This enforcement action is the result of deficiencies identified in DMHC surveys and 245 specific grievance system violations identified by the DMHC Help Center during the investigation of consumer complaints from 2013 through 2016. Including this fine, the DMHC has fined Anthem Blue Cross $11.66 million for grievance system violations since 2002.
CMS identified violations of Part D formulary and benefit administration requirements that resulted in UnitedHealth’s enrollees experiencing inappropriate denials of and/or delayed access to Part D prescription drugs at the point of sale. UnitedHealth’s violations include:
Insurance Commissioner Dave Jones today announced the enforcement action taken against Zenefits for multiple license violations has resulted in a $7 million penalty. Zenefits was charged with allowing unlicensed employees to transact insurance and circumventing insurance agent education requirements. This is the largest penalty assessed by any commissioner against Zenefits and one of the largest penalties for licensing violations ever assessed in the department’s history.
The California Department of Managed Health Care (DMHC) announced today that it issued a $350,000 fine against Blue Shield of California (Blue Shield) and a $250,000 fine against Anthem Blue Cross (Anthem) for inaccurate provider directories.