CHAPTER 167


97-H 6271 am
Approved Jul. 3, 1997


AN ACT RELATING TO INSURANCE -- HEALTH INSURANCE

It is enacted by the General Assembly as follows

SECTION 1. Chapter 27-18 of the General Laws entitled 'Accide nt and Sickness Insurance' is hereby amended by adding thereto the following sections:

{ADD 27-18-45. Whistleblowers protection. -- ADD} {ADD No accident and sickness insurer pursuant to this chapter or any other insurer offering and/or insuring health services on a prepaid basis as defined in section 42-62-4(g) shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state. ADD}

{ADD 27-18-46. Penalties and remedies. -- ADD} {ADD (a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of section 27-18-45 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one (1) year, or by both such fine and imprisonment.

(b) In addition, to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall wilfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each such violation, and each violation shall constitute a separate and distinct offense under this section. ADD}

{ADD 27-18-47. Additional relief and damages -- Reinstatement. -- ADD} {ADD (a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.

(b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.

(c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement. ADD}

SECTION 2. Chapter 27-19 of the General Laws entitled 'Nonprof it Hospital Service Corporations' is hereby amended by adding thereto the following sections:

{ADD 27-19-37. Whistleblowers protection. -- ADD} {ADD No nonprofit hospital service corporation pursuant to this chapter or any other insurer offering and/or insuring health services on a prepaid basis as defined in section 42-62-4(g) shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state. ADD}

{ADD 27-19-38. Penalties and remedies. -- ADD} {ADD (a) Any person, fir m, corporation, association or other legal entity who or which shall violate the provisions of section 27-19-37 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one (1) year, or by both such fine and imprisonment.

(b) In addition, to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall wilfully or negligently violate any provision of this chapter shall be subject t o a civil penalty, to be assessed by the insurance commissioner, in th e maximum amount of five thousand dollars ($5,000) for each such violation, and each violation shall constitute a separate and distin ct offense under this section. ADD}

{ADD 27-19-39. Additional relief and damages -- Reinstatement. -- ADD} {ADD (a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.

(b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.

(c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of th e provider agreement. ADD}

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprof it Medical Service Corporations" is hereby amended by adding thereto th e following sections:

{ADD 27-20-32. Whistleblowers protection. -- ADD} {ADD No nonprofit medical service corporation pursuant to this chapter or any other insurer offering and/or insuring health services on a prepaid basis as defined in section 42-62-4(g) shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify th e terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state. ADD}

{ADD 27-20-33. Penalties and remedies. -- ADD} {ADD (a) Any person, fir m, corporation, association or other legal entity who or which shall violate the provisions of section 27-20-32 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one (1) year, or by both such fine and imprisonment.

(b) In addition, to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall wilfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each such violation, and each violation shall constitute a separate and distinct offense under this section. ADD}

{ADD 27-20-34. Additional relief and damages -- Reinstatement. -- ADD} {ADD (a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.

(b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.

(c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement. ADD}

SECTION 4. Chapter 27-41 of the General Laws entitled Maintenance Organizations' is hereby amended by adding thereto the following sections:

{ADD 27-41-46. Whistleblowers protection. -- ADD} {ADD No health maintenance organizations pursuant to this chapter or any other insurer offering and/or insuring health services on a prepaid basis as defined in section 42-62-4(g) shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state. ADD}

{ADD 27-41-47. Penalties and remedies. -- ADD} {ADD (a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of section 27-41-46 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one (1) year, or by both such fine and imprisonment.

(b) In addition, to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall wilfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each such violation, and each violation shall constitute a separate and distinct offense under this section. ADD}

{ADD 27-41-48. Additional relief and damages -- Reinstatement. -- ADD} {ADD (a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.

(b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.

(c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement. ADD}

SECTION 5. This act shall take effect upon passage.



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