RSA 420-B:13 · Sanctions

420-B:13 Sanctions. – Upon satisfactory evidence that any health maintenance organization has violated any law or regulation or in any way has failed in meeting its obligations, the commissioner may, in his discretion, pursue any one or more of the following courses of action:

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I.

Suspend the certificate of authority to operate as a health maintenance organization under this chapter. When the certificate of authority is suspended, the organization shall not during the period of such suspension enroll any additional enrolled participants except newborn children or other newly acquired dependents of existing enrolled participants, and shall not engage in any advertising or solicitation whatever;

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II.

Revoke the certificate of authority to operate as a health maintenance organization under this chapter. When the certificate of authority is revoked, such organization shall proceed under the supervision of the commissioner, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of such organization. It shall engage in no further advertising or solicitation whatsoever. The commissioner may, by written order, permit such further operation of the organization as he may find to be in the best interest of enrolled participants, to the end that enrolled participants will be afforded the greatest practical opportunity to obtain continuing health care coverage;

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III.

Impose a penalty of not more than $2,500 for each and every unlawful act committed; each violation shall constitute a separate fineable offense;

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IV.

Issue an administrative order requiring the health maintenance organization: to cease or modify inappropriate conduct or practices by it or any of the personnel employed or associated with it; to fulfill its contractual obligations; to provide a service which has been improperly denied; or to take appropriate steps to restore the ability of the organization to provide a contracted-for service; and

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V.

Apply to any court for such legal or equitable relief as the commissioner deems appropriate. Source. 1977, 282:1, eff. Aug. 21, 1977.

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