News & Analysis as of

Fraud › Anthem Blue Cross

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Davis Wright Tremaine LLP

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Davis Wright Tremaine LLP on

Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more

Haight Brown & Bonesteel LLP

Healthcare Claim Administrator’s Authorization of Services While Failing to Disclose Alcohol-Related Exclusion Supports Action for...

Haight Brown & Bonesteel LLP on

In Tenet Healthsystem Desert v. Blue Cross of California (No. D069057, filed 3/17/16), a California Court of Appeal held that a hospital was not limited to simply collecting on its bills, but could state causes of action...more

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