Miss. DOI Takes Control of Family Health Care Plus

Mississippi Commissioner of Insurance George Dale announced that Hinds County Chancellor William Singletary approved an Order of Rehabilitation allowing the Mississippi Department of Insurance to assume control of the business affairs of the financially troubled Family Health Care Plus Inc. ( FHCP), a Mississippi domiciled health maintenance organization (HMO).

Since March 1, 2004 the HMO has been in voluntary run-off, but pursuant to Mississippi law the enrollees have up to one year to file a claim.

Commissioner Dale’s office was alerted to possible financial problems due to complaints by providers and enrollees about late or nonpayment of claims. The HMO was already on monthly financial reporting and met with MID representatives on July 8, 2004 and filed an amended May 2004 financial statement revealing that they had a net worth of $187,146.00.

Pursuant to Mississippi law HMOs are to maintain a minimum net worth of $1million at all times. It was also revealed that the HMO may have insufficient funds to cover checks that have already been issued to pay outstanding claims. In addition, the HMO may not have sufficient funds to cover the remaining claims that have been filed but not paid as of this date.

Under the rehabilitation order, Commissioner Dale will install his own management team to run the ailing HMO until its financial affairs are back in order or until it is determined that the company should be liquidated or sold. FHCP had recently been a provider in the commercial market including Hinds County and Dillards, in addition to previously being a Medicare HMO and a Medicaid HMO.

Pursuant to Mississippi law, the enrollees will only be responsible for their co-pay or deductibles if they went in network for their treatment. Under Mississippi law, the in network providers cannot bill the patient/enrollee for the HMO’s portion of the bill if the procedure was covered by the Plan.