§ 27-8-16-12 — Violations; claims review agent; notice; cease and desist orders; penalties; revocation or suspension of registration; review

Indiana § 27-8-16-12

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 16: Medical Claims Review

Text

(a) If the department believes that a claim
review agent or claim review consultant has violated this chapter, the
department shall notify the claim review agent or claim review
consultant of the alleged violation.
(b) The claim review agent or claim review consultant shall respond
to a notice given under subsection (a) within thirty (30) days after
receiving the notice.
(c) If the department:
(1) believes that a claim review agent or claim review consultant
has violated this chapter; and
(2) is not satisfied, based on the response given by the claim
review agent or claim review consultant under subsection (b), that
the violation has been corrected;
the department shall order the claim review agent or claim review
consultant under IC 4-21.5-3-6 to cease all claims review activities in
Indiana.
(d) If the department determines that a claim review agent or claim
review consultant has violated this chapter, the department:
(1) shall order the claim review agent or claim review consultant
to cease and desist from engaging in the violation; and
(2) may do either or both of the following:
(A) Order the claim review agent or claim review consultant to
pay a civil penalty of not more than five thousand dollars
($5,000) if the claim review agent or claim review consultant
has committed violations with a frequency that indicates a
general business practice.
(B) Suspend or revoke the certificate of registration of the claim
review agent or claim review consultant.
(e) An order issued or a ruling made by the department under this
section is subject to review under IC 4-21.5.

Legislative History

As added by P.L.128-1992, SEC.2. Amended by P.L.260-1995, SEC.9.