The California Department of Managed Health Care (DMHC) has taken enforcement actions including a $322,500 fine against California Physicians’ Service (Blue Shield of California) and a $135,000 fine against Care 1st Health Plan for failing to identify, timely process, and resolve consumer grievances. The plans have also failed to fully and timely provide information to the Department during the investigation of these consumer complaints.
DMHC Fines Anthem Blue Cross $5 Million for Systemic Grievance System Violations
This enforcement action is the result of deficiencies identified in DMHC surveys and 245 specific grievance system violations identified by the DMHC Help Center during the investigation of consumer complaints from 2013 through 2016. Including this fine, the DMHC has fined Anthem Blue Cross $11.66 million for grievance system violations since 2002.