Anthem must stop collecting overpayments


Anthem Blue Cross Blue Shield must stop trying to collect reimbursements that it believes were overpaid to providers, California state regulators said on Monday.

The California Department of Managed Health Care (DMHC) issued an order for Anthem to discontinue its practice because state law prohibits insurers from seeking reimbursement for overpaid medical claims more than one year old unless they can show potential provider fraud or misrepresentation.

"Healthcare providers should not face unexpected demands for reimbursement of medical claims they believe were appropriately paid years ago," DMHC Director Brent Barnhart said in a statement. "Anthem's recoupment practices violate California law and are unfair to providers who are acting in good faith."

Anthem, however, said its attempts at recouping overpayments due to double billing were consistent with American Medical Association guidelines, reported Los Angeles Business. The insurer also said patient care or safety aren't at risk. "The issue is about Anthem Blue Cross's efforts to keep healthcare affordable," Anthem spokesman Darrel Ng said.

"Anthem Blue Cross believes medical providers should be compensated for services provided but should not receive payment twice for the same procedure," he added, saying the insurer will "closely examine" the state managed care health department's order to consider its options.

To learn more:
- read the DMHC statement and order
- see the Los Angeles Business article

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