Thursday, June 19, 2008

Missouri Cracks Down on Agent Healthcare Scam

Missouri Gov. Matt Blunt announced the Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) ordered two Springfield insurance agents whose reported insurance scam was taking advantage of Missouri consumers, Mo HealthNet, and two insurance companies to pay a total of $1.2 million to the state.

Kevin Louderback of Springfield and Justin Barnes of Battlefield as well as their insurance agency, Premier Financial Services and non-profit corporation, Citizens for Aids Assistance and Prevention (CAAP & Associates) must each pay $300,000 in penalties.

DIFP issued a cease and desist order on April 25, 2008, against all parties involved after an investigation reportedly revealed Louderback and Barnes employed deception to enroll over 800 employees in a small business group plan through UnitedHealthcare Insurance Company. A majority of enrollees were Medicaid-eligible and had applied for the Health Insurance Premium Payment Program (HIPP) to pay the health insurance premiums.

The HIPP program determines if it is more cost effective for Mo HealthNet to purchase private health insurance to pay claims or pay medical claims directly through Mo HealthNet.

The agents reportedly misrepresented the work hours of eligible employees and the amount of premium the employer would pay for each employee on their insurance application with UnitedHealthcare to obtain a small group health policy.

Before submitting information to the HIPP plan for coverage, they artificially increased the premium rates charged by UnitedHealthcare to receive the entire premium, rather than only the employee’s share. The inflated premium also includes an unallowable broker’s fee that was reportedly in some instances more than double the UnitedHealthcare premium rate from HIPP.

The Consumer Affairs Division, Mo HealthNet Division and UnitedHealthcare worked to move all HIPP members back to the regular Mo HealthNet system as soon as possible in order for recipients to resume health care coverage.

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