State of Vermont

Department of Financial Regulation

89 Main Street

Montpelier, VT 05620-3101

For consumer assistance:

[Banking] 888-568-4547

[Insurance] 800-964-1784

[Securities] 877-550-3907

www.dfr.vermont.gov

Insurance Bulletin No. 211

COVID-19

Suspension of Routine Provider Audits by Insurers

Revised: March 20, 2020

This bulletin is intended to ensure that healthcare providers are able to focus attention on providing care to Vermonters during the COVID-19 pandemic, rather than responding to routine audits.

In light of the emergent nature of COVID-19's spread, the Commissioner is taking this action under 8 V.S.A. § 11(a)(2) and 18 V.S.A. § 9401(a) to ensure that all members of health insurance plans regulated by the Department have access to the care they need, and that providers are able to focus as fully as possible on providing that care.

Therefore, effective immediately, the Department is directing insurers and pharmacy benefit managers (PBMs) to suspend all routine provider audits. Insurers and PBMs remain able to conduct audits to prevent and detect ongoing fraud or other current activities that may violate Vermont statutes or regulations.

Healthcare providers, insurers, and PBMs with questions about this bulletin are encouraged to reach out to Christina Rouleau, Director of Market Conduct, or Phil Keller, Director of Insurance Regulation.

This bulletin expresses the view of the Commissioner until May 13, 2020 unless extended or modified by the Commissioner.

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Michael S. Pieciak, Commissioner

March 20, 2020

Date