CMS Fines Regence $100,000 for Medicare Violation

The board members of The Regence Group listed below represent the company’s four states – Oregon, Washington, Idaho and Utah

November 30, 2011 – The Centers for Medicare and Medicaid Services has imposed a $100,000 civil penalty against The Regence Group for failing to provide accurate information to its Medicare Advantage members. The Regence Group is the holding company for the company’s insurance products in Oregon, Washington, Idaho and Utah.

During 2011, Regence failed to send accurate information about the cost-sharing changes for durable medical equipment and related supplies, including prosthetic devices, to its 88,667 Medicare Advantage members, according to Gerard J. Mulcahy, acting director of the Program Compliance and Oversight Group for CMS.

That failure “directly adversely affected or had the substantial likelihood of adversely affecting those enrollees,” he told Mark Ganz, CEO of The Regence Group.

“Regence failed to provide Medicare enrollees with vital information about changes to benefits and cost-sharing,” according to that letter.

Because of that failure, Medicare members “did not have ample opportunity to consider plan changes in order to make an informed healthcare choice during the 2011 Medicare Annual Election Period.”

Instead of paying the fine, Regence had the opportunity to request a hearing to appeal the determination by CMS, but chose not do so, according to Georganne Benjamin, assistant director of strategic communications for The Regence Group.

“Regence inadvertently omitted information regarding a change in the cost sharing specific to durable medical equipment and related supplies when we provided benefit plan change information to our Medicare Advantage members for the 2011 contract year,” she told The Lund Report..

“This was a one-time benefit information error and correct information was subsequently provided to all affected members,” she added. “Regence acknowledged its error and did not request a hearing. Since five separate Regence affiliate companies serve Medicare beneficiaries in five separate markets, we paid a total fine of $100,000 - $20,000 for each affiliate which is the same amount as other local and national carriers who made similar errors.”

The Regence Group Board of Directors in 2010

Many of the readers of The Lund Report have asked us to publish the list of board members of The Regence Group. We obtained that list from the 2010 filing by The Regence Group to the Washington Insurance Commissioner’s Office as required by law. 

Mark C. Adams, 505 Broadway, Unit 505 Tacoma, WA  [email protected]

S. Fred Beck,  CFO, ICON Health & Fitness,1500 South 1000 West, Logan, UT [email protected]

Cynthia A. Bioteau, PhD, President and CEO,Salt Lake Community College, 4600 South Redwood Road,Salt Lake City, UT [email protected]

Gregory L. Charlton, Senior Vice President, Idaho Independent Bank, 401 W. Front St., Ste 1000, Boise, ID, [email protected]

William L. Chenevich, Vice Chairman, U.S. Bank,17650 NE Sandy Blvd., Portland, OR, [email protected]

Peggy Y. Fowler, Retired President/ CEO, Portland General Electric

Mark B. Ganz, President & CEO, The Regence Group, PO Box 1071, MS:E15A, Portland, OR [email protected]

Mark L. Hogans, CEO, M. L. Hogans, LLC Consulting, Services and Executive Director, Puget Sound BOLD Initiative

9908 SE 5th Place, Bellevue, WA [email protected]

Paula A, Jones, President and CEO, P.A. Banks Enterprises, Inc., 1821 South Prairie, Chicago, IL [email protected]

Michael G. Koppel, VP and CEO, Nordstrom, Inc., 1617 6th Ave., 6th Floor, Seattle, WA 98101, [email protected]

Katharine G. Lindemann, SVP, Savers, Inc., 11400 SE 6th St., Ste 220, Bellevue, WA [email protected]

Luis Machuca, CEO, Kryptiq Corporation, 3600 NW John Olsen Place, Hillsboro, OR [email protected]

Dr. D. Kurt Seppi, St. Luke’s Magic Valley Medical Center, 650 Addison Avenue West, Twin Falls, ID [email protected]

Jack G. Strother, Attorney, Graham and Dunn, Pier 70, 2801 Alaskan Way, Ste 300,Seattle, WA [email protected]

 

FOR MORE INFORMATION

To read about how regulators didn’t question the $56.5 million payout by Regence BlueCross BlueShield, click here.

To read about the leadership shake-up at Regence click here.

To read about the investigation of Regence by Washington’s insurance commissioner, click here

To read about Regence BlueCross BlueShield’s losing its status as the leading insurer in Oregon, click here

News source: 

Comments

For years, we have wondered if the board of The Regence Group understands that Regence executives are disconnected from the market and that brokers and clients perceive them to be arrogant. TRG has closely held information regarding board members to isolate them from the truth. If you are an employee, former employee, client or broker,now is your chance to make sure your voice is heard. You can post a comment here or contact board members directly. Let's see if it makes a difference.

How can something so simple be so difficult to manage. They offer the same lame Medicare products in all 4 states. The same government affairs VP and Medicare Director remain firmly embedded in the black box. Disgusting.

As a ten-year employee at the Director level, I was unable to find this level of detail about the Board. The Board can only be completely out of touch with the massive Facets expenditures - or poisoned by the Mark Ganz kool-aid. Meanwhile Regence is beefing up the Community Relations Department tasked with building "strong relationships with employers, business and civic leaders, and community groups across Oregon", which now boasts a new Director for Charitable Giving!! And yet, to echo a previous comment, Cheron Vail still has a job. CP-SS anyone? A half-billion dollars for a Facets conversion would finance alot of charitable giving - but at least Trizetto is grateful for the reliable revenue stream.

The Regence Group accomplishes many great things internally and does many wonderful things externally (and internally) for our community. Ms. Lund, when will you be publishing coverage of these things?

I will be more than happy to publish the great things -- internally and externally -- that The Regence Group does in the community, as mentioned by a previous commentator -- the problem is -- no one has sent me any details -- I can be reached at [email protected]

 

Diane Lund

Editor

The Lund Report

These kinds of typos can and do happen all the time. Developing the contacts each year have a lot of varibles that change each year some time up to the last minuite. These changes can be complicated. This last year CMS shortened the time line to complete the work which did not help plans. Each plan has a different contract that is around 200 pages long. If a company has 10 plans that is 2000 pages that must be created in 30-60 days. Given that most people can not figure out what plan they should be on and the time lines CMS allowed I am not surprised to see a typo.

I have seen a couple of comments about Cheron Vail. It is clear from the statements that the people who wrote them have no idea what has been happening at Regence. Good luck Cheron!

A 10% change in copays was a typo? Give me a break! All Medicare carriers know you must notify beneficiaries in advance of benefit changes. If the "error" had been in the other direction you can bet TRG would be all over their members to recoup it.