Summary of OptumHealth New Mexico Sanction Resolution by gdf57j


									      Summary of OptumHealth New Mexico Sanction Resolution
             State of New Mexico Behavioral Health Collaborative Meeting
                                   January 7, 2010

 October 29, 2009 Sanction Letter                   Sanction Resolution

Directed Corrective Action Plan
                                             Optum agrees to comply with a revised,
                                             improved DCAP covering all the areas
Directed Optum to take specific action in
                                              addressed in the original DCAP and
the areas of claims, service registration,
                                             more, including provisions on “provider
authorizations, funds mapping, provider
file audit and financial reporting.

Civil Monetary Penalty
                                           Optum agrees to place $1 million into a
                                           fund to be used to compensate providers
Lump sum fee of 1% of contract amount
                                              for increased administrative burden.
for July 1, 2009 through October 30, 2009.
                                           Optum to distribute the fund as directed
(Approx. $1.2 million)
                                           by the Collaborative. (The collaborative
                                            will work with providers to establish a
Daily prorated 1% fee of contract amount
                                             fair distribution system). Payments to
From November 1, 2009 until Optum’s
                                               begin as soon as Jan. 11, 2010 and
payment provider system is working
                                             should be complete by Feb. 11, 2010.
properly. (Approx. $10,000 p/day)
                                            Optum agrees to pay the Collaborative
                                            $30,000, which is the approximate cost
Assessed with the reasonable costs
                                            of the consultants’ fees. Optum will be
incurred by the Collaborative because of
                                               held to their obligations under the
Optum’s non-compliance (i.e. consultants’
                                            contract to pay 1 ½ % interest on clean
Optum to pay 1 ½ % interest on all unpaid
State Monitor                                   Optum agrees to place a $500,000
                                               deposit with the Collaborative from
Optum assessed with the reasonable cost      which the Monitor’s reasonable fees will
of the State Monitor.                            be paid. Optum will support the
                                                 Monitor until the Collaborative is
                                             satisfied Optum is fully performing or 6
                                             months after all items in the DCAP have
                                             been completed, whichever occurs first.

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