N.J. Admin. Code § 11:24-2.14

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24-2.14 - Enforcement remedies available

(a) The Commissioner may impose the following enforcement remedies against an HMO for violations of regulations in this chapter or other statutory requirements:

1. A monetary penalty may be imposed for each violation in an amount determined by the Commissioner, which shall be in amounts as authorized by 26:2J-24 (not less than $ 250.00 and not greater than $ 10,000 for each day that the carrier is in violation, based on the severity of the violation, as determined by the Commissioner on a case-by-case basis), as amended from time to time. The Department shall provide the HMO with reasonable notice in writing of the intent to levy the penalty, and a reasonable time, as determined by the Commissioner, within which to correct the violation. Any such penalty may be recovered in a summary proceeding pursuant to the Penalty Enforcement Law (N.J.S.A. 2A:58 et seq.);

2. Suspension of a certificate of authority pursuant to 26:2J-19, which may include the suspension of marketing and enrollment;

3. Revocation of a certificate of authority pursuant to 26:2J-19;

4. An order to cease and desist pursuant to 26:2J-24;

5. Institution of a proceeding to obtain injunctive relief pursuant to 26:2J-24;

6. Other remedies for violations of statutes, as provided by State or federal law.

(b) The Commissioner shall serve notice to the HMO of any proposed enforcement remedy under this section, setting forth the specific violations, charges or reasons for the action. Such notice shall be served on the HMO or its registered agent in person or by certified mail.

(c) The assessment of civil monetary penalties, or revocation of a certificate of authority, shall become effective 30 days after the date of mailing or the date on which such notice was personally served on an HMO, unless the HMO files with the Department a written answer to the charges and gives written notice to the Department of its desire for a hearing, in accordance with 11:24-2.1 5. In such cases, the HMO may request an abeyance of the enforcement remedy until an administrative hearing has been concluded and a final decision is rendered by the Commissioner. The Commissioner may grant the abeyance where he or she determines that such action would not endanger the health, safety, and welfare of HMO members. Hearings shall be conducted in accordance with 11:24-2.1 5.

(d) Upon the imposition of an order to suspend marketing and enrollment, or following the suspension of a certificate of authority, the HMO shall not enroll any additional enrollees, except newborn children or other newly acquired dependents of existing enrollees.

(e) Upon the revocation of the certificate of authority, the HMO shall notify all members and providers and follow procedures in N.J.S.A. 26:2J-19d.

(f) The Commissioner may issue an order directing an HMO or a representative of an HMO to cease and desist from engaging in any act or practice in violation of the provisions of this chapter and 26:2J-1 et seq. Within 20 days after service of such an order, the HMO may request a hearing on the question of whether acts or practices in violation of this chapter and 26:2J-1 et seq. have occurred.

(g) The Commissioner may institute a proceeding to obtain injunctive relief, in accordance with New Jersey Court Rules, if the Commissioner elects not to issue a cease and desist order, or in the event of non-compliance with a cease and desist order pursuant to 26:2J-24(d).

N.J. Admin. Code § 11:24-2.14

Amended by R.2000 d.183, effective 5/1/2000.
See: 31 N.J.R. 953(a), 32 N.J.R. 1544(a).
In (a)1, rewrote the first sentence.