Okla. Admin. Code § 75:45-3-6

Current through Vol. 42, No. 4, November 1, 2024

Section 75:45-3-6 - Penalties for Enforcement, Noncompliance, and Recovery of Costs

(a)Recommendations to the Insurance Commissioner by the Attorney General. After notice and opportunity for hearing before an administrative law judge, and upon an order of the administrative law judge that has been approved by the Attorney General that a PBM has violated any of the provisions of 36 O.S. §§ 6958-6968 of the Oklahoma Statutes or the administrative rules set out in Title 75 of the Oklahoma Administrative Code, the Attorney General may make a recommendation to the Insurance Commissioner that a PBM's license be suspended or revoked and/or that fines, of not less than One Hundred Dollars ($100.00) and no greater than Ten Thousand Dollars ($10,000.00), for each count, be levied against any PBM that has violated the provisions of 36 O.S. §§ 6958-6971. The Insurance Commissioner shall accept and adopt any recommendation of the Attorney General pursuant to 36 O.S. § 6966.1.

(b)Final Order of the Attorney General. In addition to the remedies in subsection (a), and after notice and opportunity for hearing before an administrative law judge, a PBM may be subject to a civil fine of not less than One Hundred Dollars ($100.00) and not greater than Ten Thousand Dollars ($10,000.00) for each violation of the provisions of the Patient's Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act or the provisions of Sections 357 through 360 of Title 59 of the Oklahoma Statues. Any order issued under this subsection shall be approved by the Attorney General.

(c)Closer Supervision Related to a General Business Practice. If the Attorney General determines, based upon an investigation of complaints, that a PBM has engaged in violations of the provisions of the Patient's Right to Pharmacy Choice Act with such frequency as to indicate a general business practice, and that the PBM should be subjected to closer supervision with respect to those practices, the Attorney General may require the PBM to file a report at any periodic interval the Attorney General deems necessary.

(d)Failure to Respond to an Inquiry. Failure to respond timely to an inquiry from the Attorney General's Office shall be grounds for sanctions pursuant to this section, including, but not limited to, fines of at least One Hundred Dollars ($100) and shall not exceed Ten Thousand Dollars ($10,000), for each violation, and/or a binding recommendation from the Attorney General to the Insurance Commissioner that a PBM's license be censured, suspended, or revoked. The payment of expenses incurred by the Attorney General's Office for any legal fees and costs including, but not limited to, staff time, salary and travel expenses, witness fees, and attorney fees, may be levied as part of any non-compliance with this section.

(e)Penalty for Failure to Timely Submit Audit or Report Findings. Failure to respond timely to the deadline to file an audit or examination report shall be considered a violation of OAC: 75:45-3-4 and/or 36 O.S. § 6962. Unless an agreement by a PBM and the Attorney General has been entered into regarding the timing to submit an audit or examination report, a PBM shall be subjected to an administrative fine of at least five hundred dollars ($500) per day for each day the PBM fails to comply with the reporting requirements.

(f)Restitution and Cost Recovery. Restitution may be levied as part of any disciplinary action against a PBM to be paid to the provider or patient involved. In addition to restitution, the cost of recovery related to the disciplinary action may be levied against a PBM for expenses incurred by the Attorney General's Office for any legal fees and costs including, but not limited to, staff time, salary, and travel expense, witness fees, and attorney fees.

(g)Investigative Costs. When making an examination under 36 O.S. § 6965, the Attorney General may retain subject matter experts, attorneys, appraisers, independent actuaries, independent certified public accountants or an accounting firm or individual holding a permit to practice public accounting, certified financial examiners or other professionals and specialists as examiners, the cost of which shall be borne by the PBM that is the subject of the examination. Nothing requires that a formal action be filed against the PBM to recover costs associated with an examination under 36 O.S. § 6965.

(h)Enforcement. The payment of any penalty issued pursuant to these rules may be enforced in the same manner as civil judgments may be enforced.

Okla. Admin. Code § 75:45-3-6

Adopted by Oklahoma Register, Volume 41, Issue 21, July 15, 2024, eff. 7/25/2024