§ 27-8-17-17 — Violations; notice to agent; cease and desist orders; penalties; revocation or suspension of registration; review

Indiana § 27-8-17-17

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 17: Health Care Utilization Review

Text

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