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.
STATE OF NEW YORK
________________________________________________________________________
2899
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
___________
Introduced by M. of A. GOTTFRIED, MAGNARELLI, GALEF, PAULIN, LIFTON,
JAFFEE, ZEBROWSKI, MONTESANO, McDONOUGH, ABINANTI, D'URSO -- Multi-
Sponsored by -- M. of A. COLTON, GLICK, 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.
LBD03433-01-9
