ANTHEM WATCH

Anthem, now Elevance Health, has faced numerous lawsuits, regulatory penalties, and public backlash due to practices prioritizing profits over patient care.

From deceptive provider networks to data breaches impacting 79 million individuals, to unjust ER claim denials and fraudulent “ghost networks” of mental health professionals, the company has consistently eroded public trust.

FOR THE RECORD (read all news)

Anthem is set to penalize facilities that use out-of-network providers.
Here’s why

October 31, 2025

Regulators have imposed millions of dollars in fines on Anthem for mishandling consumer grievances, while investors have accused the company of hiding escalating Medicaid expenses.

Collectively, these issues highlight a concerning trend of governance failures and cost-cutting measures that negatively affect patients, providers, and shareholders alike.

Key Findings

Out-of-Network Charges Class Action

In August 2014, Anthem, then operating as WellPoint, was sued in Los Angeles County Superior Court for misrepresenting the size of its physician networks under Affordable Care Act plans.

(The Los Angeles Times, 8/19/14)

Anthem customers alleged they were moved from preferred-provider organization (PPO) plans to narrower exclusive-provider organization (EPO) policies, which exposed them to significant out-of-network medical bills.
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(The Los Angeles Times, 8/19/14)
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Attorney Scott Glovsky argued that Anthem profited from collecting premiums while preventing patients from seeing their preferred doctors.
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(The Los Angeles Times, 8/19/14)
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Data Breach

Lawmakers Highlight Anthem’s Wrongdoing

In February 2018, Senator Debbie Stabenow (D-MI) criticized Anthem’s avoidable emergency room policy for deterring patients from seeking urgent medical care

(Congress.gov, 2/8/18)

Stabenow argued that Anthem’s policy forced people in acute distress to determine at home if their symptoms justified an ER visit
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(Congress.gov, 2/8/18)
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In July 2018, Senator Claire McCaskill (D-MO) released an investigative report showing Anthem denied over 12,000 ER claims as “avoidable” in 2017, reversing 73 percent on appeal.

(Lawyers And Settlements, 7/28/18)

Reports noted Anthem posted a $2.46 billion profit in 2016 while enforcing its restrictive ER claim policies.
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(STAT News, 3/9/18)
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McCaskill’s inquiry revealed that Anthem’s estimates of avoidable visits varied from 5 to 90 percent and that fear of non-payment discouraged people from seeking care.
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(Lawyers And Settlements, 7/28/18)
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Healthcare Dive reported Anthem employees “lack the necessary experience or training to apply ER claims policies correctly in the first instance.”
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(Healthcare Dive, 7/20/18)
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In October 2024, Pollock Cohen LLP and Walden Macht Haran & Williams LLP filed a class action lawsuit against Anthem Blue Cross Blue Shield of New York for maintaining fraudulent mental health provider directories.

(Pollock Cohen, 10/22/24)

Plaintiffs alleged that Anthem’s “ghost networks” listed doctors who did not exist, refused to accept insurance, or were unavailable to new patients, leading to financial harm and care delays.
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(Pollock Cohen, 10/22/24)
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A secret shopper study found that only seven of 100 listed providers accepted the insurance and were taking new patients.
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(Pollock Cohen, 10/22/24)
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NOTE: This case is currently ongoing.

Failed Mergers

In July 2015, Anthem announced a $54 billion merger with Cigna that was blocked by the U.S. Department of Justice in July 2016 over anticompetitive concerns.

(Reuters, 5/3/21)

In February 2017, a federal judge formally enjoined the merger after DOJ’s challenge.
```
(Reuters, 5/3/21)
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In May 2021, the Delaware Supreme Court upheld the ruling, rejecting Cigna’s $1.85 billion termination fee claim and Anthem’s $21.1 billion damages claim.
```
(Reuters, 5/3/21)
```

In February 2015, Anthem disclosed that hackers had infiltrated its systems starting in February 2014 through malware from a phishing email.

(AG.NY.gov, 9/30/20)

The 2014 breach compromised the personal information of 78.8 million consumers nationwide, including Social Security numbers, addresses, and employment details.
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(AG.NY.gov, 9/30/20)
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In October 2018, Anthem paid $16 million to the U.S. Department of Health and Human Services Office for Civil Rights to settle HIPAA violation claims.

(HHS.gov, 10/15/18)

In September 2020, Anthem reached a $39.5 million multistate settlement with Attorneys General, including $2.7 million allocated to New York.

(AG.NY.gov, 9/30/20)

A separate class action settlement created a $115 million fund for affected consumers, offering credit monitoring, reimbursements, and cash payments.

(AG.NY.gov, 9/30/20)

Consumer Complaints
Mishandled

Between 2002 and 2016, the California Department of Managed Health Care (DMHC) disciplined Anthem for “2,102 grievance violations, levying $5.96 million in penalties.”

(Lawyers And Settlements, 7/28/18)

In November 2017, DMHC filed an administrative action against Anthem for mishandling enrollee complaints and grievances in violation of consumer protection laws.

(DMHC.CA.gov, 12/16/24)

In December 2024, DMHC fined Anthem Blue Cross $3.5 million for failing to handle member grievances in a timely manner.

(DMHC.CA.gov, 12/16/24)

DMHC found that Anthem sent 11,670 late grievance acknowledgement letters between July 2020 and September 2022, including 447 letters more than 51 days late.
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(DMHC.CA.gov, 12/16/24)
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Anthem also sent 4,049 late grievance resolution letters, including 1,634 more than 51 days past due.
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(DMHC.CA.gov, 12/16/24)
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Anthem admitted it failed to comply with state law, paid the $3.5 million fine, and pledged to improve training and grievance procedures.
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(DMHC.CA.gov, 12/16/24)
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Ghost Networks

CalPERS Class Action

In June 2017, a member of the California Public Employees’ Retirement System sued CalPERS and Anthem Blue Cross for underpaying out-of-network claims below industry standards.

(Court House News, 6/14/17)

The lawsuit alleged that CalPERS and Anthem manipulated allowable benefit amounts, leaving members to pay more than the promised 60 percent reimbursement.
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(Court House News, 6/14/17)
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Honorable Mentions

In June 2025, Pomerantz LLP filed a securities fraud class action against Elevance Health and certain executives for misleading investors about Medicaid costs.

(Pomerantz LLP, 6/1/25)

NOTE: This case is currently ongoing.

In July 2015, Anthem announced a $54 billion merger with Cigna that was blocked by the U.S. Department of Justice in July 2016 over anticompetitive concerns.

(Reuters, 5/3/21)

In February 2017, a federal judge formally enjoined the merger after DOJ’s challenge.
```
(Reuters, 5/3/21)
```
In May 2021, the Delaware Supreme Court upheld the ruling, rejecting Cigna’s $1.85 billion termination fee claim and Anthem’s $21.1 billion damages claim.
```
(Reuters, 5/3/21)
```

Out of Network Charges Class Action

FULL RESEARCH

In August 2014, Anthem Was The Subject Of A Class Action Lawsuit In California For Moving Customers To A Limited Provider Policy, Causing “Unforeseen Medical Bills When They Were Treated By Out-Of-Network Doctors”

In August 2014, Anthem, Then WellPoint, Was Sued By A Class Of Customers Alleging The Company “Misrepresented The Size Of Its Physician Networks And The Insurance Benefits Provided In New Plans Offered Under The Affordable Care Act.”

“Health insurance giant Anthem Blue Cross faces another lawsuit over switching consumers to narrow-network health plans — with limited selections of doctors — during the rollout of Obamacare. These types of complaints have already sparked an ongoing investigation by California regulators and other lawsuits seeking class-action status against Anthem and rival Blue Shield of California. A group of 33 Anthem customers filed suit Tuesday in Los Angeles County Superior Court against the health insurer, which is a unit of WellPoint Inc. Anthem is California’s largest for-profit health insurer and had the biggest enrollment this year in individual policies in the Covered California exchange. In the latest suit, Anthem members accuse the company of misrepresenting the size of its physician networks and the insurance benefits provided in new plans offered under the Affordable Care Act.”

(Chad Terhune, “Anthem Blue Cross Sued Again Over Narrow-Network Health Plans,” The Los Angeles Times, 8/19/14)

Class Members Alleged Anthem Moved Them To A More Limited Exclusive Provider Organization Policy, Causing “Unforeseen Medical Bills When They Were Treated By Out-Of-Network Doctors.”

“In many cases, consumers say, Anthem canceled their more generous PPO, or preferred-provider organization, plan and moved them to a more limited EPO, or exclusive-provider-organization, policy. Compounding the problem, the plaintiffs say, the company gave misleading or incorrect information, both last fall and this year, about the medical providers participating in these new plans. As a result, some consumers incurred unforeseen medical bills when they were treated by out-of-network doctors, according to the suit. EPO health plans usually have little or no coverage outside the network.”

(Chad Terhune, “Anthem Blue Cross Sued Again Over Narrow-Network Health Plans,” The Los Angeles Times, 8/19/14)

Attorney Scott Glovsky: “Anthem Profits From The Premiums While These Members Cannot See Their Doctors.” “‘Anthem profits from the premiums while these members cannot see their doctors,’ said Scott Glovsky, a Pasadena attorney representing the Anthem customers.”

(Chad Terhune, “Anthem Blue Cross Sued Again Over Narrow-Network Health Plans,” The Los Angeles Times, 8/19/14)

Data Breach