Anthem Blue Cross, California’s largest for-profit payor, thought the issue was resolved after it paid a $500,000 fine in Nov. 2010. However, the DMHC said the fine did not “resolve corrective actions required by the audit process, including the remediation of claims and repaying medical providers for claims violations discovered by the audits,” according to the report.
The DMHC originally reviewed California’s seven largest health insurers in 2008 after several healthcare providers complained about inaccurate payments and unwarranted claim denials. It is uncertain how much money Anthem Blue Cross would pay back to providers if it complies with the state’s order.
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