12.3.3 Unfair Trade Practice Activities by HMOs
Florida defines the following as unfair trade practice activities by HMOs.
- Misrepresentation and false information*
- False advertising
- Defamation
- False statements and entries
- Unfair claim settlement practices**
- Failure to maintain claim handling procedures
- Operating without a subsisting certificate of authority
- Twisting
- Illegal dealing in premiums
- False claims and obtaining money dishonestly
- Prohibited discriminatory practices
- Misrepresentation in availability of providers
- Adverse action against a provider
The penalties in Florida for violating the Unfair Trade Practices Act are probation, suspension, or revocation of licensure or HMO Certificate of Authority and a fine up to $200,000. If the infraction is a criminal violation, penalties can result in imprisonment.
*What is meant by "misrepresentation in HMO applications?"
**What is an example of an "unfair claim settlement practice?"
