Regulator Fines Anthem $415,000

The Department of Managed Health Care has fined Anthem Blue Cross of California $415,000 for what the agency said was a series of violations of rights of enrollees.

According to the DMHC, Anthem violated state law 83 times involving 40 separate cases. The violations included 20 separate instances where the health plan did not respond to an enrollee grievance within 30 days. 

The violations were discovered during a routine survey of operations that took place in 2013, records show.

“The DMHC is committed to protecting the health care rights of Californians,” said DMHC Director Shelley Rouillard. “Health plan members have many healthcare rights, including the right to file a grievance. The grievance process is fundamental to ensuring members receive needed health care services with their health plans.” 

The fine is the 18th highest ever levied by the agency against an insurer. Five of those fines are against Anthem Blue Cross, including a $10,000,000 penalty for post-claims underwriting, the largest fine ever issued against the agency. The news service California HealthLine said Anthem has paid more than $2 million in fines over mishandling over enrollee grievances since 2011.

Altogether, Anthem has received 1,048 administrative penalties from the DMHC since 2001.

The DMHC said it had accepted Anthem's course of corrective action, although it was not detailed in the discussion of the administrative penalties. An Anthem spokesperson told California HealthLine this week it had hired additional staff to address the issue.