Wyoming and helped revitalize Wyoming’s health-care delivery system.Two residents open practice
CHEYENNE – Two doctors who did their residencies at the University of Wyoming’s Cheyenne Family Practice Center have opened their own family practice, the High Plains Family Medicine Clinic, on Cheyenne’s North Side.
Dr. Joseph Dobson, M.D., and Dr. Tamara Cottam, M.D. plan to offer a full-range of medical care for families in their new practice, including obstetrics. “We’ll be delivering babies and offering the whole scope of family care,” Dobson said. “I think there’s definitely a need for family practitioners in Cheyenne.”
Dobson, a graduate of Eastern Virginia Medical School, recently finished his residency at the Family Practice Center, one of two residencies in family medicine offered by the University of Wyoming. Cottam, a graduate of Creighton University School of Medicine in Omaha, Neb., will complete her residency at the Family Practice Center in July and work part-time in the clinic until then.State sets co-pay for medicines
CHEYENNE – Wyoming state health officials have approved a “quick fix” to keep a medical prescription program alive, but it will cost participants in the program more money in co-payments.
The Department of Health has approved rules requiring participants in the Minimum Medical Program to make a co-payment of $25 per prescription to keep the beleaguered program solvent. The program is designed to help poor and elderly people who don’t qualify for Medicaid, but it has been going broke because of costly medicines and drugs, including anti-depressants, and the impact of the changes will be severe.
Mary Sandison, 62, of Cheyenne has been on the program since its inception, receiving help with the medications she takes for a heart condition and high blood pressure. But now she’s facing co-payments of $150 a month on a Social Security disability monthly income of around $500 a month, and that’s enough to make her blood pressure rise.
“I talked to my senator, and he suggested raising all the hell I can between now and the Legislature,” she said, “and that’s just what I’m going to do. I said it’s either that or go to the hospital and tell them to put me in the old folks home.
Australian finds Wyo. similarities
LARAMIE – An Australian nursing professor says she sees more similarities between Australia and Wyoming than just wide-open spaces where animals outnumber people.
Janie Mason, a registered nurse and associate dean of the Northern Territory University School of Nursing in Darwin, spent her sabbatical at the University of Wyoming in Laramie, studying how health-care services are provided in the rural American West and especially on the Wind River Indian Reservation, because Northern Territory has a large population of Aborigines.She is interested in how nurse practitioners are helping serve communities here, because Wyoming’s nurse practitioners have similar roles and education to registered nurses in Australia, particularly those who travel into the “bush.” not venture for a month or more.
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FORT COLLINS – The Colorado Division of Insurance has cited HSI Health Plans Inc. of Fort Collins with 34 findings of noncompliance with Colorado insurance laws or regulations.The findings, detailed in the division’s “Market Conduct Examination Report,” range from concerns related to HSI’s policy forms to the company’s implementation of Small Group Health Insurance Reform.The Examination Report was only the second ever conducted by the Insurance Division and reflects a much greater level of inquiry than is found in the division’s typical triannual reviews of insurance companies.
A separate examination of Mutual of Omaha and Primera Inc. elicited 35…

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