Violation Tracker Individual Record

Company: 
UnitedHealthcare Insurance Company et al.
Current Parent Company: 
UnitedHealth Group
Penalty: 
$2,500,000
Year: 
2018
Date: 
February 22, 2018
Offense Group: 
consumer-protection-related offenses
Primary Offense: 
insurance violation
Violation Description: 

UnitedHealthcare and two of its subsidiaries were fined $2.5 million for using an entity for the provision of hemophilia supplies and services that lacked the required state designation and improperly required member consent for provider payment appeals. Americhoice of New Jersey, Inc. failed to promptly comply with decisions of the Independent Health Care Appeals Program that reversed its denials of authorization and claims. Oxford Health Insurance, Inc. failed to provide utilization management appeal rights to persons covered by individual health benefits plans who sought an override of a prescription drug quantity limit and provided incorrect information to callers and on its website about the individual health benefits plans it offered in New Jersey.

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 Parent: 
USA
HQ State of Parent: 
Minnesota
Ownership Structure of Parent: 
publicly traded
Major Industry of Parent: 
healthcare services
Specific Industry of Parent: 
insurance; managed care
Source Notes: 
If an online information source is not working, check the Violation Tracker Data Sources page for an updated link.
Parent company note: 
Parent-subsidiary relationship is current as of the most recent revision listed in the Update Log.