DOBI has penalized insurers $12.5M YTD; UHC on hook for $2.5M

The state Department of Banking and Insurance announced $12.5 million in fines and funds ordered returned to customers in the first half of 2018 — including a $2.5 million fine paid by UnitedHealthcare.

UHC and its affiliates AmeriChoice of New Jersey, Oxford Health Insurance and Oxford Health Plans were fined for using a non-designated provider of hemophilia services as well as failing to comply with reversals of denials of claims and authorizations by an independent claims reviewer.

In addition, $350,000 in fines was enforced for Aetna Life Insurance Co. and Aetna Health, for 335 small employer health plans that were issued after the company notified the state it was exiting the market — violating state laws.

UHC was also fined for improperly selling plans in the state, according to DOBI documents.

“A Department employee called…and was incorrectly advised that (Oxford) does not sell individual health benefits plans in New Jersey,” the documents said. “The Department requested and reviewed recordings…in which (Oxford) improperly asked medical questions of callers…and erroneously told callers they were ineligible for individual coverage due to medical conditions.”

Commissioner Marlene Caride announced the fine totals of $4.1 million imposed on companies and individuals for violations of insurance, banking and real estate laws in a statement Monday.

“The department investigated and pursued cases on behalf of consumers that resulted in millions of dollars in fines and recoveries in the first half of 2018,” she said. “These actions should send a clear message that the department takes very seriously its mission to ensure that New Jersey residents are protected and regulated entities are operating in compliance with the law.

“We encourage New Jersey consumers to file complaints like the ones that led to many of these enforcement actions as well as others that resulted in the department requiring the return of millions of dollars to New Jersey consumers. This department pledges to thoroughly investigate complaints and to vigorously enforce our laws when violations are found.”