State regulators ordered Anthem Blue Cross on Monday to stop trying to collect millions in reimbursement from providers for medical claims the health plan thinks were overpaid.
California law allows health plans to seek reimbursement for overpaid medical claims within a year of the payment date. If a plan wants to collect on claims more than a year old, it must demonstrate fraud or misrepresentation by the provider.
Earlier this year, the California Department of Managed Health Care investigated collection attempts by Anthem Blue Cross between 2008 and 2011 and found the plan tried to collect overpayments from at least 535 providers for claims that were more than a year old. Anthem did not provide evidence of fraud or misrepresentation, the agency said in a news release Monday.
The plan alleged providers had improperly coded the claims using upcoding, unbundling or miscoding procedures, the cease-and-desist order shows.
Thousand Oaks-based Anthem tried to collect payments from another 13 providers who allegedly had billed for services they had not rendered.
“Health care providers should not face unexpected demands for reimbursement of medical claims they believe were appropriately paid years ago,” agency director Brent Barnhart said in the release. “Anthem’s recoupment practices violate California law and are unfair to providers who are acting in good faith.”
Anthem spokesman Darrel Ng stressed in a prepared statement that the issue does not involve patient care or safety.
“The issue is about Anthem Blue Cross’s efforts to keep health care affordable,” he said. “Anthem Blue Cross believes medical providers should be compensated for services provided, but should not receive payment twice for the same procedure.”