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Federal Contractor Misconduct Database (FCMD)

The federal government routinely awards contracts to companies with histories of misconduct, including contract fraud and other violations. POGO believes that providing this website will help to improve contracting decisions and increase public knowledge of how the government spends billions of taxpayer dollars each year. Read more…

Using an Outdated Schedule for Reimbursements

On April 13, 2004, the New York State Insurance Department and Health Net reached an agreement that stated that Health Net would “refund policyholders $4.99 million for claims and interest for medical services. Also, Health Net will create an appeals process for claims that had been partially or fully denied and will offer new appeals on certain emergency room claims that had been denied. The Department’s recent Report on Examination revealed that Health Net utilized an outdated schedule to determine certain reimbursements for out-of-network physicians and other medical providers between July 1999 and December 2002.” Along with the $4.99 million refund, Health Net paid a $500,000 fine.

Misconduct Type
Cost/Labor Mischarge
Enforcement Agency
State/Local
Contracting Party
None
Court Type
Civil
Disposition
Settlement
Date of Settlement Agreement
4/13/2004
Contractors Involved Penalty
Total
Health Net, Inc. $5,490,000
Further Information Released
NY Insurance Dept. Press Release 10/6/2006

Federal Contractor Misconduct Database