State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_131E > GS_131E-304

§ 131E‑304. Suspension or revocation of license.

(a)        The Division may suspend, revoke, or refuse to renew a PSOlicense if the Division finds that the PSO:

(1)        Is operating significantly in contravention of its basicorganizational document, or in a manner contrary to that described in andreasonably inferred from any other information submitted under G.S. 131E‑280,unless amendments to these submissions have been filed with and approved by theDivision;

(2)        Issues evidences of coverage or uses a schedule of premiumsfor health care services that do not comply with Medicare or Medicaid programrequirements as applicable;

(3)        No longer maintains the financial reserve specified in G.S.131E‑286 or is no longer financially responsible and may reasonably beexpected to be unable to meet its obligations to beneficiaries or prospectivebeneficiaries;

(4)        Knowingly or repeatedly fails or refuses to comply with anylaw or rule applicable to the PSO or with any order issued by the Divisionafter notice and opportunity for a hearing;

(5)        Has knowingly made to the Division any false statement orreport;

(6)        Has sponsoring providers that fail to provide a substantialproportion of the services under any health plan during any 12‑monthperiod;

(7)        Has itself or through any person on its behalf advertised ormerchandised its items or services in an untrue, misrepresentative, misleading,or unfair manner;

(8)        If continuing to operate would be hazardous tobeneficiaries; or

(9)        Has otherwise substantially failed to comply with thisArticle.

(b)        A license shall be suspended or revoked only aftercompliance with G.S. 131E‑305.

(c)        When a PSO license is suspended, the PSO shall not, duringthe suspension, enroll any additional beneficiaries and shall not engage in anyadvertising or solicitation.

(d)        When a PSO license is revoked, the PSO shall proceed,immediately following the effective date of the order of revocation, to wind upits affairs and shall conduct no further business except as may be essential tothe orderly conclusion of the affairs of the PSO. The PSO shall engage in noadvertising or solicitation. The Division may, by written order, permit anyfurther operation of the PSO that the Division may find to be in the bestinterest of beneficiaries, to the end that beneficiaries will be afforded thegreatest practical opportunity to obtain continuing health care coverage. (1998‑227, s. 1.)