Georgia Fines Anthem Blue Cross Blue Shield $5M For Violations

ATLANTA, GA — The state of Georgia fined Anthem Blue Cross Blue Shield $5 million for a pattern of violating consumer rights, the Office of the Commissioner of Insurance and Safety Fire announced Tuesday.

The fine is the largest in the history of the agency, Insurance and Safety Fire Commissioner John King said.

"Since my first day in office we have been inundated with complaints about Anthem from individuals, from doctors, hospitals and others from all corners and across Georgia," King said at a news conference Tuesday.

Following an investigation spurred by complaints from patients, doctors and providers, the agency found a several "serious issues," including improper claims settlement practices, violations of the Prompt Pay Act, failure to promptly respond to complaints, providing inaccurate provider directories and significant delays in loading provider contracts, King said.

Some of these issues resulted in policyholders having to pay full price for services, King said at the news conference.

There is potential for more fines if certain improvement benchmarks aren't met, according to King.

Issues with Blue Cross Blue Shield's internal provider database system caused processing errors which affected a "significant number of claims" submitted to the company from 2015-2020, according to a consent order published by the agency. During testing of a new system in 2021, the company failed to "adopt and implement procedures for the prompt investigation and settlement of claims arising under their policies," according to the order.

Blue Cross Blue Shield must file a monthly report with the state detailing its compliance with a corrective action plan set by the consent order and must submit to periodic examinations by a firm of the state's choosing to ensure the company's compliance with the order.

Blue Cross Blue Shield also must submit 120 days' advance notice to the state of plans for any "new functions or systems" that could affect providers in order to obtain approval, according to the order.