Anthem Blue Cross Accounts for Largest Share of State Penalties
Anthem Blue Cross has racked up the highest number of enforcement actions levied by California's Department of Managed Health Care during the past decade, Payers & Providers reports.
DMHC typically issues penalties to insurers that fail to respond to member complaints or pay claims in a timely manner.
Since the department started enforcing state regulations, it has taken nearly 1,200 enforcement actions against health plans, health care providers and other entities.
Anthem has received 479 enforcement actions, or more than 40% of the statewide total. Anthem's tally is more than four times higher than the 102 enforcement actions levied against Blue Shield of California, which received the second-highest number of penalties.
Recent Actions Against Anthem
According to DMHC records, Anthem received about 275 of its total enforcement actions since early 2009. The recent penalties include a $2.5 million fine that DMHC issued in November 2009 but has yet to publicize.
During the last 18 months, Anthem received nearly $3 million in fines. The total does not include the $10 million that Anthem paid to DMHC in early 2009 to settle a lawsuit over the rescission of members' individual health insurance policies.
This year, Anthem has received 18 penalties, with fines totaling $265,000. DMHC has issued 21 other penalties this year, with fines totaling $30,000.
Size as a Factor?
Anthem officials attributed the insurer's high number of enforcement actions to its large size. Anthem provides health plans to about eight million Californians.Kaiser Foundation Health Plan, which provides coverage for 6.7 million residents, received only 84 enforcement actions during the past decade (Payers & Providers, 5/27). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.