Wednesday, February 4, 2026
DMHC fines Health Net health plans $1.3 million for mishandling provider payment disputes
SACRAMENTO - The Department of Managed Health Care (DMHC) has taken enforcement actions, including a total of $1.3 million in fines, against Health Net Community Solutions, Inc. and Health Net of California, Inc., for mishandling payment disputes from doctors, hospitals and other providers. This includes an $850,000 fine for Health Net Community Solutions, Inc. and a $450,000 fine for Health Net of California, Inc.
“Health plans must have an efficient process for managing provider payment disputes so unnecessary delays are avoided,” said DMHC Director Mary Watanabe. “Delayed payments strain the finances of doctors, hospitals, and other providers, which can disrupt the health care delivery system and potentially impact patient care.”
PROTECTIONS FOR PROVIDERS: To ensure the health care delivery system can continue to provide services to health plan members, it is important doctors, hospitals and other providers receive accurate payments from health plans in a timely manner. California law requires health plans to maintain a Provider Dispute Resolution process that allows providers to submit disputes related to payment of claims for health care services provided to plan members. Additionally, California law requires health plans acknowledge provider disputes within two working days for electronic provider disputes and 15 working days for paper provider disputes and to resolve provider disputes within 45 working days. Within five working days of a written decision in favor of the provider, the plans must pay past due payments, including interest and penalties.
In this case, Health Net Community Solutions, Inc. failed to timely acknowledge 6,587 provider disputes within the required timeframes, and 36,848 provider disputes were not resolved in a timely manner. Health Net of California, Inc. failed to timely acknowledge 19,048 provider disputes and 15,368 provider disputes were not resolved within the required timeframes.
WHAT PROVIDERS CAN DO: Health care providers looking for more information or to dispute a payment with a health plan can visit the DMHC website Provider Complaint page.
PLANS TAKE CORRECTIVE ACTION: Health Net Community Solutions, Inc. and Health Net of California, Inc. have taken corrective actions, including implementing a new Provider Dispute Resolution review process to improve efficiency and timely reviews, improved tracking of provider disputes, monitoring provider disputes more regularly, removing barriers that delay provider dispute resolutions, and improving staffing based on volume.
MORE INFORMATION: More information about Health Net Community Solutions, Inc. and Health Net of California, Inc. can be found on the health plan dashboard on the DMHC website, including information on the plan’s service area, enrollment and complaints.
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About DMHC
The mission of the DMHC is to ensure health plan members have access to equitable, high-quality, timely, and affordable health care within a stable health care delivery system. The DMHC accomplishes this important mission by regulating health plans, enforcing California’s strong consumer protection laws and assisting health plan members. For more information visit www.DMHC.ca.gov.