Becker’s: 9 payers recently fined by states

Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here.

Payers fined by states in 2025:

1. UnitedHealthcare was fined $450,000 by Delaware in September after a two-year examination revealed violations of mental health parity laws, including misapplied prior authorization and step-therapy protocols.
   
   The insurer was also fined $648,000 by Virginia in September after a multi-year examination found its mental health coverage policies unfair and more restrictive than medical or surgical benefits; fined $1 million by Rhode Island in June for improperly applying cost-sharing for COVID-19-related services during the pandemic; and fined $3.4 million by North Carolina in February following a four year investigation into the company’s claims handling practices involving balance billing. 
   
2. MVP Health Plan was fined $250,000 and will provide restitution to members as part of a broader settlement with the New York Attorney General’s Office in August over mental health provider directory inaccuracies.
   
3. Premera Blue Cross was fined $550,000 by Washington state in August for failing to comply with mental health parity laws and for inaccuracies in its provider directories. The insurer did not adequately document how it applies non-quantitative treatment limitations for behavioral health services and failed to keep its provider directory updated and accessible, violating state regulations.
   
4. Anthem Blue Cross of California‘s Medicaid plan was fined $500,000 by the state in July for failing to correct deficiencies that directly impacted members, including failing to properly handle and resolve appeals. The plan was fined $750,000 in April by the state for sending more than 5,200 denial letters to members with incorrect information about appealing claims and for not monitoring or reviewing its PBM’s denial letters to its members. The Medicaid plan was also fined $550,000 by the state in April for failing to implement an Independent Medical Review decision within the required five-day timeframe, delaying approval of necessary services by 59 days. 
   
5. Centene’s Human Affairs International of California subsidiary was fined $300,000 by the state in June for failing to meet timely access to healthcare appointment compliance standards, specifically for urgent care appointments, as required under the Knox-Keene Health Care Service Plan Act. The company was also fined $35,000 in February for failing to comply with timely access and network adequacy reporting standards.
   
6. BCBS Rhode Island was fined $20,000 by the state in June for violating state law by failing to waive cost-sharing for COVID-19-related services from out-of-network providers.
   
7. Aetna was fined $10,000 by Rhode Island in June for imposing cost-sharing for COVID-19-related services by not initially waiving costs for out-of-network services.
   
8. Blue Shield of California was fined $300,000 in April by the state for multiple violations related to claims processing errors for a member under 18. The issues included improper denial of claims, incorrect authorization entries, and delays in processing, which resulted in the member being charged more than the in-network benefit level. Blue Shield also failed to investigate and resolve grievances in a timely manner.
   
9. Cigna was fined a total of $503,000 by Virginia during three separate enforcement actions for noncompliance with mental health parity laws, along with claims handling and arbitration issues, according to regulatory documents filed in January.

This article was originally published on Becker’s Hospital Review.