The Georgia Office of the Insurance and Safety Fire Commissioner announced that it will impose more than $20 million in fines on health insurance companies for violations of the state’s Mental Health Parity Act.
Officials said the penalties follow market conduct examinations of 22 insurers, which revealed more than 6,000 violations of parity requirements designed to ensure that mental health and substance use disorder treatment is covered on par with physical health care.
Findings from Examinations
According to the Insurance Commissioner’s Office, the most common violations included:
- Inconsistent classification of benefits
- Prior authorization requirements for services not identified as needing authorization
- Improper use of concurrent review authorization
- Reprocessing of claims without clear justification
Under Georgia law (O.C.G.A. § 33-1-27), insurers can face penalties of up to $2,000 per violation, or up to $5,000 if they knew or should have known they were in violation. Additional enforcement actions may require insurers to reprocess claims, adopt compliance plans, or be placed under corrective oversight.
Enforcement Background
The Georgia Mental Health Parity Act, passed in 2022, works in coordination with the federal Mental Health Parity and Addiction Equity Act of 2008. It requires health insurers to provide coverage for mental health and substance use disorders equal to that of physical health conditions.
The law mandates annual data reviews, with reports published each August. Findings from the state’s first report in 2023 prompted audits of insurers’ business practices. These audits are described as comprehensive, data-intensive, and designed to withstand legal scrutiny.
Ongoing Oversight
The Office of the Commissioner of Insurance (OCI) said it will continue monitoring insurers and taking corrective action where necessary.
Consumers who believe they have experienced a mental health parity violation can file a complaint at oci.georgia.gov/file-consumer-insurance-complaint or call toll-free at 1-800-656-2298.
