Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Jan 06, 2016 |
referred to insurance |
Jan 07, 2015 |
referred to insurance |
Senate Bill S720
2015-2016 Legislative Session
Sponsored By
(D, WF) 33rd Senate District
Archive: Last Bill Status - In Senate Committee Insurance 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
2015-S720 (ACTIVE) - Details
- See Assembly Version of this Bill:
- A3354
- Current Committee:
- Senate Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd ยง3224-b, Ins L
- Versions Introduced in Other Legislative Sessions:
-
2009-2010:
A10850
2011-2012: A1538
2013-2014: S6445, A5145
2017-2018: S1101, A3115
2019-2020: S873, A2899
2021-2022: A870
2015-S720 (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.
2015-S720 (ACTIVE) - Sponsor Memo
BILL NUMBER: S720 TITLE OF BILL : An act to amend the insurance law, in relation to insurer recovery from health care providers PURPOSE OR GENERAL IDEA OF BILL : To enable fair and equitable resolution of allegations by insurers that a health care professional has been overpaid for a benefit claim. SUMMARY OF SPECIFIC PROVISIONS : The bill would amend section 3224-b of the insurance law to prohibit the use of extrapolation to determine amounts overpaid except in instances where there is a reasonable belief of fraud or intentional misconduct, to prohibit threats of retribution against health care professionals who challenge allegations of overpayment, and to require health plans to initiate overpayment proceedings within 12 months (instead of the current 24) of the payment. JUSTIFICATION : In some instances, health plans use the practice of extrapolation of a relatively few claims to determine overpayment amounts that can stretch into tens of thousands, and perhaps even hundreds of thousands, of dollars. Contesting a refund demand is difficult, and
2015-S720 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 720 2015-2016 Regular Sessions I N S E N A T E (PREFILED) January 7, 2015 ___________ Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed 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. Subsection (b) of section 3224-b of the insurance law is amended by adding two new paragraphs 6 and 7 to read as follows: (6) A HEALTH PLAN SHALL NOT DETERMINE AN OVERPAYMENT AMOUNT THROUGH THE USE OF EXTRAPOLATION EXCEPT WITH THE CONSENT OF THE HEALTH CARE PROVIDER, EXCEPT WHERE THERE IS A REASONABLE BELIEF OF FRAUD OR INTEN- TIONAL MISCONDUCT. (7) A HEALTH CARE PLAN MAY NOT THREATEN TO SANCTION A HEALTH CARE PROVIDER INCLUDING A REPORT TO A RELEVANT DISCIPLINARY BODY AS A RESULT OF A HEALTH CARE PROVIDER CHALLENGING AN ALLEGED OVERPAYMENT EXCEPT WHERE THERE IS A REASONABLE BELIEF OF FRAUD OR INTENTIONAL MISCONDUCT. A HEALTH CARE PLAN FOUND TO HAVE VIOLATED THIS PARAGRAPH SHALL BE SUBJECT TO A FINE OF FIFTY THOUSAND DOLLARS PER VIOLATION. 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
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