The West Virginia Office of the Insurance Commissioner (“WV OIC”) recently took regulatory actions against four unaffiliated Pharmacy Benefit Managers (“PBMs”) that were operating in West Virginia without a PBM license. These...more
The Florida Office of Insurance Regulation (“Florida OIR”) recently took regulatory action against a New York-based company (“Company”) regarding its alleged unlicensed activities in Florida. According to the Florida OIR, the...more
The South Dakota Division of Insurance (“Division”) recently took regulatory action against a Texas-based Third Party Administrator (“TPA”) regarding its activities in South Dakota. According to the Division, the TPA...more
The U.S. Department of Labor (“DOL”) recently entered into a settlement agreement with a New York-based insurer and third-party administrator (“Company”) of employer group health plans governed by the Employee Retirement...more
The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more
11/21/2023
/ Affordable Care Act ,
Claim Procedures ,
Denial of Insurance Coverage ,
Department of Labor (DOL) ,
Drug Testing ,
Employee Retirement Income Security Act (ERISA) ,
Enforcement Actions ,
Explanation of Benefits (EOBs) ,
Statutory Violations ,
TPAs ,
UnitedHealth
The Louisiana Insurance Department (“Department”) recently fined Express Scripts Administrators, LLC (“ESA”) $275,000 and MedImpact Healthcare Systems, Inc. (“MedImpact”) $250,000 for allegedly failing to pay electronically...more
The Louisiana Insurance Department (“Department”) recently issued separate Cease and Desist Orders to both a TPA operating as a Pharmacy Benefit Manager (“PBM”) and the Office of Group Benefits, a Louisiana state agency that...more
The New York Department of Financial Services (“NYDFS”) recently announced it has entered into a Consent Order with an insurance agency for alleged violations of New York’s Cybersecurity Regulation (the “NY Cybersecurity...more
The New York Department of Financial Services (“NYDFS”) recently announced that it has entered into a Consent Order with two affiliated life insurers for alleged violations of New York’s Cybersecurity Regulation (the “NY...more
A Regulatory Settlement Agreement was recently entered into by forty-one (41) states and an insurer as a result of a multistate targeted market conduct examination (“Multistate Examination”) of the insurer. The Multistate...more
The North Carolina Insurance Department (“Department”) recently announced a regulatory action against an insurer for alleged claims practices violations and contracting with a TPA before it became licensed in North Carolina....more
NEW JERSEY -
The New Jersey Department of Banking and Insurance (“New Jersey Department”) recently took regulatory action against a TPA for untimely filing its annual report with the New Jersey Department....more
The Kansas Insurance Department (“Kansas Department”) recently issued a Summary Order against a Missouri-domiciled third party administrator (“Company”) revoking the Company’s Kansas non-resident TPA license....more
The Kansas Insurance Department (“Department”) recently took regulatory action against an insurer which allegedly violated Kansas insurance laws. Specifically, the Department initiated a Market Conduct inquiry of accident and...more