New Jersey health insurance company pays $2.2m to settle ethics claims

New Jersey’s largest health insurance firm has agreed to pay $2,225,000 to settle claims that it used its influence over state officials to influence its decision not to renew health insurance coverage for independent health care workers.

In the latest case, the New Jersey Attorney General’s Office filed a lawsuit in August accusing the insurance company of improperly influencing the New York City Department of Health and Mental Hygiene (DHMH) to deny the company coverage for an independent worker, who worked for a local hospital.

The health insurance giant agreed to settle the matter in July after a federal judge ruled in June that the company’s actions violated the state’s public trust doctrine.

“In my opinion, we did not have enough information to conclude that there was a conflict of interest, and therefore, it did not appear to me that the conflict was a legitimate one,” Attorney General Christopher Porrino said in a statement.

The state attorney general’s office did not immediately respond to requests for comment on the settlement.

Earlier this year, the attorney general was investigating a separate complaint from a former employee who alleged that the insurance giant misused its influence to sway health care policy and decision-making at DHMH.

The DHMH, which was created in 2013 to administer health care for low-income New Jersey residents, was sued in 2016 by former independent worker Barbara Pascual, who alleged she was paid $800 a month in salary for the rest of her time at the hospital.

In January, the insurer settled the case, agreeing to pay a $2 million civil penalty and a $150,000 administrative penalty, and to stop the DHMH from using its power to influence the health insurance policy.

Pascuel, who has since retired, said she had been told by a DHMH administrator that the policy would not be renewed because of Pascul’s medical condition.

She said she was told that her health care plan was not covered by the insurer.

“My only option was to leave the hospital,” she said in her complaint, which said the insurer did not inform her of any of the policy’s coverage or how much it would cost.

She also alleged that she was not provided information about how much she was entitled to receive in the form of benefits, or that the plan was reviewed in advance.

“I had no way of knowing that there were two people with whom I would be getting the same amount of care,” she wrote in the complaint.

“Had I known that, I would not have been on the hospital’s waiting list, I wouldn’t have been getting care at the facility, and I wouldn

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