Vermont § 9418g - Enforcement In addition to any other remedy provided by law, the Commissioner may, in the Commissioner’s sole discretion, enforce the provisions of this subchapter as specified in this section

§ 9418g. Enforcement In addition to any other remedy provided by law, the Commissioner may, in the Commissioner’s sole discretion, enforce the provisions of this subchapter as specified in this section

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  In determining whether to undertake an enforcement action, the Commissioner may consider
  the relative resources of the complaining party and the alleged noncompliant party,
  the Commissioner’s other enforcement responsibilities, and such other factors as the
  Commissioner deems appropriate. (1) The Commissioner shall have the power to examine and investigate any health plan,
  contracting entity, covered entity, or payer to determine if the health plan, contracting
  entity, covered entity, or payer has violated the provisions of this subchapter, or
  any rules or order of the Commissioner adopted or issued pursuant to this subchapter. (2) If the Commissioner finds that a health plan, contracting entity, covered entity,
  or payer has violated this subchapter, or any rules or order of the Commissioner adopted
  or issued pursuant to this subchapter, the Commissioner may order the health plan,
  contracting entity, covered entity, or payer to cease and desist from further violations
  and may order the health plan, contracting entity, covered entity, or payer to remediate
  the violation. (3) If the Commissioner finds that a health plan, contracting entity, covered entity,
  or payer has violated this subchapter or any rules or order of the Commissioner adopted
  or issued pursuant to this subchapter, the Commissioner may impose an administrative
  penalty against the health plan, contracting entity, covered entity, or payer of not
  more than $1,000.00 for each violation and not more than $10,000.00 for each willful
  violation. In determining the amount of the penalty to be assessed, the Commissioner
  shall consider the following factors: (A) the appropriateness of the penalty with respect to the financial resources and good
  faith of the health plan, contracting entity, covered entity, or payer; (B) the gravity of the violation or practice; (C) the history of previous violations or practices of a similar nature; (D) the economic benefit derived by the health plan, contracting entity, covered entity,
  or payer and the economic impact on the health care facility or health care provider
  resulting from the violation; and (E) any other relevant factors. (4) Any dispute arising out of or relating to the provisions of this subchapter shall,
  at the option of either party, be settled by arbitration in accordance with the commercial
  rules of the American Arbitration Association or the rules or procedures of another
  mutually agreed upon alternative dispute resolution forum, such as the American Health
  Lawyers Association. Judgment upon the arbitrator’s award may be entered in any court
  having jurisdiction, and the arbitrator’s award shall be binding on both parties. (5) Nothing in this subchapter shall be construed to prohibit a health plan, contracting
  entity, covered entity, or payer from applying payment policies that are consistent
  with applicable federal or State laws and regulations, or to relieve a health plan,
  contracting entity, covered entity, or payer from complying with payment standards
  established by federal or State laws and regulations, including rules adopted by the
  Commissioner. (Added 2009, No. 61, § 36; amended 2023, No. 6, § 236, eff. July 1, 2023.)