The New York Insurance Department, now known as the Department of Financial Services, has fined Oxford (UnitedHealth) $665,000. The Department released a stipulated order in which Oxford, owned and controlled by UnitedHealth, has admitted to various regulatory violations.
The violations involve either failing to issue Explanation of Benefits Forms or issuing these forms in a way that was incomplete or misleading. These failures give rise to many rights of medical providers and patients in their battle to obtain payment on denied health insurance claims.
The State regulatory violations are similar to the type of violations that Schwartz, Conroy & Hack is enforcing under ERISA, the federal employee benefits law that governs many of the nation’s health insurance claims.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack