Yet Again? BCBSIL Fined for Violating the ISMS-Initiated Network Adequacy Law!

November 11, 2023

Last week the Illinois Department of Insurance (IDOI) fined Health Care Service Corporation (HCSC), the parent company of Blue Cross Blue Shield of Illinois (BCBSIL), another $231,900 for violating the ISMS-initiated Network Adequacy and Transparency Act (NAT Act) – this time for failing to keep up-to-date and accurate provider directories.

In March of 2023, the IDOI levied a $605,000 fine against the parent company of BCBSIL for also violating the NAT Act. IDOI’s targeted exam for network adequacy, which began in November of 2020, revealed that BCBSIL had violated the NAT Act and other state and federal laws.

Before that, the IDOI assessed a fine of $339,000 to HCSC in March 2022 due to BCBSIL violating the material change notice requirement under the state’s NAT Act and failing to submit requested information following the ending of its contract with the Springfield Clinic. This was the first time ever that the IDOI fined an insurer under this Act.

These repeated fines combined now top $1 million.

Illinois’ fiscal year 2023 budget provided funds for IDOI to hire additional employees to form the NAT Act enforcement unit. The new unit investigates insurer networks and was instrumental in investigating provider directory issues, including reviewing underlying contracts and identifying real-time violations.

Read Illinois’ News Release.

Read ISMS’ statement.

If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.

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