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2018 Division of Insurance Enforcement Activity

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Please Note: P.L. 2013, c. 259 became effective on July 1, 2014.  This law amended the Administrative Procedure Act, R.S. 52:14B-1 et seq. One of the amendments requires all state agencies to post on their websites all non-confidential final agency orders, decisions and opinions. Accordingly, all such final agency orders or decisions in disciplinary actions issued subsequent to July 1, 2014 may be accessed by clicking on the link within the summaries below. Orders or decisions issued on such matters prior to July 1, 2014 are available upon request to the Division of Insurance.

Orders to Show Cause

Magdalena Guzman, Perth Amboy, NJ and Fort Myers, FL
Order #E18-07, February 7, 2018
Respondent is charged with submitting insurance applications for fictitious employees, with forging employer signatures on insurance forms, and with failing to respond to Department inquires and a Department subpoena.

James V. Mascola,
Bridgeton, NJ
Genevieve Steward, Glassboro, NJ
Bail Group Management, LLC, Millville, NJ
East Coast Bail Bonds, LLC, Millville, NJ
Order #E18-08, February 7, 2018
Respondents are charged with failing to remit premiums for bail bonds, with failing to timely return collateral for bail bonds, with misappropriation of bail bond collateral, with conducting business through a business entity that was not licensed as a producer, with failing to register a branch office and with failing to respond to Department inquiries.

Consent Orders

Americhoice of New Jersey, Inc., Edison, NJ
Oxford Health Insurance, Inc., Shelton, CT
Oxford Health Plans (New Jersey) Inc., Shelton, CT
UnitedHealthcare Insurance Company, Hartford, CT
Order #E18-12, February 22, 2018
Respondents used 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.
Sanction: Fine - $2,500,000.

Ryan Patrick O’Connor,
La Jolla, CA
Prospect General Insurance Agency, Inc., La Jolla, CA
Order #E18-11, February 14, 2018
Respondents bound a surplus lines policy prior to becoming licensed to sell surplus lines insurance and charged fees without entering a separate written fee agreement.
Sanction: Fine - $3,000.

R&S Electronic Medical Billing, LLC,
Belleville, NJ
Order #E18-09, February 8, 2018
Respondent acted as a third party billing service prior to being certified as a third party billing service.
Sanction: Fine - $1,000.

Enrico Smith,
Clayton, NJ
Earline Princewill, Clayton, NJ
Order #E18-06, February 7, 2018
Respondent Smith solicited insurance for a company with whom he was not appointed and Respondent Princewill signed the applications solicited by Respondent Smith even though she was not involved in the solicitation or sale.
Sanction: Fine - $10,000.


Consent Orders

Carmine Fusco, Bloomfield, NJ
Order #E18-05, January 17, 2018
Respondent was convicted of mortgage fraud for willfully aiding a mortgage fraud scheme.
Sanction: Revocation, Fine - $1,500.

Howard M. Liu, Newark, DE
Order #E18-01, January 3, 2018
Respondent sold an insurance policy when his license was expired and failed to report a FINRA suspension to the Department.
Sanction: Revocation.

Gary B. Sutherland, Framingham, MA
North American Professional Liability Insurance Agency, Framingham, MA
Order #E18-02, January 9, 2018
Respondent charged fees without obtaining a required written fee agreement.
Sanction: Fine - $5,000.

OPRA is a state law that was enacted to give the public greater access to government records maintained by public agencies in New Jersey.
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