§ 26.1-26.4-05 — Utilization review agent violations - Penalty

North Dakota § 26.1-26.4-05

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-26.4: Health Care Service Utilization Review

Text

Whenever the commissioner has reason to believe that a utilization review agent subject to
this chapter has been or is engaged in conduct that violates section 26.1-26.4-03 or
26.1-26.4-04, the commissioner shall notify the utilization review agent of the alleged violation.
The utilization review agent has thirty days from the date the notice is received to respond to the
alleged violation.
If the commissioner believes that the utilization review agent has violated this chapter, or is
not satisfied that the alleged violation has been corrected, the commissioner shall conduct a
hearing on the alleged violation in accordance with chapter 28-32.
If, after the hearing, the commissioner determines that the utilization review agent has
engaged in violations of this chapter, the commissioner shall reduce the findings to writing and
shall issue and cause to be served upon the utilization review agent a copy of the findings and
an order requiring the utilization review agent to cease and desist from engaging in the
violations. The commissioner may also, at the commissioner's discretion, order:
1. Payment of a penalty of not more than ten thousand dollars for a violation that
occurred with such frequency as to indicate a general business practice; or
2. Suspension or revocation of the authority to do business in this state as a utilization
review agent if the utilization review agent knew that the act was in violation of this
chapter.