§33-25A-23a. Civil penalty imposed by commissioner.
No provider shall collect or attempt to collect from a health
maintenance organization enrollee any money for services covered by
the health maintenance organization. If a provider collects or
attempts to collect from a health maintenance organization enrollee
any money for services covered by the health maintenance
organization, then the provider may be subjected to a civil money
penalty to be imposed by the commissioner. Upon a determination
that there is probable cause to believe that there has been a
violation of this section, the commissioner may provide written
notice to the alleged violator, stating the nature of the alleged
violation and that failure to refund the amount of any improper
billing within thirty days may result in imposition of a civil
penalty pursuant to the provisions of this section. If the alleged
violator fails to make a refund within thirty days, the
commissioner shall issue a written notice of hearing stating the
nature of the alleged violation and the time and place at which the
alleged violator shall appear to show good cause why a civil
penalty should not be imposed: Provided, That if the commissioner
has previously found on three occasions that probable cause existed
to support a violation, the alleged violator shall not be afforded
the opportunity to make a refund before issuance of the notice of
hearing for any subsequent violation.
If, after notice and hearing, the commissioner determines that
a violation of this section has occurred, the commissioner may assess a civil penalty of not less than the amount charged the
subscriber but not more than one thousand dollars. Subsequent
violations of this section result in fines of not more than two
thousand dollars. Any provider so assessed shall be notified of
the assessment in writing and the notice shall specify the reasons
for the assessment. Any provider may waive the right to a hearing
and receive a reduction in penalties of twenty-five percent.