Assembly Bill A7590

2023-2024 Legislative Session

Limits the lookback period for insurance overpayment recovery from health care providers to three months

download bill text pdf

Sponsored By

Current 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

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2023-A7590 (ACTIVE) - Details

See Senate Version of this Bill:
S7076
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3224-b, Ins L

2023-A7590 (ACTIVE) - Summary

Limits the lookback period for insurance overpayment recovery from health care providers to three months.

2023-A7590 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7590
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 25, 2023
                                ___________
 
 Introduced by M. of A. LAVINE -- read once and referred to the Committee
   on Insurance
 
 AN  ACT to amend the insurance law, in relation to limiting the lookback
   period for insurance overpayment 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
 to read as follows:
   (3) A health plan shall not initiate overpayment recovery efforts more
 than [twenty-four] THREE 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.
   §  2.  This  act shall take effect on the thirtieth day after it shall
 have become a law.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11372-01-3

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