West Virginia Code § 33-25A-23a

Civil penalty imposed by commissioner
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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. Uepon 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 viorlator, 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 tthe 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 assgess a civil penalty of not less than the amount charged
the subscriber but not more than $1,000. Subsequent violations of this section result in fines
of not more than $2,000. Any perovider 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 anLd receive a reduction in penalties of twenty-five percent.

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