Basic Search  |  Summaries  |  Advanced Search

Violation Tracker Individual Record

Company: Health Net of New Jersey, Inc.
Current Parent CompanyUnitedHealth Group
Parent at the Time of the Penalty Announcement subscribe to see this data field
Recap of Ownership Changes subscribe to see this data field
Penalty: $400,000
Year: 2007
Date: March 15, 2007
Offense Group: consumer-protection-related offenses
Primary Offense: insurance violation
Violation Description: Health Net misrepresented to the Department that it wished to implement a proposed repricing methodology which, in fact, had already been put to use; Health Net's use of the repricing methodology violated small group regulations and was not in accordance with the provision of its large group contracts approved prior to April 2005; Health Net violated the terms of its small group contracts by failing to cover a 96-hour supply of certain prescription drugs; Health Net's protocols from May 2005 to September 2006 failed to provide coverage for one or more therapies appropriate to treat children with autism/pervasive developmental disorder, and in instances Health Net denied coverage, in violation of the biologically-based mental illness mandate; Health Net tiered reimbursement for certain out-of-network mental health benefits based on the professional designation of the provider which violated small group rules and which was not in accordance with its large group contracts approved prior to April 2005; and Health Net failed to timely file with the Department the administrative services agreement between it and Health Net of the Northeast, Inc. (its parent) covering administrative, consulting and other support services. Remediation is being made to adversely affected members or medical providers.
Level of Government: state
Action Type: agency action
Agency: New Jersey Department of Banking & Insurance
Civil or Criminal Case: civil
Facility State: New Jersey
HQ Country of Current Parent: USA
HQ State of Current Parent: Minnesota
Ownership Structure of Current Parent: publicly traded
Major Industry of Current Parent: healthcare services
Specific Industry of Current Parent: insurance; managed care
Source of Data(click here)
Source Notes: If an online information source is not working, check the Violation Tracker Data Sources page for an updated link.
Current parent company note: Parent-subsidiary relationship is current as of the most recent revision listed in the Update Log.