West Virginia Code § 5-16-12a

Inspections; violations and penalties
Open in Lexace · Ask the AI about this section
(a) Employers and employees participating in any of the Public Employees Insurance Agency
plans shall provide, to the director, upon request, all documentation reasonably required for
the director to discharge the responsibilities under this article. This documentation includes,
but is not limited to, employment or eligibility records sufficient to verify actual full-time
employment and eligibility of employees who participate in the Public Emploeyees Insurance
Agency plans.
(b) Upon a determination of the director or his or her designated representative that there is
probable cause to believe that fraud, abuse or other illegal activiuties involving transactions
with the agency has occurred, the director or his or her designated representative is
authorized to refer the alleged violations to the Insurance Cotmmissioner for investigation
and, if appropriate, prosecution, pursuant to article forty-one, chapter thirty-three of this
code. For purposes of this section, "transactions with the agency" includes, but is not limited
to, application by any insured or dependent, any employer or any type of health care
provider for payment to be made to that person or any third party by the agency.
(c) The Public Employees Insurance Agency is authorized through administrative proceeding
to recover any benefits or claims paid to or for any employee, or their dependents, who
obtained or received benefits througgh fraud. The Public Employees Insurance Agency is also
authorized through administrative proceeding to recover any funds due from an employer
that knowingly allowed or proveided benefits or claims to be fraudulently paid to an employee
or dependents.
(d) For the purpose of any investigation or proceeding under this article, the director or any
officer designated by him or her may administer oaths and affirmations, issue administrative
subpoenas, take evidence, and require the production of any books, papers,
correspondences, memoranda, agreements or other documents or records which may be
relevant or material to the inquiry.
(1) Administrative subpoenas shall be served by personal service by a person over the age of
eighteen, or by registered or certified mail addressed to the entity or person to be served at
his or her residence, principal office or place of business. Proof of service, when necessary,
shall be made by a return completed by the person making service, or in the case of
registered or certified mail, such return shall be accompanied by the post office receipt of
delivery of the subpoena. A party requesting the administrative subpoena is responsible for
service and payment of any fees for service. Any person who serves the administrative
subpoena pursuant to this section is entitled to the same fee as sheriffs who serve witness
subpoenas for the circuit courts of this state.
(2) Fees for the attendance and travel of witnesses subpoenaed shall be the same as for
witnesses before the circuit courts of this state. All such fees related to any administrative
subpoena issued at the request of a party to an administrative proceeding shall be paid by
the requesting party. All requests by parties for administrative subpoenas shall be in writing
and shall contain a statement acknowledging that the requesting party agrees to pay such
fees.
(3) In case of disobedience or neglect of any administrative subpoena served, or the refusal
of any witness to testify to any matter for which he or she may be lawfully interrogated, or to
produce documents subpoenaed, the circuit court of the county in which the hearing is being
held, or the judge thereof in vacation, upon application by the director, maye compel
obedience by attachment proceedings for contempt as in the case of disobedience of the
requirements of a subpoena or subpoena duces tecum issued from suchr circuit court or a
refusal to testify therein. Witnesses at such hearings shall testify under oath or affirmation.
(e) Only authorized employees or agents shall have access to confidential data or systems
and applications containing confidential data within the Pubtlic Employees Insurance Agency.

‹ Prev All West Virginia sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.