California’s Department of Managed Health Care issued Anthem Blue Cross a $15 million fine due to “longstanding and widespread failures” with handling member complaints, according to a Jan. 30 news release from the department.
The enforcement action also stipulates that the insurer will work with an independent auditor for four years. DMHC said it imposed fines and enforcement actions on the insurer in December 2024, November 2024, June 2019 and November 2009, as well.
Despite this, a March 2025 audit highlighted eight grievances and appeals deficiencies, along with failures to classify “oral expressions of dissatisfaction” as grievances. In nearly half the evaluated cases, the plan did not consistently and accurately determine grievances. Most cases with flagged exempt grievances lacked sufficient consideration and resolution, the department said.
DMHC’s Office of Enforcement continued the investigation, ultimately determining violation of the law. The most recent fine is larger than any of the previous actions reported.
“We take all member concerns seriously and are committed to responding promptly and fairly,” an Anthem Blue Cross spokesperson told Becker’s. “In coordination with the DMHC, we have implemented corrective actions to strengthen oversight, governance and transparency, including staff training and improving processes. Our focus remains on serving members and ensuring they have access to the care and support they need, while working with DMHC to meet regulatory standards.”
