Anthem again pays restitution and fine over claims delays

Anthem Health Plans and its HealthKeepers managed care plan continued to delay paying claims on time despite earlier promises to fix the problem, State Corporation Commission Bureau of Insurance filings show.

As a result, the state's biggest health insurer has agreed to settle the matter by making restitution payments totaling $346,096.12 to 1,680 consumers and 586 providers.

Anthem also paid a fine of $118,000.

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In addition, the company promised to fix issues with its internal information about contracting, credentialing, network status and fee schedules of providers. The bureau said these internal issues had delayed claims payments to behavioral health providers.

"This offer is being made solely for the purpose of a settlement and does not constitute, nor should it be construed as, an admission of any violation of law," Monica Schmude, Anthem's Virginia president, told the bureau.

State law requires payment of "clean" claims within 40 days. These are claims for which there is no good faith determination or dispute about the claim, such as benefits covered or the eligibility of the claimant.

The company had previously paid a $300,000 fine for violating the 40-day rule, and in a July 16, 2024, letter to the bureau, said it had addressed all internal issues related to delayed claims in 2021.

But even as it wrote, the bureau was again fielding complaints about delayed claims, and Anthem settled this matter by making restitution payments of $2,676 and paying a $111,900 fine.

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