senate Bill S1659

Decreases amounts of payments wrongfully received for health care fraud

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Co-Sponsors

Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 11 / Jan / 2011
    • REFERRED TO CODES
  • 04 / Jan / 2012
    • REFERRED TO CODES
  • 15 / May / 2012
    • 1ST REPORT CAL.765
  • 16 / May / 2012
    • 2ND REPORT CAL.
  • 21 / May / 2012
    • ADVANCED TO THIRD READING
  • 21 / Jun / 2012
    • PASSED SENATE
  • 21 / Jun / 2012
    • DELIVERED TO ASSEMBLY
  • 21 / Jun / 2012
    • REFERRED TO CODES

Summary

Decreases certain amounts of payments wrongfully received that would trigger higher degrees of the crime of health care fraud.

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Bill Details

Versions:
S1659
Legislative Cycle:
2011-2012
Current Committee:
Assembly Codes
Law Section:
Penal Law
Laws Affected:
Amd ยงยง177.10, 177.15, 177.20 & 177.25, Pen L
Versions Introduced in Previous Legislative Cycles:
2009-2010: S111
2007-2008: S7275

Sponsor Memo

BILL NUMBER:S1659

TITLE OF BILL:
An act
to amend the penal law, in relation to health care fraud

PURPOSE:
The purpose of this bill is to decrease the amount of wrongfully
received payments needed to trigger higher statutory criminal
classification.

SUMMARY OF PROVISIONS:
Section 177.10 of the penal law is amended from $3,000 to $1,000.
Section 177.15 of the penal law is amended from $10,000 to $5,000
Section 177.20 of the penal law is amended from $50,000 to $25,000
Section 177.25 of the penal law is amended from $1 million to $500,000

EXISTING LAW:
The current amount of fraud required for health care fraud in the 4th
degree through 1st degree is $3,000; $10,000; $50,000 and $1 million
respectively.

JUSTIFICATION:
The current dollar amounts required to trigger higher degrees of the
crime of health care fraud are unacceptably high. New York must not
tolerate the loss of health care funding to fraud. Nor should we as a
State allow lenient treatment of individuals who view health care
fraud as a "business". According to the National Health Care
Anti-Fraud Association, health care fraud costs the United States
approximately $94 billion in 2004 alone. One estimate indicated that
health care fraud costs every man, woman and child in the United
States $11 per week or $550 per year. New York must make every effort
to reduce health care fraud. Reducing fraud will reduce health care
costs. Even one fraudulently submitted claim or one bill for services
never performed is too many. Under the current system of law, a
physician who charges $200 per visit for patients he/she never
actually sees could submit 14 fraudulent claims before triggering the
higher level crime contained in section 177.10.

Under this hypothetical example, the claims would not only cost money
but would cost insurance companies, Medicare, Medicaid etc" time and
resources investigating and processing these bogus claims, Other
crimes involving theft such as grand larceny are triggered at $1,000,
Theft of health care funds and services should not be treated
differently.

LEGISLATIVE HISTORY:
S.7275 of 2008
03/26/08 Referred to Codes
S.111 of 2009
01/07/09 REFERRED TO CODES
01/06/10 REFERRED TO CODES

FISCAL IMPLICATIONS:
None.


LOCAL FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1659

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 11, 2011
                               ___________

Introduced  by  Sen. SAMPSON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Codes

AN ACT to amend the penal law, in relation to health care fraud

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 177.10 of the penal law, as added by chapter 442 of
the laws of 2006, is amended to read as follows:
S 177.10 Health care fraud in the fourth degree.
  A person is guilty of health care fraud in the fourth degree when such
person, on one or more occasions, commits the crime of health care fraud
in the fifth degree and the payment or portion of the payment wrongfully
received,  as the case may be, from a single health plan, in a period of
not more than one year, exceeds [three]  ONE  thousand  dollars  in  the
aggregate.
  Health care fraud in the fourth degree is a class E felony.
  S  2.  Section 177.15 of the penal law, as added by chapter 442 of the
laws of 2006, is amended to read as follows:
S 177.15 Health care fraud in the third degree.
  A person is guilty of health care fraud in the third degree when  such
person, on one or more occasions, commits the crime of health care fraud
in the fifth degree and the payment or portion of the payment wrongfully
received,  as the case may be, from a single health plan, in a period of
not more than one year, exceeds  [ten]  FIVE  thousand  dollars  in  the
aggregate.
  Health care fraud in the third degree is a class D felony.
  S  3.  Section 177.20 of the penal law, as added by chapter 442 of the
laws of 2006, is amended to read as follows:
S 177.20 Health care fraud in the second degree.
  A person is guilty of health care fraud in the second degree when such
person, on one or more occasions, commits the crime of health care fraud
in the fifth degree and the payment or portion of the payment wrongfully

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05879-01-1

S. 1659                             2

received, as the case may be, from a single health plan, in a period  of
not  more than one year, exceeds [fifty] TWENTY-FIVE thousand dollars in
the aggregate.
  Health care fraud in the second degree is a class C felony.
  S  4.  Section 177.25 of the penal law, as added by chapter 442 of the
laws of 2006, is amended to read as follows:
S 177.25 Health care fraud in the first degree.
  A person is guilty of health care fraud in the first degree when  such
person, on one or more occasions, commits the crime of health care fraud
in the fifth degree and the payment or portion of the payment wrongfully
received,  as the case may be, from a single health plan, in a period of
not more than one year, exceeds  [one  million]  FIVE  HUNDRED  THOUSAND
dollars in the aggregate.
  Health care fraud in the first degree is a class B felony.
  S 5. This act shall take effect immediately.

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