Bill Text: NY A03115 | 2017-2018 | General Assembly | Introduced

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Bill Title: Relates to insurer recovery from health care providers; provides that except where there is a reasonable belief of fraud or intentional misconduct, a health plan shall not determine an overpayment amount through the use of extrapolation except with the consent of the health care provider.

Spectrum: Moderate Partisan Bill (Democrat 15-2)

Status: (Introduced - Dead) 2018-01-03 - referred to insurance [A03115 Detail]

Download: New_York-2017-A03115-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          3115
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                    January 26, 2017
                                       ___________
        Introduced  by  M.  of  A. GOTTFRIED, MAGNARELLI, GALEF, PAULIN, HIKIND,
          LIFTON, JAFFEE, ZEBROWSKI, MONTESANO, McDONOUGH,  SEPULVEDA,  ABINANTI
          --  Multi-Sponsored  by -- M. of A. COLTON, GLICK, McDONALD, THIELE --
          read once and referred to the Committee on Insurance
        AN ACT to amend the insurance law, in relation to insurer recovery  from
          health care providers
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Subsection (b) of section 3224-b of the  insurance  law  is
     2  amended by adding two new paragraphs 6 and 7 to read as follows:
     3    (6)  A  health  plan shall not determine an overpayment amount through
     4  the use of extrapolation except with the  consent  of  the  health  care
     5  provider,  except  where there is a reasonable belief of fraud or inten-
     6  tional misconduct.
     7    (7) A health care plan may not threaten  to  sanction  a  health  care
     8  provider  including a report to a relevant disciplinary body as a result
     9  of a health care provider  challenging  an  alleged  overpayment  except
    10  where there is a reasonable belief of fraud or intentional misconduct. A
    11  health  care plan found to have violated this paragraph shall be subject
    12  to a fine of fifty thousand dollars per violation.
    13    § 2. This act shall take effect immediately.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01013-01-7