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Utah Insurance

Workers Comp Fraud Costs More Than $32 Billion Every Year

Don’t Get Stuck Looking for a Quick Buck

An estimated $9 billion of fraud every year stems from claims filed by workers misrepresenting injuries or receiving benefits from the wrong employer.

Scammers get caught through surveillance, social media monitoring, or medical provider records. Don’t try it.

Penny-Pinching Payroll

Employers are the worst fraudsters. An estimated $23 billion in premium fraud is caused by employers’ underhanded tactics, including misclassifying workers and underreporting payroll.

Most states require workers comp insurance for employees. When cheaters duck these responsibilities, honest employers pay higher premiums and employees are denied the treatment and help they deserve.

Fraud investigators and state auditors are watching. Injured employees left without coverage often come forward. If you’re an employer, pay what you owe — it isn’t worth the risk.

Be the Solution, Not the Problem

Employees:

  • Report suspected fraud to the Utah Insurance Department at https://insurance.utah.gov/consumer/fraud/report-fraud.
  • Payments offered in cash “under the table” are fraud.
  • If you’re injured and your company doesn’t want you to file a claim, be suspicious.
  • Be honest about your injuries. Fraud is not worth jail and fines. If others are committing fraud, report them.

Employers:

  • If you suspect a bogus claim, notify your insurance carrier.
  • Look for delays between the alleged injury and the claim filing.
  • Verify medical treatment is actually related to the claimed injury.
  • Be suspicious of statements that conflict with the findings of medical providers and witnesses.

Workers Comp Fraud Costs More Than $32 Billion Every Year

How to Get Your Free COVID-19 Tests

Using Your Health Insurance

As of January 15, 2022, a new federal policy under the Families First Coronavirus Response Act (FFCA) requires health insurers to cover up to eight over-the-counter (OTC) COVID-19 tests per month with no clinical assessment or up-front cost for each covered member, if the tests are purchased on or after that date.

Consumers should check with their health insurer about direct coverage options through a preferred pharmacy or direct-to-consumer shipping program.

Health insurers that arrange for pharmacies and other retailers to cover the up-front costs of these tests will only be required to reimburse up to $12 per test (or the full cost of the test, whichever is lower) if the test is purchased through an out-of-network provider. In these cases, a consumer may need to provide a copy of the receipt. If tests are temporarily unavailable through direct coverage options due to a supply shortage, and insurer may continue to limit reimbursement to $12 per test (or the full cost of the test, whichever is lower) for OTC COVID-19 tests purchased outside of the direct coverage program.

A health insurer may limit coverage of OTC COVID-19 tests purchased without the involvement of a health care provider to tests purchased from established retailers typically expected to sell OTC COVID-19 tests. Tests purchased from a private individual, online person-to-person, or an online resale or auction marketplace may not be covered. The only OTC COVID-19 tests that must be covered are tests authorized for use by the Food and Drug Administration (FDA) that can be obtained without a prescription, used and processed without a laboratory, and purchased.

It is important to note that a flex spending account (FSA) or health savings account (HSA) may not provide reimbursement for an OTC COVID-19 test that was paid or reimbursed by an insurer.

Insurers are permitted to take reasonable steps to prevent, detect, and address fraud and abuse.

For more information, please go to https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free.

Free From the Federal Government

For Everyone:

You can also order four free rapid antigen at-home tests per household directly from the federal government. Test kits will be shipped through the US Postal Service starting in late January.

No insurance is required to get these tests.

You can sign up to get yours at https://www.covidtests.gov/.

For Medicare Beneficiaries:

Beginning April 4, 2022, and until the end of the public health emergency, Medicare will cover over-the-counter self-administered COVID-19 tests at no cost to beneficiaries if you have Medicare Part B, including those enrolled in a Medicare Advantage plan. This is in addition to the eight free at-home tests you can continue to order per month from the federal government at https://www.covidtests.gov/. You can get OTC COVID-19 tests at any pharmacy or health care provider that participates in this initiative. Check with your pharmacy or health care provider to see if they are participating. You can find list of eligible pharmacies and other health care providers at https://www.medicare.gov/medicare-coronavirus#300.

Because additional eligible pharmacies and health care providers may also participate, people with Medicare should check with their pharmacy or health care provider to find out whether they are participating.

Please note that Medicare won’t cover OTC COVID-19 tests if you only have Medicare Part A (Hospital Insurance) coverage, but you may be able to get free tests through other programs.

Additional information may be found at https://www.medicare.gov/medicare-coronavirus#300 and https://www.cms.gov/newsroom/fact-sheets/medicare-covers-over-counter-covid-19-tests.

Notice of Company Applying to Become a Utah Certified Reinsurer

December 15, 2021 — Fidelis Underwriting Limited an England insurance company has applied to become a Certified Reinsurer in the State of Utah. If you have any questions or concerns please contact Jay Sueoka with the Utah Insurance Department at (801) 957-9253 or by email at jsueoka@utah.gov no later than January 24, 2022.

Utah PMN Posting

Insurance Department Distributes $25 Million to Arches Claimants

Providers have been waiting for liquidation process to run its course

Insurance Commissioner Jon Pike, acting as liquidator of Arches Mutual Insurance Co., by and through his special deputy liquidator Stillman Consulting Services LLC, is pleased to announce that checks are being sent to Arches’ medical providers for 100% of their approved claim amounts. In all, 1,997 checks are being cut to disburse $25 million to medical providers.

“This is great news for medical providers who have had outstanding claims with Arches for the past six years,” said Commissioner Pike. “Litigation with the federal government has taken a long time, and I am pleased that we’re finally able to make this distribution.”

Further payments to other claimants are forthcoming, pending verification and court approval of their claim amounts. More information about the Arches liquidation is available at http://www.utinsreceivers.org/arches.htm.

 

Press Release
Insurance Department Distributes $25 Million to Arches Claimants

Insurance Scammers & Cybercrime: On the Rise

Awareness is your best defense against insurance scammers and hackers who want to steal your information.

Most cybercrimes involve identity theft. Criminals steal personal information to hack accounts and access funds. Identity theft can lead to insurance fraud. Here are come common scams.

Phishing — Scammers impersonate legitimate entities using malicious emails and texts to trick you into giving them your sensitive information. If you suspect a phishing attack, contact the proper entity directly to verify the request is real.

Formjacking — Cyber scammers hack a legitimate website to steal user information. Each time a customer fills out a form, a duplicate of the entered information is sent to the scammer. Contact the company if you supect formjacking.

False Quizzes — Swindlers use surveys and quizzes to pry loose personal data. Launching a quiz app may give permission to pull information from your social media profile or phone, giving hackers an opening to steal your identity.

Public Wi-Fi — Using public Wi-Fi at coffee shops, libraries, or other locations puts you at risk for having information stolen. Avoid storing sensitive information on your phone and never share personal information over public Wi-Fi.

If you become the victim of a scam or suspect fraud, report it. You can report insurance scams and fraud to the Utah Insurance Department at https://insurance.utah.gov/consumer/fraud/report-fraud.

You can also report scams to other government agencies at:

Description of cyber crime and insurance scams

Insurance Scammers & Cybercrime: On the Rise

Telemedicine: Safe Steps for Patients

Covid-19 is spurring telemedicine growth. Plan ahead, stay alert, and be aware of costly scams.

Verify Coverage — More insurers are covering telemed, but verify coverage before setting your appointment.

Telemed App — Learn how your telemed app or online portal works, and test it before you use it.

Quiet Area — Set up in a quiet area with good lighting, and make sure your device is plugged in or charged.

Prescriptions — Have your prescriptions ready so you can discuss them accurately.

Refuse Strangers — Scammers try to lure you with “free” exams by doctors you don’t know. They steal your ID and insurance and may falsely bill you too.

Fishy Charges — Check for bogus charges, like a 30-minute session that was billed as an hour.

If you suspect that you’re a victim of telemedicine fraud, report it safely, easily, and anonymously at https://insurance.utah.gov/consumer/fraud/report-fraud.

Description of telemedicine and its potential scams

Telemedicine: Safe Steps for Patients

2021 Special Enrollment Period in Response to the COVID-19 Emergency

The Department of Health & Human Services (HHS) has announced a Special Enrollment Period (SEP) for individuals and families to shop for Marketplace coverage in response to the COVID-19 Public Health Emergency. This SEP will allow individuals and families in states with Marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage.

Beginning February 15, 2021 and running through May 15, 2021, the Marketplace will be open to make this SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application.

Visit HealthCare.gov to enroll in coverage starting Feb. 15, 2021.

Notice of University of Utah Health Insurance Plans’ Proposed Acquisition of Control of Steward Health Choice Utah, Inc.

Public Comment Notice

Please take notice that the Interim Commissioner of the Utah Insurance Department has received an application from the University of Utah Health Insurance Plans (“UHIP”) to acquire control of Steward Health Choice Utah, Inc. (“Health Choice Utah”), a health maintenance organization domiciled in the State of Utah. UHIP is a Utah nonprofit corporation controlled by the University of Utah. The acquisition of control will be accomplished pursuant to an Equity Purchase Agreement dated September 25, 2020, whereby UHIP would acquire from IASIS Healthcare LLC 100% of the outstanding capital stock of Health Choice Utah.

Pursuant to Utah Insurance Code § 31A-16-103, notice is hereby given by the Interim Commissioner of the Utah Insurance Department regarding the acquisition of control of a Utah domestic insurer or health maintenance organization. The public and all policyholders, enrollees, providers and other affected persons are hereby provided the opportunity to provide public comments. Comments must be provided no later than December 29, 2020. The Utah Interim Insurance Commissioner, or her designee, will consider the following factors in evaluating the proposed transaction:

Whether, after the acquisition of control, Health Choice Utah would not be able to satisfy the requirements for the issuance of a license to write the line or lines of insurance for which it is presently licensed;
Whether the effect of the acquisition of control would substantially lessen competition in insurance in Utah or tend to create a monopoly in insurance;
Whether the financial condition of UHIP would jeopardize the financial stability of Health Choice Utah or prejudice the interest of its policyholders or any remaining securityholders who are unaffiliated with UHIP;
Whether the terms of the acquisition are unfair and unreasonable to the securityholders of Health Choice Utah;
Whether the plans or proposals UHIP (if any) has to liquidate Health Choice Utah, sell its assets, or consolidate or merge it with any person, or to make any other material change in its business or corporate structure or management, are unfair and unreasonable to the policyholders of Health Choice Utah and are not in the public interest; and
Whether the competence, experience and integrity of those persons who would control the operation of Health Choice Utah are such that it would not be in the interest of the policyholders of Health Choice Utah and the public to permit the merger or other acquisition of control.
See Utah Ins. Code § 31A-16-103(8).

ANY ENROLLEE, PROVIDER OR OTHER AFFECTED PERSON MAY SUBMIT COMMENTS REGARDING THE PROPOSED ACQUISITION AND MAY RECEIVE A SUMMARY OF THE UHIP APPLICATION OR OTHER NON-CONFIDENTIAL MATERIALS ON FILE WITH THE COMMISSIONER BY SENDING A REQUEST IN WRITING AND A COPYING FEE OF $.25/PAGE TO:

University of Utah
Office of the General Counsel
201 S. Presidents Circle, Rm 309
Salt Lake City, Utah 84112
Attention: Brian Watts
(801) 585-7002
brian.watts@legal.utah.edu

ALTERNATIVELY, ARRANGEMENTS TO REVIEW A COPY OF THE NON- CONFIDENTIAL FORM A APPLICATION MATERIALS MAY BE MADE BY CONTACTING STACY ZHANG, (801) 538-3832 OR SZHANG@UTAH.GOV.

IF YOU WISH TO SUBMIT COMMENTS REGARDING THE PROPOSED ACQUISITION, PLEASE PROVIDE YOUR COMMENTS TO THE INTERIM COMMISSIONER IN WRITING, AT JILLWHITE@UTAH.GOV, NO LATER THAN DECEMBER 29, 2020.

Dated this 18th day of December, 2020

Tanji Northrup
Interim Commissioner of the Utah Insurance Department

 

RELATED
PDF Version
Utah PMN Posting
Commissioner’s Order

Fraud Awareness: 5 Ways to Stay Safe

Stay alert to insurance scams year-round. Get the most out of your insurance policies. Be safe, know the warning signs — and report scams.

Home Repairs — Avoid storm chasers who knock on your door for repair work after storms.

Bandit Towing — Never deal with a random tow truck that just shows up at the crash scene.

Staged Crashes — Drive safely. Watch for cars that suddenly pull in front of yours.

Medicare Alert — Hang up on callers demanding your personal info to “update” your Medicare account.

Telemedicine — Ignore pitches for “free” video health exams & back braces requiring your personal info.

If you suspect an insurance scheme, report it safely, easily, and anonymously at https://insurance.utah.gov/consumer/fraud/report-fraud.

5 Ways to Stay Safe