KRS 304.99-123: Penalties for noncompliance with KRS 304.17A-700 to 304.17A-730 and

KRS 205.593, 304.14-135, 304.99-123, and other statutes.

(1) In addition to any other penalty or remedy authorized by law, the department may

assess the following fines for noncompliance with KRS 304.17A -700 to 304.17A -

730 and KRS 205.593, 304.14-135, and 304.99-123:

(a) A fine of one thousand dollars ($1,000) per day or ten percent (10%) of the

unpaid claim amount, whichever is greater, for each day that a clean claim

remains unpaid in violation of KRS 304.17A -700 to 304.17A -730 and KRS

205.593, 304.14-135, and 304.99-123; and

(b) Except for the late payment of claims under subsection (2) of this section, a

fine of up to ten thousand dollars ($10,000) where the commissioner

determines that an insurer has willfully and knowingly violated KRS

304.17A-700 to 304.17A-730 and KRS 205.593, 304.14 -135, and 304.99-123

or has a pattern of repeated violations of KRS 304.17A -700 to 304.17A -730

and KRS 205.593, 304.14-135, and 304.99-123.

(2) For purposes of subsection (1)(a) and (3) of this section, an insurer is in compliance

when:

(a) Ninety-five percent (95%) of the clean claims received by the insurer, its

agent, or designee during each calendar quarter, excluding pharmaceutical

claims, were adjudicated within the claims payment timeframes in accordance

with KRS 304.17A-702; and

(b) At least ninety percent (90%) of the total dollar amount for clean claims

received by the insurer, its agent, or designee during each calendar quarter,

excluding pharmaceutical claims, that were not denied or contested, was paid

within the claims payment timeframes established in KRS 304.17A-702.

(3) In addition to any other penalty or remedy authorized by law, the department may

assess the fines authorized by subsection (1) of this section against any Medicaid

managed care organization, as defined in KRS 205.532, for noncompliance with

KRS 304.17A -700 to 304.17A -730, 205.593, and 304.14 -135 and KRS 205.522,

205.532 to 205.536, and 304.17A-515.