Indiana § 27-13-36.2-6 Civil penalties

Indiana Statutes

§ 27-13-36.2-6 — Civil penalties

Indiana § 27-13-36.2-6

Title 27INSURANCE

Art. 13HEALTH MAINTENANCE ORGANIZATIONS

Ch. 36.2Provider Payment

This text of Indiana § 27-13-36.2-6 (Civil penalties) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-13-36.2-6 (2026).

Text

(a)If the commissioner finds that a health maintenance organization has failed during any calendar year to process and pay clean claims in compliance with this chapter, the commissioner may assess an aggregate civil penalty against the health maintenance organization according to the following schedule:

(1)If the health maintenance organization has paid at least eighty-five percent (85%) but less than ninety-five percent (95%) of all clean claims received from all providers during the calendar year in compliance with this chapter, a civil penalty of up to ten thousand dollars ($10,000).

(2)If the health maintenance organization has paid at least sixty percent (60%) but less than eighty-five percent (85%) of all clean claims received from all providers during the calendar year in complia

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(a) If the commissioner finds that a health
maintenance organization has failed during any calendar year to
process and pay clean claims in compliance with this chapter, the
commissioner may assess an aggregate civil penalty against the health
maintenance organization according to the following schedule:
(1) If the health maintenance organization has paid at least
eighty-five percent (85%) but less than ninety-five percent (95%)
of all clean claims received from all providers during the calendar
year in compliance with this chapter, a civil penalty of up to ten
thousand dollars ($10,000).
(2) If the health maintenance organization has paid at least sixty
percent (60%) but less than eighty-five percent (85%) of all clean
claims received from all providers during the calendar year in
compliance with this chapter, a civil penalty of at least ten
thousand dollars ($10,000) but not more than one hundred
thousand dollars ($100,000).
(3) If the health maintenance organization has paid less than sixty
percent (60%) of all clean claims received from all providers
during the calendar year in compliance with this chapter, a civil
penalty of at least one hundred thousand dollars ($100,000) but
not more than two hundred thousand dollars ($200,000).
(b) In determining the amount of a civil penalty under this section,
the commissioner shall consider whether the health maintenance
organization's failure to achieve the standards established by this
chapter is due to circumstances beyond the health maintenance
organization's control.
(c) A health maintenance organization may contest a civil penalty
imposed under this section by requesting an administrative hearing
under IC 4-21.5 not more than thirty (30) days after the health
maintenance organization receives notice of the assessment of the fine.
(d) If the commissioner imposes a civil penalty under this section,
the commissioner may not impose a penalty against the health
maintenance organization under IC 27-4-1 for the same activity.
(e) Civil penalties collected under this section shall be deposited in
the state general fund.