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CMA calls on DMHC to levy bigger fines, exercise greater oversight of health plans



December 12, 2010
Area(s) of Interest: Licensing & Regulatory Issues Payor Issues and Reimbursement 

California's seven largest health plans were fined nearly $5 million for failing to properly pay medical claims submitted by thousands of doctors and hospitals over the last three years, the state Department of Managed Health Care (DMHC) announced on Nov. 29.

The California Medical Association (CMA) responded by calling on regulators to exercise greater vigilance.

"California's physicians support the Department of Managed Health Care's attempt to hold insurers accountable to the law," CMA President James Hinsdale, M.D., said in a statement. "These fines, however, are chump change that amount to little more than a slap on the wrist for highly profitable health plans that systematically deny legitimate claims and routinely block, delay or limit physician reimbursements as one tactic to boost their bottom lines.

"Our members are especially concerned about solo physician practitioners and specialists, who are significantly impacted by these illegal practices.

"Every battle over a claim hurts access to care by taking a physician's time away from treating patients. Unpaid claims also cause patients immense stress that can undermine their recovery. It's crucial that DMHC and other regulators remain vigilant and force insurers to follow the law so that doctors can focus on patient care."

Insurance regulators said the companies also would pay tens of millions of dollars in restitution to medical providers whose claims were underpaid or incorrectly rejected.

The fines capped an 18-month investigation by DMHC into the payment practices of Aetna Inc., Anthem Blue Cross of California, Blue Shield of California, Cigna Corp., Health Net Inc., Kaiser Foundation Health Plan and UnitedHealthcare/PacifiCare.


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