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AUGUSTA (AP) – Anthem Blue Cross/Blue Shield of Maine and its subsidiary, Maine Partners Health Plan, have been fined $250,000 and $100,000 respectively by the state Bureau of Insurance.

The fines are for failing to pay interest on undisputed claims that Anthem did not pay within 30 days, as required by state law.

Anthem and its subsidiary must also pay more than $1.2 million in interest to over 387,000 claimants, including enrollees and health-care providers, to correct the violations, which occurred from September 1999 to March 2002.

All total, a minimum of $1.4 million will be returned directly to Maine citizens and another $353,000 in civil penalties will be deposited in the state’s general fund, Bureau of Insurance Superintendent Alessandro Iuppa said.

The insurance bureau and attorney general’s office are planning similar investigations of all domestic health maintenance organizations to determine if claims are being paid promptly and, if not, whether interest is being paid, Iuppa said. Anthem, which has around 500,000 subscribers, was the first company examined.

Anthem spokesman William Cohen said the company has upgraded its computers and that bills are now being paid correctly and on time.

The company acknowledged its wrongdoing to the state, he said.

“Our view is that in many respects we were a whistle-blower on ourselves,” he said.

The agreement between Anthem and the state also resolved three other violations.

Anthem will pay an estimated $100,000 to enrollees and providers who may have been reimbursed less than what they were entitled when Anthem failed to pay claims for out-of-network providers at a higher level than when no in-network provider was available within the enrollee’s service area.

Anthem also agreed to refund more than $250,000 in overpayments to enrollees who were overcharged for some premiums.

And Anthem will pay a civil penalty of $1,000 for failing to register three of its health plans as preferred provider organization products.

AP-ES-08-13-03 1447EDT


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