By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law
As of July 1, 2014, at 12:01 a.m., Physicians United Plan (PUP) will be liquidated. The insurance company was declared insolvent by a Florida circuit judge in Tallahassee on June 9, 2013. The judge turned the company over to the Florida Chief Financial Officer for immediate control of the company’s property and assets.
PUP is a Medicare Advantage plan, which is a private insurance company that insures Medicare patients. The Orlando, Florida-based company reports having 38,000 insurance subscribers. Those members have been switched back to original Medicare and a Part D prescription drug plan to avoid losing coverage during the transition. PUP subscribers will have to move to a new plan this fall if they want to stay with the Medicare Advantage program.
Click here to read the letter from the Department of Financial Services on the transition of patients from PUP to Medicare.
Background on the PUP Liquidation.
PUP failed to raise a required $30 million by the June 3, 2014, a deadline set to meet the state’s guidelines for financial solvency of an insurance company. The court order allows Florida’s Chief Financial Officer to “take immediate possession of all the property, assets and estate, and all other property of every kind whatsoever and wherever located.” PUP agreed to allow the Florida Division of Financial Services to become its court-appointed receiver on April 16, 2014.
To read the consent order appointing the Florida Department of Financial Services as the receiver of PUP, click here.
How Will This Affect Hospitals and Medical Providers?
If a medical group had a capitated plan, PUP should have been paying the physician group a set amount each month to keep its patients healthy. These groups won’t be hit as hard as others. However, more than 87 percent of PUP doctors were on fee-for-service contracts with PUP. These providers are more likely to get paid 20 to 30 percent of their outstanding bills after liquidation.
What to Say When a PUP Patient Comes Into Your Office.
After PUP was placed under the state’s control, patients reported health care providers have been canceling their appointments, canceling procedures and not filling their prescriptions. So on June 13, 2014, the Department of Financial Services sent a stern letter to health care providers warning them to continue taking patients with PUP. The letter stated: “Refusal of care, cancellation of appointments and any similar activities impacting member care form the basis of nonpayment of services and other state action.” To read the warning letter from the Florida Department of Financial Services to health care providers, click here.
On June 16, 2014, the Department of Financial Services advised health care providers to submit the claims to Medicare for prompt payment after June 23, 2014.
Comments?
What do you think about the liquidation of PUP? Do you think it will have an affect on your practice? Do you have any hesitations about PUP being liquidated? Please leave any thoughtful comments below.
Contact Experienced Health Law Attorneys.
The Health Law Firm routinely represents physicians and medical groups in insurance issues. It also represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
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Sources:
Powers, Scott. “PUP Customers Must Find New Medicare Plans.” Orlando Sentinel. (June 9, 2014). From: http://www.orlandosentinel.com/business/os-state-shutting-down-medicare-insurer-20140609,0,2911253.story
Aboraya, Abraham. “Judge Approves Liquidating Physicians Unite Plan on July 1.” Orlando Business Journal. (June 9, 2014). From: http://www.bizjournals.com/orlando/blog/2014/06/judge-approves-liquidating-physicians-united-plan.html
Shedden, Mary. “Don’t Abandon PUP Patients: State.” Health News Florida. (June 13, 2014). From: http://bit.ly/1lt8WoA
About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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