§ 14409
404 words·~2 min read·
/ca/welfare-and-institutions-code/14409A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)No prepaid health plan, marketing representative, or marketing organization shall in any manner misrepresent itself, the plans it represents, or the Medi-Cal program. A violation of this section shall include, but is not limited to, all of the following:
(1)False or misleading claims that marketing representatives are employees or representatives of the state, county, or anyone other than the prepaid health plan or the organization by whom they are reimbursed.
(2)False or misleading claims that the prepaid health plan is recommended or endorsed by any state or county agency, or by any other organization which has not certified its endorsement in writing to the prepaid health plan.
(3)False or misleading claims that the state or county recommends that a Medi-Cal beneficiary enroll in a prepaid health plan.
(4)Claims that a Medi-Cal beneficiary will lose their benefits under the Medi-Cal program or any other health or welfare benefits to which they are legally entitled, if they do not enroll in a prepaid health plan.
(b)Violations of this article or regulations adopted by the department pursuant to this article shall result in one or more of the following sanctions that are appropriate to the specific violation, considering the nature of the offense and frequency of occurrence within the prepaid health plan:
(1)Revocation of one or more permitted methods of marketing.
(2)Termination of authorization for a plan to provide application assistance.
(3)Refusal of the department to accept new enrollments for a period specified by the department.
(4)Refusal of the department to accept enrollments submitted by a marketing representative or organization.
(5)Forfeiture by the plan of all or part of the capitation payments for persons enrolled as a result of such violations.
(6)Requirement that the prepaid health plan in violation of this article personally contact each enrollee enrolled to explain the nature of the violation and inform the enrollee of their right to disenroll.
(7)Application of sanctions as provided in Section 14197.7.
(8)Temporarily suspend capitation payments for beneficiaries enrolled in violation of this article, or regulations adopted thereunder, until the prepaid health plan is in substantial compliance with the statutory and regulatory requirements.
(c)Any marketing representative who violates subdivision
(a)while engaged in door-to-door solicitation is guilty of a misdemeanor, and shall be subject to a fine of five hundred dollars ($500) or imprisonment in a county jail for six months, or both.