On Monday, the state Department of Managed Health Care ordered Anthem Blue Cross to stop seeking millions of dollars in reimbursements for health care claims from more than one year ago that the insurer believes were overpaid, the Sacramento Business Journal reports.
State law allows health insurers to seek reimbursements for overpaid medical claims within one year of the payment date.
If insurers seek reimbursement for claims that are older than one year, they must demonstrate that the health care providers engaged in fraud or misrepresentation (Robertson, Sacramento Business Journal, 7/17).
Between 2008 and 2011, Anthem sought to collect reimbursements from 535 health care providers for overpayments on claims that were more than one year old, according to DMHC (Kutscher, Modern Healthcare, 7/17). Anthem alleged that the providers had improperly coded the claims (Sacramento Business Journal, 7/17).
According to the DMHC order, the agency conducted an investigation of Anthem's allegations and found that the insurer could provide no evidence of fraud or misrepresentation by the health care providers.
In a news release about the order, DMHC Director Brent Barnhart said, "Health care providers should not face unexpected demands for reimbursement of medical claims they believe were appropriately paid years ago" (Modern Healthcare, 7/17).
Darrel Ng -- a spokesperson for Anthem -- 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, "We will closely examine today's action by DMHC and are considering our options" (Sacramento Business Journal, 7/17).