10 payers recently fined by states

Payers have faced state penalties in 2024 for slow reimbursements, improper claims denials, or the sale of unapproved products.

Examples this year of payers fined or agreeing to settlements with states:

  1. Anthem Blue Cross of California was fined $3.5 million by the state in November for failing to handle member complaints appeals in a timely manner. The state fined the company an additional $500,000 in November for failing to provide basic healthcare services and acknowledge complaints filed by a health plan member during cancer treatment. The insurer and its Medicaid subsidiary were fined a total of $850,000 in August for illegally limiting coverage for gender dysphoria treatments. The two plans were also fined a total of $8.5 million in September for failing to address claims payment disputes in a timely manner with physicians, hospitals and providers. In January, Anthem was fined $690,000 for failure to reimburse providers and members in a timely manner.

  2. L.A. Care Health Plan will pay a $55 million penalty to California to resolve allegations the plan improperly denied claims, and had a backlog of unresolved grievances. 

  3. Centene's Fidelis Care agreed to pay $7.6 million back to the state of New York to settle the issue of billing Medicaid for services provided by an individual convicted of a crime.

  4. Highmark was fined $363,570 in Delaware in September for nearly 500 situations related to improper volunteer ambulance company claims reimbursement.

  5. Blue Shield of California paid $250,000 to California in August for charging more than 300 members copays for contraceptive services.

  6. Cigna agreed to pay $236,900 to Virginia in July to settle allegations around an array of violations, including issues with provider reimbursements, claims processing and mental health parity laws.

  7. Anthem BCBS Virginia will pay $362,000 to settle allegations that it violated state law, including improper denial of claims and incorrect reimbursements, the Richmond Times-Dispatch reported in July.

  8. Cigna was fined $600,000 by Texas in June for failing to comply with multiple independent claims dispute resolution requirements under state law.

  9. UnitedHealthcare was fined $546,500 by Utah in May for selling unapproved health plans to state residents.

  10. Molina Healthcare of Washington was fined $100,000 for enrollment and billing errors in March.

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