10 payers recently fined by states

Payers have faced state penalties over the last year for slow reimbursements, improper claims denials, or the sale of unapproved products.

Recent examples of payers fined or agreeing to settlements with states:

  1. UnitedHealthcare was fined $3.4 million by North Carolina in February 2025 following a four year investigation into the company's claims handling practices involving balance billing. The company was also fined $546,500 by Utah in May 2024 for selling unapproved health plans to state residents.

  2. Cigna was fined $800,000 by Texas in December 2024 for failing to comply with state independent dispute resolution requirements, which aims to address surprise billing. The fine follows Cigna’s repeated noncompliance with state law, as well as a prior agreement to resolve similar violations earlier in 2024. Texas fined the insurer $600,000 in June 2024 over similar issues. 

    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 2025. Cigna also agreed to pay $236,900 to Virginia in July 2024 to settle allegations around an array of violations, including issues with provider reimbursements, claims processing and mental health parity laws.

  3. Centene's California Health and Wellness was fined $100,000 by California in December for failure to meet a required 70% compliance rate for urgent and non-urgent care appointment availability.

  4. Anthem Blue Cross of California was fined $3.5 million by the state in November for failing to handle member complaints appeals in a timely manner. The state fined the company an additional $500,000 in November for failing to provide basic healthcare services and acknowledge complaints filed by a health plan member during cancer treatment. The insurer and its Medicaid subsidiary were fined a total of $850,000 in August for illegally limiting coverage for gender dysphoria treatments. The two plans were also fined a total of $8.5 million in September for failing to address claims payment disputes in a timely manner with physicians, hospitals and providers. In January, Anthem was fined $690,000 for failure to reimburse providers and members in a timely manner.

  5. L.A. Care Health Plan will pay a $55 million penalty to California to resolve allegations the plan improperly denied claims, and had a backlog of unresolved grievances. 

  6. Centene's Fidelis Care agreed to pay $7.6 million back to the state of New York to settle the issue of billing Medicaid for services provided by an individual convicted of a crime.

  7. Highmark was fined $363,570 in Delaware in September for nearly 500 situations related to improper volunteer ambulance company claims reimbursement.

  8. Blue Shield of California paid $250,000 to California in August for charging more than 300 members copays for contraceptive services.

  9. Anthem BCBS Virginia will pay $362,000 to settle allegations that it violated state law, including improper denial of claims and incorrect reimbursements, the Richmond Times-Dispatch reported in July.

  10. Molina Healthcare of Washington was fined $100,000 for enrollment and billing errors in March 2024.

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