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January 14, 2026
Kaiser Permanente Pays $556M in Largest Medicare Advantage Fraud Settlement
Kaiser affiliates settled False Claims Act allegations for submitting invalid diagnosis codes to inflate Medicare Advantage payments. The settlement—the largest MA risk adjustment case ever—stemmed from systematic pressure on physicians to add diagnoses via medical record addenda without proper clinical basis.
Read DOJ Announcement →Recent California DMHC Actions
Source: CA DMHC Database-
Blue Cross of California Partnership PlanFailure to correct deficiencies including mishandling member complaintsView DMHC Source →
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Blue Cross of California Partnership PlanFailing to timely implement Independent Medical Review determination, delaying member's treatment by 54 daysView DMHC Source →
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Blue Cross of California (Anthem Blue Cross)Sending 5,252 denial letters with incorrect regulator information for member appealsView DMHC Source →
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Blue Shield of CaliforniaMishandling claims payments, delaying reimbursements over a five-year periodView DMHC Source →
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Blue Shield of CaliforniaGrievance system failure (HSC 1368(a)(1)) - behavioral health claims denied despite authorization
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UnitedHealthcare of CaliforniaMedical records delays; minor denied residential mental health treatment with inadequate explanation
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Blue Shield of CaliforniaUrgent care access violation - patient unable to access specialist referral within 48 hours post-emergency
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UnitedHealthcare Benefits PlanIncomplete grievance resolution; claims agreed to reprocessing never adjusted
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Blue Shield of CaliforniaGrievance processing delays; DME claim improperly denied; grievance not resolved within 30 days
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Blue Cross of California (Anthem Blue Cross)Failing to handle member complaints and grievances in a timely mannerView DMHC Source →
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Blue Cross of California Partnership Plan & Anthem Blue CrossIllegally limiting coverage of gender dysphoria services ($400k + $450k split)View DMHC Source →
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Blue Shield of CaliforniaIllegally billing 334 members for contraceptive health care servicesView DMHC Source →
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Multiple Insurers (Cigna, Health Net, Blue Shield, UnitedHealthcare, Meritage)Failure to timely reimburse, contest, or deny claims (HSC 1371(a)(1))