Failure to Provide Covered Services Sample Clauses

Failure to Provide Covered Services. If the Department determines that the Contractor has failed to provide, or arrange to provide, a medically necessary service that the Contractor is required to provide under law or this Contract, the Department may (i) impose a sanction of $5,000.00 to $25,000.00, (ii) suspend enrollment of Potential Enrollees with the Contractor, or (iii) impose both sanctions.

Failure to Provide Covered Services. If the Department determines that Contractor has substantially failed to provide, or arrange to provide, a Medically Necessary service that Contractor is required to provide under law or this Contract, the Department may: 7.16.11.1 impose a civil money penalty of $5,000.00 to $25,000.00, 7.16.11.2 suspend enrollment of Potential Enrollees with Contractor, or

Failure to Provide Covered Services. If a member requests a Fair Hearing before TDH because HMO has failed to provide a covered service, the Bureau of Managed Care may recommend to the hearing officer that a determination be made to impose sanctions upon HMO, in addition to any remedy entered for an on behalf of the Member. The recommendation to impose sanctions must include an amount of recommended sanctions. The amount of the sanction may be in any amount of not less than $1,000 or more than $25,000 depending upon the nature of the denial and the hardship or health threat that the denial placed upon the Member.