Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43A - INDEPENDENT REVIEW ORGANIZATIONS (IROs) › Subchapter B - CERTIFICATION AND REQUIREMENTS FOR INDEPENDENT REVIEW ORGANIZATIONS (IROs) › Section 284-43A-120 - Grounds for action against an applicant or a certified IRO

Current through Register Vol. 24-14, July 15, 2024
(1) The
				commissioner may deny an application for certification, or suspend, revoke, or
				modify certification if the applicant, certified IRO, its agents, officers,
				directors, or any person with any interest:
(a) Makes a misrepresentation of, false
				statement of, or fails to disclose, a material fact to the commissioner. This
				applies to any data attached to any record requested or required by the
				commissioner or matter under investigation or in a self-assessment;
(b) Obtains or attempts to obtain
				certification by fraudulent means or misrepresentation;
(c) Fails or refuses to comply with the
				requirements of
				RCW
				 48.43.537,
				48.43.535(5), or
				this chapter;
(d) Conducts business
				or advertising in a misleading or fraudulent manner;
(e) Refuses to allow the commissioner access
				to records, or fails to promptly produce for inspection any book, record,
				document, or item requested by the commissioner, or willfully interferes with
				an investigation;
(f) Accepts
				referral of cases from the commissioner under
				RCW
				 48.43.535 without certification, or with
				certification which has been terminated, or is subject to sanction;
(g) Was the holder of a license,
				certification, or contract issued by the commissioner or by any competent
				authority in any state, federal, or foreign jurisdiction that was terminated
				for cause and never reissued, or sanctioned for cause and the terms of the
				sanction have not been fulfilled;
(h) Had accreditation from a recognized
				national or state IRO accrediting body that was terminated for cause and never
				reissued, or sanctioned for cause and the terms of the sanction have not been
				fulfilled;
(i) Willfully prevents,
				interferes with, or attempts to impede in any way the work of any
				representative of the commissioner and the lawful enforcement of any provision
				of this chapter. This includes, but is not limited to: Willful
				misrepresentation of facts during an investigation, or administrative
				proceeding, or any other legal action; or use of threats or harassment against
				any patient, client, customer, or witness; or use of financial inducements to
				any patient, client, customer, or witness to prevent or attempt to prevent him
				or her from providing evidence during an investigation, in an administrative
				proceeding, or any other legal action involving the commissioner;
(j) Willfully prevents or interferes with any
				commissioner representative in the preservation of evidence;
(k) Misrepresented or was fraudulent in any
				aspect of the conduct of business;
(l) Within the last five years, has been
				found in a civil or criminal proceeding to have committed any act that
				reasonably relates to the person's fitness to establish, maintain, or
				administer an IRO;
(m) Violates any
				state or federal statute, or administrative rule regulating the IRO;
(n) Fails to comply with an order issued by
				the insurance commissioner or designee;
(o) Uses interference, coercion,
				discrimination, reprisal, or retaliation against a patient, client, or customer
				exercising his or her rights;
(p)
				Offers, gives, or promises anything of value or benefit to any federal, state,
				or local employee or official for the purpose of influencing that employee or
				official to circumvent federal, state, or local laws, regulations, or
				ordinances governing the certification holder or applicant.