Penalty Amount
$2,350,000
Consumers Affected
4,000,000
New York Attorney General Letitia James announced settlements with Carelon after investigations found inaccurate mental health provider directories and improper denials of substance use disorder treatment using unapproved criteria. Carelon must pay $2.35 million in penalties, fees, and costs, provide eligible members with restitution or repayment, and change its provider-directory and coverage-review practices.
Carelon must pay $2.35 million in penalties, fees, and costs; provide up to $8 million in restitution for eligible out-of-network mental health expenses and repay eligible members for other improper out-of-pocket costs. It must correct provider listings, verify directory information, meet appointment-access requirements, use OASAS-approved criteria for substance use treatment reviews, and submit to independent monitoring and reporting.
Review health-plan, behavioral-health administrator, and provider-network vendor agreements for clear obligations to maintain accurate directories, verify provider availability and network status, meet appointment-access standards, and offer out-of-network coverage when timely in-network care is unavailable. Check claims-administration and utilization-review clauses to require the applicable OASAS-approved medical-necessity criteria, consideration of complete member records, compliant denial and appeal processes, and repayment of improperly denied claims. Add audit, monitoring, reporting, remediation, and reimbursement obligations, and ensure member-facing directory and coverage communications accurately describe access and benefits.
Entity
Carelon Behavioral Health, Inc.
Industry
HealthcareOfficial Press Release
https://ag.ny.gov/press-release/2026/attorney-general-james-expands-access-mental-health-and-substance-use-disorder
carelon behavior health inc and carelon behavioral health ip
https://ag.ny.gov/sites/default/files/settlements-agreements/carelon-behavior-health-inc-and-carelon-behavioral-health-ipa-inc-assurance-of-discontinuance-2026.pdf
carelon behavioral health inc aod 2026
https://ag.ny.gov/sites/default/files/settlements-agreements/carelon-behavioral-health-inc-aod-2026.pdf
New York Attorney General Enforcement Page
https://ag.ny.gov/press-releases
"Carelon Behavioral Health, Inc. (Carelon)"
"Carelon will pay $2.35 million in penalties, fees, and costs"
"Carelon's online provider directories contained many errors, including listings for providers who were unreachable, no longer practicing, not accepting new patients, or not actually in-network."
"Carelon improperly denied members’ substance use disorder treatment requests using unapproved medical necessity criteria in at least 41 instances."
"Since 2017, New York law has required insurers to use medical necessity criteria approved by the New York State Office of Addiction Services and Supports (OASAS) when reviewing requests for substance use disorder treatment."
The New York Attorney General issued a consumer alert and online guide about scams targeting service members and veterans, including phishing and credit-monitoring scams that may misuse personal information. The release provides steps for protecting information and reporting suspected scams; it does not announce an enforcement action or monetary penalty.
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The New York Attorney General issued guidance explaining Shield Law protections for reproductive and gender-affirming health care information and the steps required before responding to covered information requests. This is guidance, not an enforcement action against a named company; it describes potential penalties for improper disclosure or failure to follow required procedures.
$10.0M
A March 2023 breach exposed personal and protected health information associated with more than 13.3 million people after attackers accessed company systems using an employee’s credentials. The Perry Johnson companies agreed to pay at least $300,000, with an additional $9.7 million in penalties due if they fail to meet the agreement, and to implement security, incident response, and health-data handling reforms.
New York Attorney General James and Governor Hochul announced guidance advising county executives and sheriffs that they must end agreements to house or detain people for federal civil immigration violations by November 25, 2026. The Local Cops, Local Crimes Act makes those agreements void and unenforceable after the deadline; no monetary penalty or specific enforcement order is announced.
New York Attorney General Letitia James issued a consumer alert warning federal student loan borrowers that consolidating loans after changes under the One Big Beautiful Bill Act may limit repayment options and forgiveness eligibility. This is consumer guidance, not a privacy enforcement action; the release announces no fine or enforcement remedy.