gh contracts with providers that include independent physicians and groups, hospitals, ancillary providers, and its own clinics. The company’s network of providers includes primary care physicians, specialists, and hospitals. The company’s strategy is to contract with providers in those geographic areas and medical specialties necessary to meet the needs of its members. Physicians: The company contracts with both primary care physicians and specialists, majority of whom are organized into medical groups or independent practice associations. Primary care physicians provide office-based primary care services. The company’s specialists care for patients for a specific episode or condition, usually upon referral from a primary care physician, and are usually compensated on a fee-for-service basis. Hospitals: The company contracts with hospitals that have experience dealing with the medical needs of the Medicaid population. The company reimburses hospitals under various payment methods, including fee-for-service, per diems, diagnostic-related groups capitation, and case rates. Direct Delivery: The clinics that the company operates are located in neighborhoods where its members live, and provide the company a first-hand opportunity to understand the special needs of its members. The clinics that the company operates, and the clinics and hospital services that the company manages, assist the company in developing and implementing community education, disease management, and other programs. Management Information Systems Claims Processing: The company’s health plans operate on a single managed care platform for claims processing (the QNXT system). Centralized Management Services: The company provides certain centralized medical and administrative services to its health plans pursuant to administrative services agreements, including medical affairs and quality management, health education, credentialing, management, financial, legal, information systems, and human resources services. Growth Strategy The company’s growth strategy is to enter new programs within existing markets, such as Medicaid expansion, health insurance marketplace, Medicare-Medicaid Plans, and direct delivery; enter new strategic markets; and deliver administrative value to Medicaid agencies. Regulatory Compliance All health plans are subject to the Health Insurance Portability and Accountability Act, including the company. The company’s operations are subject to various state and federal health care laws commonly referred to as ‘fraud and abuse’ laws. Fraud and abuse prohibitions include a range of activities, including kickbacks for referral of members, billing for unnecessary medical services, improper marketing, and violations of patient privacy rights. These fraud and abuse laws include the federal False Claims Act, which prohibits the knowing filing of a false claim or the knowing use of false statements to obtain payment from the federal government. Intellectual Property The company has registered and maintains various service marks, trademarks and trade names that it uses in its businesses, including marks and names incorporating the ‘Molina’ or ‘Molina Healthcare’ phrase, and from time to time, the company applies for additional registrations of such marks. Competition The company’s primary competitors in the Medicaid managed care industry include Centene Corporation; WellCare Health Plans, Inc.; UnitedHealth Group Incorporated; Anthem, Inc.; and Aetna Inc. Molina Medicaid Solutions competes with large MMIS vendors, such as HP Enterprise Services, ACS (owned by Xerox Corporation), Computer Services Corporation, and CNSI. History Molina Healthcare, Inc. was founded in 1980 by Dr. C. David Molina. The company was incorporated in 2002.
molina healthcare inc
(MOH:New York Consolidated)
Long Beach, CA 90802
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