Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Jan 04, 2012 |
referred to insurance |
Jan 10, 2011 |
referred to insurance |
Assembly Bill A1538
2011-2012 Legislative Session
Sponsored By
GOTTFRIED
Archive: Last Bill Status - In Assembly Committee
- Introduced
-
- In Committee Assembly
- In Committee Senate
-
- On Floor Calendar Assembly
- On Floor Calendar Senate
-
- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
co-Sponsors
Charles Lavine
William Magnarelli
Sandy Galef
Daniel Burling
multi-Sponsors
William Colton
Deborah Glick
George Latimer
John McEneny
2011-A1538 (ACTIVE) - Details
2011-A1538 (ACTIVE) - Summary
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.
2011-A1538 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 1538 2011-2012 Regular Sessions I N A S S E M B L Y January 10, 2011 ___________ Introduced by M. of A. GOTTFRIED, LAVINE, MAGNARELLI, GALEF, BURLING, PAULIN, JACOBS, SCHIMEL, HIKIND, LIFTON, JAFFEE, ZEBROWSKI, MONTESANO, McDONOUGH, LANCMAN, SCARBOROUGH -- Multi-Sponsored by -- M. of A. GLICK, McENENY, PHEFFER, REILLY, SWEENEY, 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: Section 1. Paragraph 3 of subsection (b) of section 3224-b of the insurance law, as amended by chapter 237 of the laws of 2009, is amended and two new paragraphs 6 and 7 are added to read as follows: (3) A health plan shall not initiate overpayment recovery efforts more than [twenty-four] TWELVE months after the original payment was received by a health care provider. However, no such time limit shall apply to overpayment recovery efforts that are: (i) based on a reasonable belief of fraud or other intentional misconduct[, or abusive billing], (ii) required by, or initiated at the request of, a self-insured plan, or (iii) required or authorized by a state or federal government program or coverage that is provided by this state or a municipality thereof to its respective employees, retirees or members. Notwithstanding the aforemen- tioned time limitations, in the event that a health care provider asserts that a health plan has underpaid a claim or claims, the health plan may defend or set off such assertion of underpayment based on over- payments going back in time as far as the claimed underpayment. [For purposes of this paragraph, "abusive billing" shall be defined as a billing practice which results in the submission of claims that are not consistent with sound fiscal, business, or medical practices and at such frequency and for such a period of time as to reflect a consistent course of conduct.] EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05377-01-1
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