Managed Care Litigation & Enforcement

Anthem Blue Cross has agreed to settle an enforcement action brought by the California Department of Managed Health Care (DMHC) regarding its claims payment procedures. The settlement requires Anthem to pay health care providers money owed to them for the underpayment of interest on late-paid claims, with appropriate penalties for services dating back to 2007. The total payment is estimated at more than $3 million. Anthem must remediate provider claims for services provided between July 1, 2007, and April 30, 2011. In addition, Anthem must make changes in its claims payment and provider dispute process, including improved training and auditing policies and procedures to ensure the appropriate payment of claims. The changes to its claims payment procedures must be made within 90 days, and the claim remediation must be complete within 120 days. The April 24 Settlement Agreement and Order is available at www.dmhc.ca.gov/library/reports/news/abcagree.pdf.