News Release

New Jersey Department of
Banking and Insurance

Commissioner Marlene Caride

For Immediate Release:
July 23, 2018

For Further Information:
Trish Graber or Marshall McKnight (609) 292-5064

Includes $2.5 Million Fine Imposed on UnitedHealthcare Insurance Company,
the Largest Licensee Fine in Nine Years

TRENTON – Department of Banking and Insurance Commissioner Marlene Caride today announced the Department issued fines and ordered the return of funds owed consumers totaling $12.5 million in the First Quarter and Second Quarter of 2018. Fines totaled $4.1 million imposed on companies and individuals for violations of State insurance, banking and real estate laws in New Jersey during the first six months of 2018.

“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,” said Commissioner Caride. “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.”

Enforcement actions taken by the department in the First Quarter involved all regulated industries. In the First Quarter of 2018, licensees and carriers were ordered to repay Real Estate, Insurance and Banking consumers $5 million as part of Department investigations resulting from formal complaints. The Department also imposed a total of $2.7 million in fines.

First Quarter enforcement actions included a $2.5 million fine paid by UnitedHealthcare Insurance Company, the largest fine in nine years, for various insurance violations. Violations by UnitedHealthcare and its affiliates, AmeriChoice of New Jersey; Oxford Health Insurance and Oxford Health Plans (New Jersey) included use of a non-designated provider of hemophilia services and supplies for nine months. They also included failures to promptly comply with decisions of the Independent Health Care Appeals Program that reversed denials of claims and authorizations.

Fines imposed in the Second Quarter of 2018 totaled $1.4 million. A total of $3.4 million was ordered to be returned to consumers by licensees and carriers.

Second Quarter enforcement actions included a $350,000 fine paid by Aetna Life Insurance Company and Aetna Health Inc. The carriers violated New Jersey state law by issuing 335 new small employer health plans after notifying the Department that they were withdrawing from the New Jersey market. Within two months of announcing a withdrawal from the market, health insurers are required by law to stop issuing new policies. The violation was detected following the filing of required enrollment reports. 

“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,” said Commissioner Caride. “This Department pledges to thoroughly investigate complaints and to vigorously enforce our laws when violations are found.”

Interested parties may find the consent order regarding UnitedHealthcare and its affiliates at: http://www.state.nj.us/dobi/division_insurance/enforcement/e18_12.pdf and may find the Aetna Life Insurance Company and Aetna Health Inc. consent order at: https://www.state.nj.us/dobi/division_insurance/enforcement/e18_69.pdf.
 
Other enforcement actions may be found on the Department website Insurance, Bureau of Fraud Deterrence, Banking and Real Estate.

Consumers, providers and other interested parties who wish to make an inquiry or file a complaint may contact the Department for assistance at 1-800-446-7467, or call 609-292-7272.

To read more information on filing a complaint with the Department, or to file a complaint in writing or electronically, consumers and medical providers can go online at www.state.nj.us/dobi/consumer.htm.