- (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 .
As added by P.L.128-1992, SEC.1.