Physicians encouraged to report unfair payment patterns

December 03, 2020
Area(s) of Interest: Practice Management 

Despite a California law passed in 2000 to address widespread payment abuses by health care service plans, a 2018 survey by the California Medical Association (CMA) showed that some health plans still regularly engage in unfair payment practices, with two-thirds of physician practices reporting routine payment abuses in violation of state law.

In an effort to address this issue, CMA sponsored legislation, AB 2674, in 2018 requiring the Department of Managed Health Care (DMHC) to review complaints filed by providers who believe a plan is engaging in an unfair payment pattern. Effective July 1, 2019, DMHC must annually review complaint data for possible unfair payment patterns, allowing the department to initiate an audit or enforcement action when necessary.

The effectiveness of this new law depends on physicians and their office staff. CMA urges practices to closely monitor their accounts receivable to ensure that they have been paid properly and to report any violations to DMHC through its provider complaint portal or by calling the DHMC Help Center at (888) 466-2219.

For a summary of California's unfair payment practices law, see CMA’s "Know Your Rights: Identify and Report Unfair Payment Practices,” which summarizes vital physician protections under California state law.

CMA can help you get paid

Physicians are reminded that members have access to CMA’s practice management experts for free one-on-one help with contracting, billing and payment problems. Need assistance? Contact CMA's reimbursement helpline at (888) 401-5911 or email us.



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