Bill Text: NY A03354 | 2015-2016 | General Assembly | Introduced

New York Assembly Bill 3354 (Prior Session Legislation)

Introduced

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 14-2)

Status: (Introduced - Dead) 2016-01-06 - referred to insurance [A03354 Detail]

Download: New_York-2015-A03354-Introduced.html

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         3354
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 22, 2015
                                      ___________
       Introduced  by  M.  of  A. GOTTFRIED, LAVINE, MAGNARELLI, GALEF, PAULIN,
         SCHIMEL, HIKIND,  LIFTON,  JAFFEE,  ZEBROWSKI,  MONTESANO,  McDONOUGH,
         SCARBOROUGH,  BROOK-KRASNY  --  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    S 2. This act shall take effect immediately.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD03132-01-5