After Anthem Blue Cross was unable to rectify violations found in a recent state audit, the California Department of Managed Health Care has ordered the health insurer to pay hospitals and physicians for unsettled claims from as far back as 2007, according to an Associated Press/San Francisco Chronicle report.
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.
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.
Related Articles on Health Insurer Refunds:
HHS Strikes Down Payor's 13% Premium Increases
11 Health Insurers Ordered to Refund $114.5M to New York Policyholders
Final Regulations on Medical Loss Ratio Issued