What is Happening With Our Doctors |
Doctors and regulators are becoming fed up with OXFORD HEALTH PLANS (Norwalk, CT) and its failure to pay millions of dollars in claims, so they are taking action. A group that represents 5,000 Manhattan doctors was preparing to file two arbitration proceedings Tuesday against the healthcare giant, citing "a pattern of delays, denials and detours from acceptable practice, " according to a New York Times report published Tuesday. The group, known as the New York County Medical Society, described its insurrection against a managed care provider such as Oxford as unprecedented. On a second front, New York state attorney general Dennis Vacco issued a subpoena Monday to Oxford requesting information related to the settlement agreement he negotiated with the company last July, the Times reported. In that agreement, Oxford had agreed to pay 9 percent annual interest on undisputed claims more than 30 days old. The subpoena, according to people who have seen it, tries to pinpoint how much progress Oxford has made on the mound of back bills and interest, according to the report. In possible violation of the July agreement, the company has so far failed to provide Vacco with a quarterly progress report that might shed light on the matter. "There has been no compliance report filed as of yet, " said Marc Carey, a spokesman for the attorney general's office, in the Times report. "We will continue to push ahead to ensure that the document is filed. " In the doctors' filings, one proceeding asks that an arbitrator review doctors' claims and order Oxford to pay the money they say they are owed, while the other asks that an arbitrator require Oxford to establish clearer payment guidelines. The crux of the discontentment is the amount of money Oxford owes in delayed bills. The company has blamed computer snafus for massive billing problems that have led to losses in the hundreds of millions. The doctors, who cannot take their grievances to court under their contracts with Oxford, have banded together to try to recover their share. The Times report said the amount may be about $ 145 million, based on copies of the arbitration filings it obtained. But that figure may well include amounts owed to hospitals and doctors outside Manhattan. Oxford issued a statement Tuesday saying the group has "no basis " for floating the $ 145 million figure. "Our records show that this is a substantial overstatement, " Oxford said. Oxford spokeswoman Nicole Reilly told the Times that company records for all doctors in its plans showed Oxford owing less than $ 45 million in claims older than a month. With the dispute dragging on for months, many of the doctors have apparently concluded that something is better than nothing and are allowing the lawyers who represent them to work on a contingency basis, according to the report. That means the lawyers can keep one-fourth of whatever they recover, unless Oxford can also be made to pick up lawyers' fees and other arbitration costs. "Our level of tolerance has been tested to the absolute limits, " said Valentine Burroughs, the president of the society who described monthly meetings with Oxford officials that resulted in little progress. The society said some doctors were owed $ 1 million or had not been paid for care they provided more than a year ago. Oxford said Tuesday it has advanced payments to doctors and has agreed to pay interest on delayed claims. Secondly, the company said it pays the "majority " of its physician claims in less than 30 days. "Oxford claims processing operations have improved and are getting better, " the company stated. A fixed payment schedule is "unnecessary, " Oxford said, "since a new state law went into effect last month requiring companies in our industry to pay interest on claims after 45 days. We agreed to pay interest before it was a state law. " Oxford recently was rumored to be a takeover candidate by AETNA INC. (Hartford, CT), which helped Oxford's moribund stock rebound slightly. But analysts doubt such a move will occur until Oxford digs out from its troubles. In addition to the massive losses, a pile of shareholder lawsuits, a huge drop in stock value and growing discontent by its doctors, the company is also looking for a new chief executive and chief financial officer. The company faces additional scrutiny from state insurance departments in New York and Connecticut, the Times reported. New York's insurance department, which has already weighed in with a report criticizing Oxford's management, is still reviewing the company's financial condition. That review will be completed after the fourth-quarter results are released, a department spokesman said. The results are not expected before mid-February. CONTACT: Nicole Reilly for Oxford (212/885-0353) |
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