W. Va. Code R. § 114A-1-8

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114A-1-8 - Enforcement; Examination; Penalties

8.1. The Secretary or its vendor shall notify the Commissioner of any health plan that fails to submit data.

8.2. The Commissioner may seek to enjoin any further violation of W. Va. Code § 33-4A-1et seq. or any rule adopted thereunder by filing a petition in the Circuit Court of Kanawha County.

8.3. The Commissioner may deny, suspend, or revoke the license of a TPA subject to this rule for any violation of W. Va. Code § 33-4A-1et seq. or any rule adopted thereunder or, in lieu of such action, impose a penalty pursuant of W. Va. Code § 33-46-17(d) in a sum not to exceed $10,000.

8.4. Pursuant to the authority granted by W. Va. Code § 33-2-3a, the Commissioner may conduct an investigation of any person he or she has cause to believe is violating or has violated any provision of W. Va. Code § 33-4A-1et seq. or any rule adopted thereunder.

8.5. The Commissioner may conduct an examination of any insurer or TPA subject to this rule pursuant to W. Va. Code § 33-2-9 to determine compliance with the provisions of W. Va. Code § 33-4A-1et seq. and any rule adopted thereunder. The costs of such examination may be assessed against the insurer or TPA.

8.6. The Commissioner may, in addition to or in lieu of any other sanctions, impose a penalty on any data submitter for failure to comply with the submission requirements of this rule in an amount not to exceed $100 per day for the first two weeks of non-compliance and $500 per day thereafter, not to exceed a maximum of $25,000 per any single occurrence.

W. Va. Code R. § 114A-1-8