Alleged mishandling of more than 130,000 claims by insurance provider PacifiCare led to a joint action by the California Department of Insurance and the California Department of Managed Health Care. PacifiCare’s alleged violations include wrongful denials of covered claims; incorrect payment of claims; lost documents, including certificates of creditable coverage and medical records; failure to timely acknowledge receipt of claims; and multiple requests for documentation that was previously provided. PacifiCare is owned by UnitedHealth Group This joint effort is the first action ever by both CDI and DMHC against a single health plan or insurer. Generally, CDI regulates provider-preferred organization (PPO) health products and DMHC regulates health-maintenance organization (HMO) products.
