The Arlington-based health plan, the largest in North Texas, penalized physicians who exceeded a predetermined pharmacy budget by requiring them to pay 35 percent of the additional cost, according to the insurance regulators' report. The plan also rewarded physicians who spent less than the budgeted amount.
Financial incentives can be detrimental to the best interest of patients.
Harris Methodist Health Plan has always and will continue to place the care of its members first. Health plan officials have until April 21 to request a hearing with an administrative law judge, who would then send a recommendation to state Insurance Commissioner Elton Bomer. Harris officials also could negotiate with the Department of Insurance staff who recommended the fine or agree to pay it, Hanna said. Meanwhile, several hundred physicians who are providers with the Harris plan have filed a class-action suit. The physicians also are requesting a declaration by the insurance commissioner that such incentives are illegal and that the pharmacy clause be withdrawn from Harris' contracts with physicians.