§ 31–3423. Penalties and enforcement.

(a) The Commissioner, after giving reasonable written notice of intent and providing a reasonable time within which the health maintenance organization may respond, in lieu of suspension or revocation of a certificate of authority under § 31-3419, may levy an administrative penalty in an amount not to exceed $50,000 for any violation when, in the Commissioner’s judgment, the Commissioner finds that the public interest would be best served by the continued operation of the company. The Commissioner may increase this penalty by the amount which the Commissioner determines to be the damages suffered by enrollees or other members of the public. The amount of any penalty shall be paid by the health maintenance organization through the Office of the Commissioner to the District of Columbia Treasurer. Civil penalties may be imposed as alternative sanctions for any infraction of the provisions of District law or any rules or regulations issued which pertain to health maintenance organizations.

(b)(1) If the Commissioner shall for any reason have cause to believe that any violation of this chapter has occurred or is threatened, the Commissioner may give notice to a health maintenance organization and to its representatives, or other persons who appear to be involved in such suspected violation, to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to such suspected violation; and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing such violation.

(2) Proceedings under this subsection shall not be governed by any formal procedural requirements and may be conducted in such manner as the Commissioner may deem appropriate under the circumstances. However, unless consented to by the health maintenance organization, no rule or order may result from a conference until the requirements of this section are satisfied.

(c)(1) The Commissioner may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provisions of this chapter.

(2) Within 30 days after service of the cease and desist order, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred. Such hearings shall be conducted pursuant to the DCAPA, and judicial review shall be available as provided by the DCAPA.

(d) In the case of any violation of the provisions of this chapter, if the Commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to subsection (c) of this section, the Commissioner may institute a proceeding to obtain injunctive or other appropriate relief in the Superior Court of the District of Columbia.

(e) Notwithstanding any other provisions of this chapter, if a health maintenance organization fails to comply with the net worth requirement of this chapter, the Commissioner may take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to its enrollees.

(Apr. 9, 1997, D.C. Law 11-235, § 25, 44 DCR 818; Mar. 27, 2003, D.C. Law 14-252, § 2(i), 50 DCR 225.)

Prior Codifications

1981 Ed., § 35-4523.

Effect of Amendments

D.C. Law 14-252 rewrote subsec. (a) which had read as follows: “(a) The Commissioner may, in lieu of suspension or revocation of a certificate of authority under § 31-3419, levy an administrative penalty in an amount not less than $10,000 nor more than $50,000, if reasonable notice in writing is given of the intent to levy the penalty and the health maintenance organization has a reasonable time within which to remedy the defect in its operations which gave rise to the penalty citation. The Commissioner may augment this penalty by an amount equal to the sum that the Commissioner calculates to be the damages suffered by enrollees or other members of the public.”