Anthem Special Investigations Unit may be recouping beyond statutory timeframe In 2011, the California Medical Association (CMA) raised concerns with Anthem’s attempts to recoup money from physicians beyond the statutory timeframe. Through its Special Investigations Unit (SIU), Anthem was pursuing physicians for refunds of payments made outside of the 365-day period allowed by California law. That law permits recoupment of claims older than a year only if the payment was made based on fraud or misrepresentation. CMA determined that Anthem was employing a definition of “misrepresentation” that was much broader than what is allowed under law. CMA thus filed ... June 26, 2015 General, Managed Care Department of Managed Health Care, Recoupment, Anthem Blue Cross 0 0 Comment Read More »
