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:
- 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.
- UnitedHealthcare was fined $1 million by Rhode Island in June for improperly applying cost-sharing for COVID-19-related services during the pandemic. The company was also fined $3.4 million by North Carolina in February following a four year investigation into the company’s claims handling practices involving balance billing.
- 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.
- 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.
- 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.
- Anthem Blue Cross of California 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 company’s 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.
- 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.
