DMHC Increasingly Fining Health Plans for Untimely Payments
California's Department of Managed Health Care this year has issued fines at more than twice the rate of recent years against heath plans that did not pay providers in a timely manner, Payers & Providers reports.
California health plans have long been required to pay providers in a timely manner, which is usually defined as within:
- Five days of determining a payment dispute; or
- Within 45 days of receiving a claim.
Since the late 1990s, DMHC has issued an average of six penalties per year related to timely payments.
In 2011, the agency issued 10 penalties related to timely payouts -- the most ever issued in a 12-month period year. However, DMHC only issued three fines related to timely payments in 2013 and two fines over the matter in 2012.
Details of 2014 Fines
So far this year, DMHC has issued seven fines related to timely payments -- more than the annual average for the agency.
The fines total about $172,500 and were levied on:
- Alameda Alliance for Health;
- Anthem Blue Cross;
- Cigna's behavioral health unit;
- Contra Costa County Medical Services;
- Sharp Health Plan;
- Simnsa Health Care; and
- United Concordia Dental Plan.
William Barcellona, senior vice president of governmental affairs at the California Association of Physician Groups, said that health plans paying claims within an acceptable time period has not been a major problem.
However, Los Angeles County Medical Association CEO Rocky Delgadillo said the issue is a "constant complaint in health care." Delgadillo added, "I applaud the DMHC for doing the enforcement, but even if they triple the number of actions next year, it won't be enough" to fix such issues (Shinkman, Payers & Providers, 8/14).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.