UHC, Oxford, Americhoice Fined $2.5 Million for Regulatory Violations

    By: Melinda Martinson, Esq. on Apr 05, 2018

    The Department of Banking & Insurance (DOBI) fined UnitedHealthcare (UHC), Oxford and Americhoice $2.5 million for regulatory violations, some of which MSNJ brought to DOBI’s attention based on our members’ complaints. In particular, we asserted that UHC could not require physicians to provide patient consent on payment appeals; DOBI agreed and has fined UHC for this violation.

    The Consent Order also found that:

    • Oxford failed to comply with Independent Utilization Review Organization (IURO) decisions in a timely manner, with delays of care ranging from 39 to 217 days;
    • Oxford also handled prior authorization requests to exceed chemotherapy quantity limits in an individual plan as administrative, depriving the patient of utilization management appeal rights; and
    • While Oxford was to offer guarantee issue individual health plans to New Jersey residents, it was found to have directed those calls to a 1-800 number which incorrectly advised interested individuals that the company did not sell such plans.
    Released: April 5, 2018, 11:26 am
    Keywords: Announcements | Help and Training

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