44-5,120.Fraudulent or abusive acts or practices;defined; powers, dutiesand functions of director of workers compensation and commissioner ofinsurance; application of section; administrative investigation andenforcement; hearings; costs; cease and desist orders; civil penalties;repayments, interest; review referrals, immunity.(a) The director of workerscompensation is hereby authorized and directed to establish asystem for monitoring, reporting and investigatingsuspected fraud or abuseby any persons who are not licensed or regulated by the commissioner ofinsurancein connection with securing theliability of an employer under the workers compensation act or inconnection with claims or benefits thereunder.The commissioner of insurance is hereby authorized and directed to establish asystem for monitoring, reporting and investigating suspected fraud or abuse byany persons who are licensed or regulated by the commissioner of insurance inconnection with securing the liability of an employer under the workerscompensation act or in connection with claims thereunder.
(b) This section applies to:
(1) Persons claiming benefits under the workers compensation act;
(2) employers subject to the requirements of the workerscompensation act;
(3) insurance companies including group-funded self-insurance planscovering Kansas employers and employees;
(4) any person, corporation, business, health care facilitythat is organized either for profit or not-for-profit and that renders medicalcare,treatment or servicesinaccordance with the provisions of the workers compensation actto an injured employee who is covered thereunder;and
(5) attorneys and other representatives of employers, employees,insurers or other entities that are subject to the workers compensation act.
(c) The commissioner of insurance may examine the workers compensationrecords ofinsurance companies or self-insurers as necessary to ensurecompliance with the workers compensation act. Each insurance company providingworkers compensation insurance in Kansas, the company'sagents, and those entities that the company has contracted to providereview services or to monitor services and practices under the workerscompensation act shallcooperate with the commissioner of insurance, and shall make available to thecommissioner any records or other necessary information requested by thecommissioner.The commissioner of insuranceshall conduct an examination authorized by this subsection inaccordance with the provisions of K.S.A. 40-222 and40-223 and amendments thereto.
(d) Fraudulent or abusiveacts or practices for purposes of the workers compensation act include,willfully, knowingly or intentionally:
(1) Collecting from an employee, through a deduction from wages or asubsequent fee, anypremium or other fee paid by the employer to obtain workerscompensation insurance coverage;
(2) misrepresenting to an insurancecompany or the insurance department, the classification ofemployees of an employer, or the location, number of employees,or true identity of the employer with the intent to lessen orreduce the premium otherwise chargeable for workers compensationinsurance coverage;
(3) lending money to the claimant during the pendency of theworkers compensation claim by an attorney representing theclaimant, but this provision shall not prohibit the attorney from assistingthe claimant in obtaining financial assistance from anothersource, except that (A) the attorney shall not have a financial interest,directlyor indirectly, in the source from which the loan or other financial assistanceis secured and(B) the attorney shall not be personally liable in any way for the creditextended to the claimant;
(4) obtaining, denying or attempting to obtain or deny paymentsof workers compensation benefits for any person by:
(A) Making a false or misleading statement;
(B) misrepresenting or concealing a material fact;
(C) fabricating, altering, concealing or destroying a document;or
(D) conspiring to commit an act specified by clauses (A),(B) or (C) of this subsection (d)(4);
(5) bringing, prosecuting or defending an action forcompensation under the workers compensation act or requesting initiation of anadministrative violation proceeding that, in either case, has no basis in factoris not warranted by existing law or a good faith argument forthe extension, modification or reversal of existing law;
(6) breaching a provision of anagreement approved by the director;
(7) withholding amounts not authorized by the director from theemployee's or legal beneficiary's weekly compensation payment or fromadvances from any such payment;
(8) entering into a settlement or agreement without the knowledgeand consent of the employee or legal beneficiary;
(9) taking a fee or withholding expenses in excess of the amountsauthorized by the director;
(10) refusing or failing to make prompt delivery to the employeeor legal beneficiary of funds belonging to the employee or legalbeneficiary as a result of a settlement, agreement, order oraward;
(11) misrepresentingthe provisions ofthe workers compensation actto an employee, an employer, ahealth care provider or a legal beneficiary;
(12) instructing employers not to file required documents withthe director;
(13) instructing or encouraging employers to violate theemployee's right to medical benefits under the workers compensation act;
(14) failing to tender promptly full death benefits if a clearand legitimate dispute does not exist as to the liability of theinsurance company, self-insured employer or group-funded self-insuranceplan;
(15) failing to confirm medical compensation benefits coverage to any personor facility providing medical treatment to a claimant if a clearand legitimate dispute does not exist as to the liability of theinsurance carrier, self-insured employer or group-funded self-insuranceplan;
(16) failing to initiate or reinstate compensation when due if aclear and legitimate dispute does not exist as to the liabilityof the insurance company, self-insured employer or group-funded self-insuranceplan;
(17) misrepresenting the reason for not paying compensation orterminating or reducing the payment of compensation;
(18) refusing to pay compensation as and when the compensation isdue;
(19) refusing to pay any order awarding compensation;
(20) refusing to timely file required reports or records under the workerscompensation act, except as provided in K.S.A. 44-557 and amendmentsthereto; and
(21) for a health care provider to submit a charge for health care that wasnot furnished.
(e) Whenever the director or the commissioner of insurance has reason tobelieve that anyperson has engaged or is engaging in any fraudulent orabusive act or practice in connection with the conduct ofKansas workers compensation insurance, claims, benefits orservices in this state,that such fraudulent or abusive act or practice is not subject to possibleproceedings under K.S.A. 40-2401 through 40-2421 and amendments thereto by thecommissioner of insurance,and that a proceeding by the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,withrespect thereto would be in the interest of the public, thedirectoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,shall issue and serve upon such person a summary order or statement ofthe charges with respect thereto and shall conduct a hearing thereon inaccordance with the provisions of the Kansas administrativeprocedure act.Complaints filed with the director or the commissioner of insurance may bedismissed by the director or the commissioner of insurance on their owninitiative, and shall be dismissed upon the written request of the complainant,if the director or commissioner of insurance has not conducted a hearing ortaken other administrative action dismissing the complaint within 180 days ofthe filing of the complaint. Any such dismissal of a complaint in accordancewith this section shall constitute final action by the director or commissionerof insurance which shall be deemed to exhaust all administrative remedies underK.S.A. 44-5,120 and amendments thereto for the purpose of allowing subsequentfiling of the matter in court by the complainant. Dismissal of a complaint inaccordance with this section shall not be subject to appeal or judicialreview.
(f) If, after such hearing, the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,determines that theperson charged has engaged in any fraudulent or abusive act orpractice, any costs incurred as a result of conducting anyadministrative hearing authorized under the provisions of thissection may be assessed against the person or persons found tohave engaged in such acts.In an appropriate case to reimburse costs incurred, such costs may be awardedto a complainant.As used in this subsection, "costs"include witness fees, mileage allowances, any costsassociated with reproduction of documents which become a part ofthe hearing record and the expense of making a record of thehearing.
(g) If, after such hearing, the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,determines that theperson or persons charged have engaged in a fraudulent or abusiveact or practice the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,shall issue an order or summary order requiring suchperson to cease and desist from engaging in such act or practiceand, in the exercise of discretion, may order any one or more ofthe following:
(1) Payment of a monetary penalty of not more than $2,000 foreach and every act constituting the fraudulent or abusive act or practice, butnot exceeding an aggregatepenalty of $20,000 in a one-year period;
(2) redress of the injury by requiring the refund of any premiumspaid by and requiring the payment of any moneys withheld from, anyemployee, employer, insurance company or other person or entityadversely affected by the act constituting a fraudulent or abusive act orpractice;
(3) repayment of an amount equal to the total amount that the personreceived as benefitsor any other payment under the workers compensation act and anyamount that the person otherwise benefited as a result of an act constitutinga fraudulent or abusive act or practice,with interest thereon determined so thatsuch total amount, plus any accrued interest thereon, bearsinterest, from the date of the payment of benefits or other such payment or thedate the person was benefited, at the current rate of interest prescribed bylaw forjudgments under subsection (e)(1) of K.S.A. 16-204 and amendmentsthereto per month or fraction of a month until repayment.
(h) After the expiration of the time allowed for filing apetition for review of an order issued under this section, if no such petitionhas been duly filedwithin such time, the director at any time, after notice andopportunity for hearing in accordance with the provisions of theKansas administrative procedure act, may reopen and alter, modify orset aside, in whole or in part, any order issued under thissection, whenever in the director's opinion conditions of fact orof law have so changed as to require such action or if the publicinterest so requires.
(i) Upon the order of the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,after notice and hearingin accordance with the provisions of the Kansas administrativeprocedure act,any person who violates a cease and desist order of thedirectoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,issued under this section maybe subject, at thediscretion of the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,to a monetary penalty of not more than$10,000 for each and every act or violation, but not exceeding anaggregate penalty of $50,000 for any six-month period in additionto any penalty imposed pursuant to subsection (g).
(j) Any civil fine imposed under this section shall be subject to review inaccordance with the act for judicial review and civil enforcement of agencyactions in the district court in Shawnee county.
(k) All moneys received under this section for costs assessed, which are notawarded to a complainant, or monetary penalties imposedshall be deposited in the state treasury and credited to theworkers compensation fee fund.
(l) Any person who refers a possibly fraudulent or abusive practice to anystate or governmental investigative agency, shall be immune from civil orcriminal liability arising from the supply or release of such referral as longas such referral is made in good faith with the belief that a fraudulent orabusive practice has, is or will occur and said referral is not made by theperson or persons who are in violation of the workers compensation act in orderto avoid criminal prosecution or administrative hearings.
44-5,120.Fraudulent or abusive acts or practices;defined; powers, dutiesand functions of director of workers compensation and commissioner ofinsurance; application of section; administrative investigation andenforcement; hearings; costs; cease and desist orders; civil penalties;repayments, interest; review referrals, immunity.(a) The director of workerscompensation is hereby authorized and directed to establish asystem for monitoring, reporting and investigatingsuspected fraud or abuseby any persons who are not licensed or regulated by the commissioner ofinsurancein connection with securing theliability of an employer under the workers compensation act or inconnection with claims or benefits thereunder.The commissioner of insurance is hereby authorized and directed to establish asystem for monitoring, reporting and investigating suspected fraud or abuse byany persons who are licensed or regulated by the commissioner of insurance inconnection with securing the liability of an employer under the workerscompensation act or in connection with claims thereunder.
(b) This section applies to:
(1) Persons claiming benefits under the workers compensation act;
(2) employers subject to the requirements of the workerscompensation act;
(3) insurance companies including group-funded self-insurance planscovering Kansas employers and employees;
(4) any person, corporation, business, health care facilitythat is organized either for profit or not-for-profit and that renders medicalcare,treatment or servicesinaccordance with the provisions of the workers compensation actto an injured employee who is covered thereunder;and
(5) attorneys and other representatives of employers, employees,insurers or other entities that are subject to the workers compensation act.
(c) The commissioner of insurance may examine the workers compensationrecords ofinsurance companies or self-insurers as necessary to ensurecompliance with the workers compensation act. Each insurance company providingworkers compensation insurance in Kansas, the company'sagents, and those entities that the company has contracted to providereview services or to monitor services and practices under the workerscompensation act shallcooperate with the commissioner of insurance, and shall make available to thecommissioner any records or other necessary information requested by thecommissioner.The commissioner of insuranceshall conduct an examination authorized by this subsection inaccordance with the provisions of K.S.A. 40-222 and40-223 and amendments thereto.
(d) Fraudulent or abusiveacts or practices for purposes of the workers compensation act include,willfully, knowingly or intentionally:
(1) Collecting from an employee, through a deduction from wages or asubsequent fee, anypremium or other fee paid by the employer to obtain workerscompensation insurance coverage;
(2) misrepresenting to an insurancecompany or the insurance department, the classification ofemployees of an employer, or the location, number of employees,or true identity of the employer with the intent to lessen orreduce the premium otherwise chargeable for workers compensationinsurance coverage;
(3) lending money to the claimant during the pendency of theworkers compensation claim by an attorney representing theclaimant, but this provision shall not prohibit the attorney from assistingthe claimant in obtaining financial assistance from anothersource, except that (A) the attorney shall not have a financial interest,directlyor indirectly, in the source from which the loan or other financial assistanceis secured and(B) the attorney shall not be personally liable in any way for the creditextended to the claimant;
(4) obtaining, denying or attempting to obtain or deny paymentsof workers compensation benefits for any person by:
(A) Making a false or misleading statement;
(B) misrepresenting or concealing a material fact;
(C) fabricating, altering, concealing or destroying a document;or
(D) conspiring to commit an act specified by clauses (A),(B) or (C) of this subsection (d)(4);
(5) bringing, prosecuting or defending an action forcompensation under the workers compensation act or requesting initiation of anadministrative violation proceeding that, in either case, has no basis in factoris not warranted by existing law or a good faith argument forthe extension, modification or reversal of existing law;
(6) breaching a provision of anagreement approved by the director;
(7) withholding amounts not authorized by the director from theemployee's or legal beneficiary's weekly compensation payment or fromadvances from any such payment;
(8) entering into a settlement or agreement without the knowledgeand consent of the employee or legal beneficiary;
(9) taking a fee or withholding expenses in excess of the amountsauthorized by the director;
(10) refusing or failing to make prompt delivery to the employeeor legal beneficiary of funds belonging to the employee or legalbeneficiary as a result of a settlement, agreement, order oraward;
(11) misrepresentingthe provisions ofthe workers compensation actto an employee, an employer, ahealth care provider or a legal beneficiary;
(12) instructing employers not to file required documents withthe director;
(13) instructing or encouraging employers to violate theemployee's right to medical benefits under the workers compensation act;
(14) failing to tender promptly full death benefits if a clearand legitimate dispute does not exist as to the liability of theinsurance company, self-insured employer or group-funded self-insuranceplan;
(15) failing to confirm medical compensation benefits coverage to any personor facility providing medical treatment to a claimant if a clearand legitimate dispute does not exist as to the liability of theinsurance carrier, self-insured employer or group-funded self-insuranceplan;
(16) failing to initiate or reinstate compensation when due if aclear and legitimate dispute does not exist as to the liabilityof the insurance company, self-insured employer or group-funded self-insuranceplan;
(17) misrepresenting the reason for not paying compensation orterminating or reducing the payment of compensation;
(18) refusing to pay compensation as and when the compensation isdue;
(19) refusing to pay any order awarding compensation;
(20) refusing to timely file required reports or records under the workerscompensation act, except as provided in K.S.A. 44-557 and amendmentsthereto; and
(21) for a health care provider to submit a charge for health care that wasnot furnished.
(e) Whenever the director or the commissioner of insurance has reason tobelieve that anyperson has engaged or is engaging in any fraudulent orabusive act or practice in connection with the conduct ofKansas workers compensation insurance, claims, benefits orservices in this state,that such fraudulent or abusive act or practice is not subject to possibleproceedings under K.S.A. 40-2401 through 40-2421 and amendments thereto by thecommissioner of insurance,and that a proceeding by the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,withrespect thereto would be in the interest of the public, thedirectoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,shall issue and serve upon such person a summary order or statement ofthe charges with respect thereto and shall conduct a hearing thereon inaccordance with the provisions of the Kansas administrativeprocedure act.Complaints filed with the director or the commissioner of insurance may bedismissed by the director or the commissioner of insurance on their owninitiative, and shall be dismissed upon the written request of the complainant,if the director or commissioner of insurance has not conducted a hearing ortaken other administrative action dismissing the complaint within 180 days ofthe filing of the complaint. Any such dismissal of a complaint in accordancewith this section shall constitute final action by the director or commissionerof insurance which shall be deemed to exhaust all administrative remedies underK.S.A. 44-5,120 and amendments thereto for the purpose of allowing subsequentfiling of the matter in court by the complainant. Dismissal of a complaint inaccordance with this section shall not be subject to appeal or judicialreview.
(f) If, after such hearing, the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,determines that theperson charged has engaged in any fraudulent or abusive act orpractice, any costs incurred as a result of conducting anyadministrative hearing authorized under the provisions of thissection may be assessed against the person or persons found tohave engaged in such acts.In an appropriate case to reimburse costs incurred, such costs may be awardedto a complainant.As used in this subsection, "costs"include witness fees, mileage allowances, any costsassociated with reproduction of documents which become a part ofthe hearing record and the expense of making a record of thehearing.
(g) If, after such hearing, the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,determines that theperson or persons charged have engaged in a fraudulent or abusiveact or practice the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,shall issue an order or summary order requiring suchperson to cease and desist from engaging in such act or practiceand, in the exercise of discretion, may order any one or more ofthe following:
(1) Payment of a monetary penalty of not more than $2,000 foreach and every act constituting the fraudulent or abusive act or practice, butnot exceeding an aggregatepenalty of $20,000 in a one-year period;
(2) redress of the injury by requiring the refund of any premiumspaid by and requiring the payment of any moneys withheld from, anyemployee, employer, insurance company or other person or entityadversely affected by the act constituting a fraudulent or abusive act orpractice;
(3) repayment of an amount equal to the total amount that the personreceived as benefitsor any other payment under the workers compensation act and anyamount that the person otherwise benefited as a result of an act constitutinga fraudulent or abusive act or practice,with interest thereon determined so thatsuch total amount, plus any accrued interest thereon, bearsinterest, from the date of the payment of benefits or other such payment or thedate the person was benefited, at the current rate of interest prescribed bylaw forjudgments under subsection (e)(1) of K.S.A. 16-204 and amendmentsthereto per month or fraction of a month until repayment.
(h) After the expiration of the time allowed for filing apetition for review of an order issued under this section, if no such petitionhas been duly filedwithin such time, the director at any time, after notice andopportunity for hearing in accordance with the provisions of theKansas administrative procedure act, may reopen and alter, modify orset aside, in whole or in part, any order issued under thissection, whenever in the director's opinion conditions of fact orof law have so changed as to require such action or if the publicinterest so requires.
(i) Upon the order of the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,after notice and hearingin accordance with the provisions of the Kansas administrativeprocedure act,any person who violates a cease and desist order of thedirectoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,issued under this section maybe subject, at thediscretion of the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,to a monetary penalty of not more than$10,000 for each and every act or violation, but not exceeding anaggregate penalty of $50,000 for any six-month period in additionto any penalty imposed pursuant to subsection (g).
(j) Any civil fine imposed under this section shall be subject to review inaccordance with the act for judicial review and civil enforcement of agencyactions in the district court in Shawnee county.
(k) All moneys received under this section for costs assessed, which are notawarded to a complainant, or monetary penalties imposedshall be deposited in the state treasury and credited to theworkers compensation fee fund.
(l) Any person who refers a possibly fraudulent or abusive practice to anystate or governmental investigative agency, shall be immune from civil orcriminal liability arising from the supply or release of such referral as longas such referral is made in good faith with the belief that a fraudulent orabusive practice has, is or will occur and said referral is not made by theperson or persons who are in violation of the workers compensation act in orderto avoid criminal prosecution or administrative hearings.
44-5,120.Fraudulent or abusive acts or practices;defined; powers, dutiesand functions of director of workers compensation and commissioner ofinsurance; application of section; administrative investigation andenforcement; hearings; costs; cease and desist orders; civil penalties;repayments, interest; review referrals, immunity.(a) The director of workerscompensation is hereby authorized and directed to establish asystem for monitoring, reporting and investigatingsuspected fraud or abuseby any persons who are not licensed or regulated by the commissioner ofinsurancein connection with securing theliability of an employer under the workers compensation act or inconnection with claims or benefits thereunder.The commissioner of insurance is hereby authorized and directed to establish asystem for monitoring, reporting and investigating suspected fraud or abuse byany persons who are licensed or regulated by the commissioner of insurance inconnection with securing the liability of an employer under the workerscompensation act or in connection with claims thereunder.
(b) This section applies to:
(1) Persons claiming benefits under the workers compensation act;
(2) employers subject to the requirements of the workerscompensation act;
(3) insurance companies including group-funded self-insurance planscovering Kansas employers and employees;
(4) any person, corporation, business, health care facilitythat is organized either for profit or not-for-profit and that renders medicalcare,treatment or servicesinaccordance with the provisions of the workers compensation actto an injured employee who is covered thereunder;and
(5) attorneys and other representatives of employers, employees,insurers or other entities that are subject to the workers compensation act.
(c) The commissioner of insurance may examine the workers compensationrecords ofinsurance companies or self-insurers as necessary to ensurecompliance with the workers compensation act. Each insurance company providingworkers compensation insurance in Kansas, the company'sagents, and those entities that the company has contracted to providereview services or to monitor services and practices under the workerscompensation act shallcooperate with the commissioner of insurance, and shall make available to thecommissioner any records or other necessary information requested by thecommissioner.The commissioner of insuranceshall conduct an examination authorized by this subsection inaccordance with the provisions of K.S.A. 40-222 and40-223 and amendments thereto.
(d) Fraudulent or abusiveacts or practices for purposes of the workers compensation act include,willfully, knowingly or intentionally:
(1) Collecting from an employee, through a deduction from wages or asubsequent fee, anypremium or other fee paid by the employer to obtain workerscompensation insurance coverage;
(2) misrepresenting to an insurancecompany or the insurance department, the classification ofemployees of an employer, or the location, number of employees,or true identity of the employer with the intent to lessen orreduce the premium otherwise chargeable for workers compensationinsurance coverage;
(3) lending money to the claimant during the pendency of theworkers compensation claim by an attorney representing theclaimant, but this provision shall not prohibit the attorney from assistingthe claimant in obtaining financial assistance from anothersource, except that (A) the attorney shall not have a financial interest,directlyor indirectly, in the source from which the loan or other financial assistanceis secured and(B) the attorney shall not be personally liable in any way for the creditextended to the claimant;
(4) obtaining, denying or attempting to obtain or deny paymentsof workers compensation benefits for any person by:
(A) Making a false or misleading statement;
(B) misrepresenting or concealing a material fact;
(C) fabricating, altering, concealing or destroying a document;or
(D) conspiring to commit an act specified by clauses (A),(B) or (C) of this subsection (d)(4);
(5) bringing, prosecuting or defending an action forcompensation under the workers compensation act or requesting initiation of anadministrative violation proceeding that, in either case, has no basis in factoris not warranted by existing law or a good faith argument forthe extension, modification or reversal of existing law;
(6) breaching a provision of anagreement approved by the director;
(7) withholding amounts not authorized by the director from theemployee's or legal beneficiary's weekly compensation payment or fromadvances from any such payment;
(8) entering into a settlement or agreement without the knowledgeand consent of the employee or legal beneficiary;
(9) taking a fee or withholding expenses in excess of the amountsauthorized by the director;
(10) refusing or failing to make prompt delivery to the employeeor legal beneficiary of funds belonging to the employee or legalbeneficiary as a result of a settlement, agreement, order oraward;
(11) misrepresentingthe provisions ofthe workers compensation actto an employee, an employer, ahealth care provider or a legal beneficiary;
(12) instructing employers not to file required documents withthe director;
(13) instructing or encouraging employers to violate theemployee's right to medical benefits under the workers compensation act;
(14) failing to tender promptly full death benefits if a clearand legitimate dispute does not exist as to the liability of theinsurance company, self-insured employer or group-funded self-insuranceplan;
(15) failing to confirm medical compensation benefits coverage to any personor facility providing medical treatment to a claimant if a clearand legitimate dispute does not exist as to the liability of theinsurance carrier, self-insured employer or group-funded self-insuranceplan;
(16) failing to initiate or reinstate compensation when due if aclear and legitimate dispute does not exist as to the liabilityof the insurance company, self-insured employer or group-funded self-insuranceplan;
(17) misrepresenting the reason for not paying compensation orterminating or reducing the payment of compensation;
(18) refusing to pay compensation as and when the compensation isdue;
(19) refusing to pay any order awarding compensation;
(20) refusing to timely file required reports or records under the workerscompensation act, except as provided in K.S.A. 44-557 and amendmentsthereto; and
(21) for a health care provider to submit a charge for health care that wasnot furnished.
(e) Whenever the director or the commissioner of insurance has reason tobelieve that anyperson has engaged or is engaging in any fraudulent orabusive act or practice in connection with the conduct ofKansas workers compensation insurance, claims, benefits orservices in this state,that such fraudulent or abusive act or practice is not subject to possibleproceedings under K.S.A. 40-2401 through 40-2421 and amendments thereto by thecommissioner of insurance,and that a proceeding by the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,withrespect thereto would be in the interest of the public, thedirectoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,shall issue and serve upon such person a summary order or statement ofthe charges with respect thereto and shall conduct a hearing thereon inaccordance with the provisions of the Kansas administrativeprocedure act.Complaints filed with the director or the commissioner of insurance may bedismissed by the director or the commissioner of insurance on their owninitiative, and shall be dismissed upon the written request of the complainant,if the director or commissioner of insurance has not conducted a hearing ortaken other administrative action dismissing the complaint within 180 days ofthe filing of the complaint. Any such dismissal of a complaint in accordancewith this section shall constitute final action by the director or commissionerof insurance which shall be deemed to exhaust all administrative remedies underK.S.A. 44-5,120 and amendments thereto for the purpose of allowing subsequentfiling of the matter in court by the complainant. Dismissal of a complaint inaccordance with this section shall not be subject to appeal or judicialreview.
(f) If, after such hearing, the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,determines that theperson charged has engaged in any fraudulent or abusive act orpractice, any costs incurred as a result of conducting anyadministrative hearing authorized under the provisions of thissection may be assessed against the person or persons found tohave engaged in such acts.In an appropriate case to reimburse costs incurred, such costs may be awardedto a complainant.As used in this subsection, "costs"include witness fees, mileage allowances, any costsassociated with reproduction of documents which become a part ofthe hearing record and the expense of making a record of thehearing.
(g) If, after such hearing, the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,determines that theperson or persons charged have engaged in a fraudulent or abusiveact or practice the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,shall issue an order or summary order requiring suchperson to cease and desist from engaging in such act or practiceand, in the exercise of discretion, may order any one or more ofthe following:
(1) Payment of a monetary penalty of not more than $2,000 foreach and every act constituting the fraudulent or abusive act or practice, butnot exceeding an aggregatepenalty of $20,000 in a one-year period;
(2) redress of the injury by requiring the refund of any premiumspaid by and requiring the payment of any moneys withheld from, anyemployee, employer, insurance company or other person or entityadversely affected by the act constituting a fraudulent or abusive act orpractice;
(3) repayment of an amount equal to the total amount that the personreceived as benefitsor any other payment under the workers compensation act and anyamount that the person otherwise benefited as a result of an act constitutinga fraudulent or abusive act or practice,with interest thereon determined so thatsuch total amount, plus any accrued interest thereon, bearsinterest, from the date of the payment of benefits or other such payment or thedate the person was benefited, at the current rate of interest prescribed bylaw forjudgments under subsection (e)(1) of K.S.A. 16-204 and amendmentsthereto per month or fraction of a month until repayment.
(h) After the expiration of the time allowed for filing apetition for review of an order issued under this section, if no such petitionhas been duly filedwithin such time, the director at any time, after notice andopportunity for hearing in accordance with the provisions of theKansas administrative procedure act, may reopen and alter, modify orset aside, in whole or in part, any order issued under thissection, whenever in the director's opinion conditions of fact orof law have so changed as to require such action or if the publicinterest so requires.
(i) Upon the order of the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,after notice and hearingin accordance with the provisions of the Kansas administrativeprocedure act,any person who violates a cease and desist order of thedirectoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,issued under this section maybe subject, at thediscretion of the directoror the commissioner of insurance, in the case of any person licensed orregulated by the commissioner,to a monetary penalty of not more than$10,000 for each and every act or violation, but not exceeding anaggregate penalty of $50,000 for any six-month period in additionto any penalty imposed pursuant to subsection (g).
(j) Any civil fine imposed under this section shall be subject to review inaccordance with the act for judicial review and civil enforcement of agencyactions in the district court in Shawnee county.
(k) All moneys received under this section for costs assessed, which are notawarded to a complainant, or monetary penalties imposedshall be deposited in the state treasury and credited to theworkers compensation fee fund.
(l) Any person who refers a possibly fraudulent or abusive practice to anystate or governmental investigative agency, shall be immune from civil orcriminal liability arising from the supply or release of such referral as longas such referral is made in good faith with the belief that a fraudulent orabusive practice has, is or will occur and said referral is not made by theperson or persons who are in violation of the workers compensation act in orderto avoid criminal prosecution or administrative hearings.
