Health Net

Last updated
Health Net, Inc.
Company typeSubsidiary
Industry Managed health care
Founded1979
Headquarters Woodland Hills, Los Angeles, California
Key people
 J. Brian Ternan (CEO)
Products Health insurance
Number of employees
3,000
Parent Centene
Website www.healthnet.com

Health Net, LLC, a subsidiary of Centene Corporation, is an American health care insurance provider. Health Net and its subsidiaries provide health plans for individuals, families, businesses and people with Medicare and Medicaid, as well as commercial, small business, and affordable care insurance. [1] [2]

Contents

In 2016, Centene acquired Health Net for $6.8 billion. [3] [4]

History

Health Net was established as the nonprofit Health Net of California in 1977 by Blue Cross. [5] In 1992, a California order permitted the company to convert from a nonprofit to a for-profit company. [6] Under the terms of the California Department of Corporations' conversion order, the California Wellness Foundation, the successor charity to its nonprofit status, received $300 million plus 80 percent of the equity of Health Net's parent holding company. [6]

In August 1993, Health Net merged with Qualmed to form Health Systems International. [7] [8] In April 1997, Health Systems International merged with Foundation Health Corporation to form Foundation Health Systems. [9] Also in 1997, Foundation Health Systems acquired PACC Health Plans and Physicians Health Services. [9] [10]

In November 2000, Foundation Health Systems changed its name to Health Net, Inc. when the company started trading on the New York Stock Exchange under the symbol HNT. [11]

In July 2009, UnitedHealth Group bought Health Net's northeastern licensed subsidiaries for $510 million, and its Medicare and Medicaid businesses for $60 million. [12] In November 2009, Connecticut's attorney general office investigated a lost, unencrypted hard drive with customer data. [13] Health Net offered two years of free credit protection from a company called Debix to affected customers. [13]

In November 2010, the Centers for Medicare and Medicaid Services (CMS) suspended Health Net for marketing and enrolling new members for compliance issues. [14] The sanctions were lifted in August 2011. [14] In January 2012, the company agreed to sell its Medicare Prescription Drug Plan (PDP) business to CVS Caremark Corp. (CVS) for approximately $160 million in cash. [15] [16] Health Net continued to providing prescription drug plans as part of its Medicare Advantage plans. [17]

Mergers and Acquisitions

On July 2, 2015, Centene Corporation announced it would acquire Health Net for $6.8 billion. [3] The acquisition was completed in March 2016 and combined headquarters were established in St. Louis, Missouri. [3] [4] The acquisition resulted in Health Net Federal Services (HNFS) becoming a separate subsidiary of Centene. [18] [19]

In 2018, Health Net in Arizona was merged into other Centene holdings to form Arizona Complete Health, and Martha Smith was named as its Plan President and CEO. [20] [21] Separately, in September 2019, Brian Ternan was appointed CEO of Health Net in California, leading operations in that state. [22]

In 2007, a California patient sued Health Net claiming that the company wrongfully terminated her care during chemotherapy treatments. [23] During the case, a company employee performance review revealed that a manager had tied bonuses for an analyst in charge of rescission reviews to the rate of enrollees whose coverage was discontinued. [23] Health Net claimed that the patient withheld health information, including a heart problem, that would have disqualified her from coverage. [23] She replied that the insurance broker had filled out the form for her. [23] In February 2008, the court ruled in Bates' favor and ordered Health Net to over $9 million in damages. [24]

In 2008, Health Net agreed to pay $215M to settle allegations that it had unfairly reimbursed out-of-network providers between 1995 and 2007. [25]

In September 2012, the Los Angeles County Medical Association and two patients sued Health Net for denying medically necessary treatment, including cancer care. [26] The lawsuit alleged that Health Net denied claims based on its own definition of "medical necessity" rather than standards set forth by California law. [26] A judge ruled in Health Net's favor in July 2013. [27]

In 2016, Health Net Federal Services became a wholly-owned subsidiary of Centene, ending its time as a publicly traded company. [28] In 2021, Health Net's former subsidiary, Health Net Federal Services, agreed to pay $97M to settle allegations that it had duplicated or inflated claims submitted to the Department of Veterans Affairs between 2013 and 2019. [29]

See also

Related Research Articles

<span class="mw-page-title-main">CVS Pharmacy</span> American pharmacy chain

CVS Pharmacy, Inc. is an American retail corporation. A subsidiary of CVS Health, it is headquartered in Woonsocket, Rhode Island. Originally named the Consumer Value Stores, it was founded in Lowell, Massachusetts in 1963.

<span class="mw-page-title-main">Cigna</span> American health services organization

The Cigna Group is a for-profit American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. Cigna is incorporated in Delaware.

The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.

...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.

UnitedHealth Group Incorporated is an American multinational health insurance and services company based in Minnetonka, Minnesota. Offering insurance products under UnitedHealthcare, and health care services and care delivery aided by technology and data under Optum, it is the world's eleventh-largest company by revenue and the largest health care company by revenue.

<span class="mw-page-title-main">Tenet Healthcare</span> American healthcare company

Tenet Healthcare Corporation is a for-profit multinational healthcare services company based in Dallas, Texas, United States. Through its brands, subsidiaries, joint ventures, and partnerships, including United Surgical Partners International (USPI), the company operates 65 hospitals and over 450 healthcare facilities. Tenet also operates Conifer Health Solutions, which provides healthcare support services to health systems and other clients.

Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. Express Scripts had 2016 revenues of $100.752 billion. Since December 20, 2018, the company has been a direct subsidiary of Bloomfield, Connecticut-based Cigna.

CVS Caremark is the pharmacy benefit management subsidiary of CVS Health, headquartered in Woonsocket, Rhode Island.

WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States.

In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. According to the American Pharmacists Association, "PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims." PBMs operate inside of integrated healthcare systems, as part of retail pharmacies, and as part of insurance companies.

Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500.

CVS Health Corporation is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance provider, among many other brands. The company is the world's largest healthcare company, and its headquarters are in Woonsocket, Rhode Island. In 2023, the company was ranked 65th in the Forbes Global 2000.

In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.

Blue Cross and Blue Shield of Alabama (BCBSAL) is a nonprofit health insurance company headquartered in Birmingham, Alabama. The company was founded in 1936, provides coverage to more than 3 million people and is a member of the Blue Cross and Blue Shield Association (BCBS). BCBSAL employs nearly 5,000 people, which includes almost 3,500 people at its corporate headquarters in Birmingham. The company also operates Cahaba Government Benefit Administrators and Cahaba Safeguard Administrators, both headquartered in Birmingham. It commands over 90 percent of the health insurance market in Alabama, a state with half a million uninsured people, one of the highest uninsured rates in the nation at 10 percent of the population.

<span class="mw-page-title-main">Universal American</span>

Universal American is a Fortune 500 company with offices throughout the United States, and headquarters in Rye Brook, New York. The company offered health insurance, and also deals in Medicare managed care plans, and Medicare prescription drug benefits. Its CEO is Richard A. Barasch.

<span class="mw-page-title-main">Elevance Health</span> American healthcare company

Elevance Health, Inc. is an American health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California, Wellpoint, and Carelon. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within its affiliated companies' health plans.

<span class="mw-page-title-main">Fidelis Care</span> New York-based health insurance subsidiary of Centene

Fidelis Care is a New York-based health insurance company formed in 1993.

IPC Healthcare, previously known as IPC The Hospitalist Company, was a publicly traded corporation which operates a national physician group practice focused on the delivery of hospital medicine and related facility-based services. IPC providers manage the care of patients in coordination with primary care physicians and specialists in over 1,900 facilities in 28 states across the U.S. The company name is derived from an earlier company called In-Patient Consultants Management, Inc. and the NASDAQ ticker name was changed to IPCM in 2008. The company changed its name to IPC Healthcare in January 2015. The company was acquired by TeamHealth in 2015 for $1.6 billion.

This article summarizes healthcare in California.

<span class="mw-page-title-main">PillPack</span> American online pharmacy

PillPack, Inc. is an American online pharmacy which is a subsidiary of Amazon. It is based in Manchester, New Hampshire, United States. The company was founded in 2013.

References

  1. ↑ Beck, Melinda (2010-03-09). "When Anger Is An Illness". The Wall Street Journal . ISSN   0099-9660 . Retrieved 2021-09-20.
  2. ↑ Japsen, Bruce. "Centene's $6.3B Health Net Deal Shows Medicaid Plans Quick To Diversify". Forbes. Retrieved 2022-07-13.
  3. 1 2 3 Bray, Chad (July 2, 2015). "Centene to Acquire Its Managed Care Rival Health Net for $6.8 Billion". The New York Times. Retrieved November 18, 2020.
  4. 1 2 Liss, Samantha (March 24, 2016). "Centene completes Health Net deal". St. Louis Post-Dispatch. Retrieved 2020-11-18.
  5. ↑ Stassel, Stephanie (28 September 1991). "Paul Wilson; Sunkist Executive, Founding Chairman of Health Net". Los Angeles Times . Retrieved 2020-11-18.
  6. 1 2 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". Los Angeles Times. Retrieved December 10, 2017.
  7. ↑ Lee, Don (31 August 1993). "Rivals Health Net, QualMed Agree to Merge : Health care: The strategic alliance would give the two HMOs a combined 1.2 million customers in six Western states". Los Angeles Times. Retrieved 2020-11-18.
  8. ↑ Freudenheim, Milt (1995-03-28). "Company News; 2 California Health Care Providers Agree to a $1.8 Billion Merger (Published 1995)". The New York Times . ISSN   0362-4331 . Retrieved 2020-11-18.
  9. 1 2 "Foundation Health Will Buy Physicians Health, as Expected". Wall Street Journal. 1997-05-09. ISSN   0099-9660 . Retrieved 2020-11-18.
  10. ↑ Brock, Kathy (13 April 1997). "Health care giant swallows PACC". Portland Business Journal .
  11. ↑ "Foundation Health Systems Now Known as Health Net". Los Angeles Times. 21 November 2000. Retrieved 10 December 2017.
  12. ↑ Bordonaro, Greg (4 December 2009). "State approves UnitedHealthcare, Health Net Merger". Hartford Business Journal. Archived from the original on 2013-02-16. Retrieved 2013-02-01.
  13. 1 2 Mearian, Lucas (2009-11-19). "Health Net says 1.5M medical records lost in data breach". Computerworld . Retrieved 2020-11-18.
  14. 1 2 "Update 1-Health Net says CMS lifts sanctions on Medicare programs". Reuters. 2011-08-02. Retrieved 2021-09-20.
  15. ↑ "Health Net (HNT) Announces Plans to sell Stand-Alone Prescription Plan Business to CVS Caremark (CVS) for ~$160M". 9 January 2012. Archived from the original on 2019-07-23. Retrieved 2020-01-11.
  16. ↑ Crowe, Deborah (9 January 2012). "Health Net Sells Medicare Drug Plan for $160 Million". Los Angeles Business Journal. Retrieved 2020-11-18.
  17. ↑ "Health Net sells Medicare drug plan business to CVS Caremark for $160M". Healthcare Finance News. 10 January 2012. Retrieved 2020-11-18.
  18. ↑ Robertson, Kathy (10 November 2016). "Exclusive: Health Net gets new $17.7 billion military health care contract". www.bizjournals.com. Retrieved 2021-09-20.
  19. ↑ Sauter, Michael; Stebbins, Samuel. "These 30 companies, including Boeing, get the most money from the federal government". USA Today . Retrieved 2021-09-20.
  20. ↑ "Health Net name disappearing in Arizona". Phoenix Business Journal. Retrieved 2019-06-21.
  21. ↑ "Investments in telehealth solutions in Arizona address the need for members to continue essential care". www.bizjournals.com. Retrieved 2022-07-13.
  22. ↑ Russell, John (30 January 2020). "Anthem sues senior executive who took job with competitor, demands return of $4M". Indianapolis Business Journal. Retrieved 2020-11-18.
  23. 1 2 3 4 Girion, Lisa (November 9, 2007). "Health Insurer Tied Bonuses to Dropping Sick Policyholders". Los Angeles Times. Retrieved September 13, 2013.
  24. ↑ "Canceled Cancer Patient Awarded $9 Million". www.cbsnews.com. February 22, 2008. Retrieved 2021-09-20.
  25. ↑ "Health Net inks $215M settlement on payment allegations". Fierce Healthcare. July 25, 2008. Retrieved February 23, 2022.
  26. 1 2 "Health Net faces suit over refusals to cover treatments". Los Angeles Times. September 13, 2012. Retrieved September 20, 2021.
  27. ↑ "Health Net's 'Medical Necessity' Definition OK'd By Judge - Law360". www.law360.com. Retrieved September 20, 2021.
  28. ↑ "CA insurer Health Net pays $97M to settle VA billing probe". Sacramento Bee.{{cite news}}: Check |archive-url= value (help)
  29. ↑ "Health Net Federal Services Pays over $97M for Overstated Billings to the VA". www.justice.gov. April 6, 2021. Retrieved February 23, 2022.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.