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Violation Tracker Individual Record

Company: Horizon Healthcare Services, Inc. and Horizon Healthcare of New Jersey Inc.
Current Parent Company: Horizon Healthcare Services
Penalty: $1,500,000
Year: 2017
Date: November 15, 2017
Offense Group: consumer-protection-related offenses
Primary Offense: insurance violation
Violation Description: Respondent Horizon Healthcare Services, Inc. failed to promptly comply with decisions of the Independent Health Care Appeals Program (IHCAP), failed to properly compute interest on claims paid after IHCAP reversals, improperly paid claims following IHCAP decisions to providers rather than covered persons where the claims were submitted without an assignment of benefits and the covered person had already paid the provider and failed to respond to Department inquiries. Respondent Horizon Healthcare of New Jersey, Inc. was found to have engaged in multiple improper business practices as a result of market conduct examination, including but not limited to, untimely claim processing, failure to promptly comply with stage 1 appeal decisions and IHCAP reversals, failure to properly compute interest, improper claim denials and claim payment errors. Respondent Horizon Healthcare of New Jersey, Inc. also improperly denied certain claims for third party liability.
Level of Government: state
Action Type: agency action
Agency: New Jersey Department of Banking & Insurance
Civil or Criminal Case: civil
Facility State: New Jersey
HQ Country of Current Parent: USA
HQ State of Current Parent: New Jersey
Ownership Structure of Current Parent: non-profit
Major Industry of Current Parent: financial services
Specific Industry of Current Parent: insurance
Source of Data: (click here)
Source Notes: If an online information source is not working, check the Violation Tracker Data Sources page for an updated link.
Current parent company note: Parent-subsidiary relationship is current as of the most recent revision listed in the Update Log.