Friday, November 8, 2019
The DMHC Requires Orange County Doctor to Stop Balance Billing Enrollees
(Sacramento) – The California Department of Managed Health Care (DMHC) settled a lawsuit against Dr. Nancy B. Way, requiring her to stop illegally balance billing California enrollees. The settlement requires Dr. Way to stop all illegal balance billing, to conduct an audit to determine the amount of illegally collected balance billing payments she received from enrollees and reimburse the entire amount with interest. Additionally, Dr. Way was required to pay a $13,000 civil penalty.
"The Department takes our mission of protecting the health care rights of Californians very seriously," said DMHC Director Shelley Rouillard. "Dr. Way must immediately stop balance billing and reimburse enrollees for this illegal practice. I encourage consumers who receive bills they don't think they should have to pay to contact their health plan to make sure they are not being billed illegally."
California law protects health care consumers enrolled in health plans licensed by the DMHC from the practice of balance billing. Balance billing happens when a doctor or provider bills the enrollee for a balance not paid by the health plan.
The DMHC issued a Cease and Desist (C&D) Order demanding Dr. Way stop balance billing enrollees and to cease any efforts to collect payments under this illegal practice. Dr. Way did not comply with the DMHC's Order, resulting in the Department filing a civil lawsuit in Orange County Superior Court ordering Dr. Way to stop her unlawful actions and to reimburse the victims.
The DMHC and Dr. Way reached a settlement agreement to resolve the case. Under the agreement, Dr. Way agreed to immediately stop all balance billing, reimburse with interest any California health plan enrollees she balance billed and pay a $13,000 penalty.
If a consumer is balance billed or receives a surprise medical bill, they should file a grievance with their health plan and include a copy of the bill. Their health plan will review the grievance and should contact the provider to stop billing the enrollee. If the consumer does not agree with their health plan's response or if the plan takes more than 30 days to fix the problem, they can file a complaint with the DMHC Help Center at www.HealthHelp.ca.gov or 1-888-466-2219.
About DMHC:
The DMHC protects the health care rights of more than 26 million Californians and ensures a stable health care delivery system. The DMHC Help Center has assisted approximately 2.4 million Californians to resolve complaints and issues with their health plan. The DMHC Help Center provides assistance in all languages and all services are free. For more information visit www.HealthHelp.ca.gov or call 1-888-466-2219.