Health Net

Health Net, LLC, a Centene company, is an American health care insurance provider. Health Net's behavioral health services subsidiary, MHN, provides behavioral health, substance abuse and employee assistance programs (EAPs) to approximately 7.3 million individuals in various states, including the company's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs. HMO, POS, insured PPO, and government contracts subsidiaries provide health benefits to approximately 5.9 million individuals in all 50 states and the District of Columbia through group, individual, Medicare, Medicaid, Tricare, and Veterans Affairs programs.[1]

Health Net, Inc.
Subsidiary
IndustryManaged health care
HeadquartersWoodland Hills, Los Angeles, California
Key people
J. Brian Ternan (CEO)
ProductsHealth insurance
Number of employees
3,000
ParentCentene
Websitehealthnet.com

In July 2015, Centene announced its intention to acquire Health Net for $6.8 billion. St. Louis-based Centene completed its acquisition of Health Net in March 2016.[2]

Health Net's dual headquarters are located in St. Louis, Missouri and Woodland Hills, Los Angeles, California.

History

Health Net of California was first established as a non-profit corporation in 1977. A 1992 state of California order permitted the health care company to convert itself from a nonprofit into a for-profit company. At the same time, the state order required the new company to transfer 80% of its equity to the California Wellness Foundation, a successor charity to its non-profit status.[3] Under the terms of the California Department of Corporations' conversion order approving Health Net's for-profit status, the California Wellness Foundation received $300 million plus 80 percent of the equity of Health Net's parent holding company.[4]

In August 1993, Health Net merged with Qualmed to form Health Systems International. The merger created a 1.8-million-member HMO with a market value of $725 million, one of the biggest publicly traded health care companies at the time. Dr. Malik Hasan had founded Qual-Med, with his wife Seeme Hasan in southern Colorado. Qual-Med first went public in June 1991.[5]

In May 1997, Health Systems International merged with Foundation Health Corporation to form Foundation Health Systems. At the time of the merger the newly created Foundation Health was valued at $1.27 billion and was the 4th largest health insurer in the U.S. and the second largest HMO in California. It had more than 5 million members in 17 states and in 2.8 California.[5] In November 2000 Foundation Health Systems officially changed its name to Health Net, Inc. when the company started trading on the New York Stock under the symbol HNT.[6][7]

State-specific divisions existed under a variety of names prior to the 2000 renaming of Health Net, Inc.:

  • Health Net of California Inc., the company's California division, incorporated in 1977
  • Founded as QualMed Oregon Health Plan, it was officially renamed Health Net Health Plan of Oregon in 2000, Inc.[8]
  • Health Net of Arizona, Inc. was founded in 1981, as Intergroup of Arizona by a multi-specialty medical group in Tucson. In 1994, Intergroup became a wholly owned subsidiary of Foundation Health Corporation.[7]

On July 2, 2015, Centene Corporation announced it would acquire Health Net for $6.8 billion. Upon completion, Health Net shareholders will own 29% of the combined company.[9] Health Net of California Inc. president, Steve Sell, explained that the merger will benefit the consumers as the said deal was meant to strengthen Health Net's business. However, health advocates were not easily convinced due to the company's major deficiencies that were identified in 2013 by state regulators.[10]

On June 20, 2017, Health Net Federal Services, LLC, (HNFS) a wholly owned subsidiary of Centene Corporation (NYSE: CNC), announced it has earned the Health Network Accreditation from URAC, an independent organization that promotes healthcare quality through accreditation, certification and measurement.[11]

In 2018, Health Net in Arizona was merged into other Centene holdings to form Arizona Complete Health.[12]

Divestures

In July 2009, UnitedHealth Group bought Health Net's northeastern licensed subsidiaries for $450 million. At the time, the subsidiaries had 578,000 members in Connecticut, New York and New Jersey.[13][14] In January 2012, Health Net sold its Medicare Prescription Drug Plan business to a subsidiary of CVS Caremark for approximately $160 million in cash.[15]

Divisions and subsidiaries

Health Net insurance Health Net offers health insurance plans for individuals and families, groups/companies, and Medicare beneficiaries in Arizona, California, Oregon, and Washington. In addition, Health Net provides health coverage for California State Plans such as "Healthy Families" and "Medi-Cal."[16]

  • Its individual and family plans include Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), short term health insurance plans, and health savings account (HSA) health insurance options.
  • The company's large and small business portfolio of products include HMO, PPO, tailored networks, health savings account HSA and "Salud", a plan specifically for Hispanics.[17]
  • The health insurance company offers public health insurance through California State programs such as Medicaid, Healthy Families, Healthy Kids (welfare), and Medi-Cal. The state of California offers low-cost health insurance for children under 19 years of age via its Healthy Families Program; while, low income individuals can enroll for California's Medi-Cal.[18]

Health Net Federal Services, Inc. (HNFS) is the government operations division of Health Net. It is the TRICARE North region provider as of July 1, 2004. Health Net's bid for the Tricare North region business contract, effective starting April 1, 2010, was given to Aetna,[19] however Aetna's contract has been suspended pending the outcome of Health Net's protest. On May 13, 2010, Health Net Federal Services was formally awarded the contract as the TRICARE Managed Care Support (MCS) contractor for the TRICARE North Region by the United States Department of Defense (DoD).[20] The announcement followed the May 5, 2010, news of the DoD's intent to award.

HNFS was awarded the T-3 TRICARE39 North Region contract beginning on April 1, 2011, which includes the following states: Connecticut, Delaware, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Washington DC, West Virginia, and Wisconsin.[7] HNFS also provides health care for U.S. Veterans nationwide. HNFS's programs include community-based outpatient clinics, recovery audit services, and rural mental health programs.[7]

Health Net Dental is based in Irvine, CA and offers dental coverage for Healthy Families, Los Angeles Medi-Cal, and Sacramento Medi-Cal customers.

Managed Health Network, Inc. is a subsidiary that offers Employee assistance program (EAPs), behavioral health solutions, integrated disease management, as well as work/life balance, wellness, employee productivity, and organizational efficiency programs.[21]

Awards and recognitions
  • 2018 Health Net earned 4 of 5 stars from the Center for Medicare and Medicaid Services in their annual star rating report
  • 2018 Health Net earned Prestigious Commendable Accreditation Status from the National Committee for Quality Assurance (NCQA)
  • 2017 Health Net Federal Services earned the Health Accreditation from Utilization Review Accreditation Commission (URAC)
  • 2010 Healthnet.com and the newly launched Health Net Mobile app received numerous Awards: Official Honoree (Insurance Category)
  • 2010 Webby Award[22] Silver Award Winner (Insurance Site)
  • 2010 W3 Awards[23] Silver Award Winner (Health & Wellness Mobile App)
  • 2010 W3 Awards[23]

Sponsorships and philanthropy

Health Net Foundation

The Health Net Foundation was created in 2007 as the philanthropic arm of Health Net. It makes charitable contributions to organizations that promote wellness and preventive care, combat childhood obesity and support health programs for military families in communities where Health Net does business. Health Net launched its Foundation in September 2007 by providing a Three-Year $1.35 Million Grant to the American Heart Association.[24] The Health Net Foundation has provided other grants such as the $175,000 given to twelve California school-based health centers and community medical clinics to improve dental care and oral health.[25]

Other sponsorships

In addition to its Foundation, Health Net Federal Services has also participated in philanthropic causes. The division established a scholarship to be administered through National Military Family Association (NMFA) designating $150,000 to be awarded to military spouses in the TRICARE North Region.[7] Health Net Federal Services sponsors military-related sports-related events and veterans' sports clinics such as the National Veterans Golden Age Games in Honolulu[26] and the Veterans Wheelchair Games.

Since the 1980s, Health Net has been a sponsor of the March of Dimes' largest fundraising event, March for Babies. In 2008, more than 300 Health Net associates walked in March for Babies events across California contributing more than $325,000 through various fund-raising efforts.

For a number of years, Health Net sponsored the Health Net Pro Cycling Team, which now is sponsored by UnitedHealth Group. Health Net Pro Cycling Team Presented by Maxxis was run by Momentum Sports Group and based in the United States. Health Net won the team title in the 2004, 2005, 2006 and 2007 USA Cycling National Racing Calendar series competitions.

Quality of care

In California's Health Care Quality Report Card 2011 Edition by California's Office of the Patient Advocate, Health Net (CA) received 2 out of 4 stars in Meeting National Standards of Care.[27]

Controversies

Restatement

On February 11, 2004, the company restated its results for the first three-quarters of 2003 and for the full years of 2002 and 2001. The adjustments amounted to a $4.4 million increase in net income for the first three-quarters of 2003, or about 3 cents a share.[28]

Patsy Bates lawsuit

In 2007, Patsy Bates, a California beautician, sued Health Net claiming that they wrongfully terminated her care in the middle of her chemotherapy treatments. An internal company employee performance review made public during the lawsuit revealed that one of the company's managers had tied bonuses to the rescission rate for one analyst in charge of rescission reviews to discover reasons (such as application fraud) to discontinue coverage to enrollees. The company pointed out that Bates had withheld critical information - that she had damaged her heart by the use of fen-phen for diet purposes and stated an inaccurate weight; Bates replied that the insurance broker had filled out the form for her and she had been busy in her salon.[29] In February 2008, the court ruled in favor of Bates, ordering Health Net to pay $8.4 million in punitive damages and $750,000 for emotional distress.[30]

Connecticut Attorney General investigation

In November 2009, Connecticut attorney general Richard Blumenthal said Health Net lost the personal information of nearly 450,000 state residents and "failed to inform consumers for six months."[31][32] The data on the drive was unencrypted and included information about financial, health, and personal information.[32] It was discovered missing from the company's Connecticut office.[32] Health Net circulated a letter to customers in December 2009, including an offer of free credit protection from a company called Debix for two years.

CMS suspension

On November 19, 2010, the Centers for Medicare and Medicaid Services (CMS) immediately suspended Health Net because the insurer improperly administered the Medicare drug benefit in contracts for its national prescription drug plan and local Medicare Advantage prescription drug plans.[33] The suspension required Health Net to cease marketing and enrollment of new members of all Health Net Medicare Advantage Prescription Drug (MAPD) and stand-alone Prescription Drug Plan (Part D) contracts, effective November 20, 2010. The sanctions relate to compliance with certain Part D requirements. The suspension did not affect existing Health Net Medicare enrollees.[34]

Although the company was allowed to resume marketing its Medicare products in August 2011, on January 6, 2012, the company agreed to sell its Medicare stand-alone Prescription Drug Plan (PDP) business to CVS Caremark Corp. (CVS) for about $160 million in cash. Health Net would continue to provide prescription drug plans as part of its Medicare Advantage plan offerings.[35]

Network data breach

On March 14, 2011, Health Net disclosed that nine server drives, containing personal information of 1.9 million members and providers, went missing in transit from its Rancho Cordova (CA) data center to an IBM data center in Boulder (CO). The insurer found out about the security lapse on January 21 when IBM, which manages the company's IT infrastructure, informed Health Net it was unable to locate the missing server drives.[36]

Health Net's missing computer records represent the largest data breach reported to the Office for Civil Rights (OCR) website and the third largest medical information breach in the Privacy Rights Clearinghouse database.[37] The data breach effects roughly 1.9 million people including 845,000 Californians, 100,000 Oregonians, 3,500 Vermonters and thousands more in other states.

The company offered two years free credit monitoring along with identity theft insurance to those affected. The Californian Department of Managed Health Care and the Department of Insurance have announced separate investigations into the breach.[38]

Los Angeles County Medical Association lawsuit

On September 13, 2012, the Los Angeles County Medical Association joined two patients in suing Health Net for illegally denying medically necessary treatment, including cancer care. The lawsuit alleges that Health Net routinely and systematically denies claims based on its own definition of "medical necessity", violating well-established standards set forth by California law. According to the suit, Health Net is "the leader" in this calculated corporate practice to avoid paying claims.[39]

Memorandum of Department of Veterans Affairs Inspector General

In September 2017, VA Inspector General Michael Missal issued a memorandum that listed four major “errors” that had resulted in excess payments to Health Net. These were:

  • Duplicate Errors–Payments for medical claims that have been paid more than once;
  • Other Health Insurance8 (OHI) Errors–Payments that were not adjusted for the amount OHI was responsible to pay the provider;
  • Pass-Through Errors–Payments to reimburse the third-party administrator (TPA) that were more than the TPA paid the provider and;
  • Rate Errors–Payments that did not use the appropriate Medicare or contract adjusted rate

Missal stated that duplicate payments alone accumulated over $50 million in overpayments to Health net.[40]

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See also
  • Top 100 US Federal Contractors

References
  1. "Investor Information - Corporate Profile". investor.health.net. Retrieved 10 December 2017.
  2. "Centene Completes Acquisition Of Health Net". InsuranceNewsNet. 24 March 2016.
  3. Peltz, James F. (February 8, 1992). "Health Net Wins For-Profit Status : * Medicine: The state lets the Woodland Hills-based HMO convert from a nonprofit organization after it agrees to cede majority ownership to a foundation". Retrieved December 10, 2017.
  4. "History & Financial Statements - The California Wellness Foundation". www.calwellness.org. Retrieved 10 December 2017.
  5. "Malik Hasan - Malik Hasan's Career, Company And Mergers - The High Price Of Health - FRONTLINE - PBS". www.pbs.org. Retrieved 10 December 2017.
  6. "Foundation Health Systems Now Known as Health Net". 21 November 2000. Retrieved 10 December 2017 – via LA Times.
  7. "Page Not Found". www.hnfs.com. Archived from the original on 31 January 2013. Retrieved 10 December 2017.
  8. "Health Net Health Plan of Oregon Inc.: Private Company Information - Bloomberg". investing.businessweek.com. Retrieved 10 December 2017.
  9. "Archived copy" (PDF). Archived from the original (PDF) on 2015-07-04. Retrieved 2015-07-03.CS1 maint: archived copy as title (link)
  10. "State mulls conditions on $6.8B acquisition of Health Net". www.bizjournals.com. Retrieved 2020-01-22.
  11. "URAC Accreditation". www.hnfs.com. Retrieved 10 December 2017.
  12. "Health Net name disappearing in Arizona". Phoenix Business Journal. Retrieved 2019-06-21.
  13. "Archived copy". Archived from the original on 2013-02-16. Retrieved 2013-02-01.CS1 maint: archived copy as title (link)
  14. "Archived copy". Archived from the original on 2019-07-23. Retrieved 2020-01-11.CS1 maint: archived copy as title (link)
  15. "Archived copy". Archived from the original on 2019-07-23. Retrieved 2020-01-11.CS1 maint: archived copy as title (link)
  16. "Health Net - Page not available". www.healthnet.com. Archived from the original on 11 April 2013. Retrieved 10 December 2017.
  17. Preferred provider organization
  18. "Health Net - Page not available". www.healthnet.com. Archived from the original on 11 April 2013. Retrieved 10 December 2017.
  19. "UPDATE: Health Net Loss Of Tricare Pact Fans M&A Speculation". July 14, 2009. Archived from the original on 2009-07-17. Retrieved 2013-09-13.
  20. "Archived copy". Archived from the original on 2012-10-19. Retrieved 2010-05-14.CS1 maint: archived copy as title (link)
  22. "Archived copy". Archived from the original on 2009-10-01. Retrieved 2012-12-22.CS1 maint: archived copy as title (link)
  23. "W³ Awards - Winners List". www.w3award.com. Retrieved 10 December 2017.
  26. "Health Net Sponsors the 25th National Veterans Golden Age Games in Honolulu" (PDF). www.businesswire.com. May 23, 2011. Retrieved 2019-06-04.
  27. "Archived copy" (PDF). Archived from the original (PDF) on 2012-07-23. Retrieved 2016-02-06.CS1 maint: archived copy as title (link)
  28. "HEALTH NET'S EARNINGS NEARLY DOUBLE, BUT STOCK PRICE PLUMMETS". Missing or empty |url= (help)
  29. Girion, Lisa (November 9, 2007). "Health Insurer Tied Bonuses to Dropping Sick Policyholders". Los Angeles Times. Retrieved 2013-09-13.
  30. "Insurer Fined $9M for Dropping Calif. Breast Cancer Patient in Middle of Her Chemo". Associated Press. Archived from the original on 2008-02-26. Retrieved 2008-02-23.
  31. "Health Net Missing Data From 450K Customers–Insurer Failed To Inform Customers For Six Months". Eyewitness News. November 18, 2009. Retrieved 2009-12-07. Attorney General Richard Blumenthal says health insurer Health Net lost financial, health and personal information of nearly 450,000 state residents and failed to inform consumers for six months. Health Net spokeswoman Alice Ferreira in Shelton said in a statement that an unencrypted portable disk drive was discovered missing from the company's Connecticut office. She said that because of the nature of the files saved on the drive, the company was initially unable to determine what information was on it.
  32. "Conn. Health Insurer Acknowledges Missing Data". CBS News. Nov 18, 2009. Archived from the original on March 13, 2014. Retrieved 2009-12-07. Connecticut Attorney General Richard Blumenthal said Wednesday that health insurer Health Net lost financial, health and personal information of nearly 450,000 state residents and failed to inform consumers for six months.
  33. "Medicare Imposes Marketing and Enrollment Suspension on Three Health and Drug Sponsors". Retrieved 2010-11-24.
  34. "Health Net Statement Regarding CMS Actions". Business Wire. Retrieved 2010-11-24.
  35. "UPDATE: Health Net To Sell A Medicare Prescription Unit To CVS". The Wall Street Journal, WSJ.com. Retrieved 2012-01-10.
  36. Helfand, Duke (2011-03-16). "Health Net Faces Second Probe Over Loss of Personal Data". The Los Angeles Times. Retrieved 2013-09-13.
  37. "Health Net Breach Tops Federal List". GovInfoSecurity.com. Retrieved 2012-12-26.
  38. "Health Net, Inc. Investigating Unaccounted-for Server Drives". Health Net Investor Relations. Archived from the original on 2011-03-23. Retrieved 2011-04-19.
  39. "LA Doctors, patients sue Health Net for Denying Claims". Reuters. September 13, 2012. Retrieved 2013-09-13.
  40. "Report" (PDF). www.va.gov. Retrieved 2019-06-04.
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