S T A T E O F N E W Y O R K
________________________________________________________________________
3342
2009-2010 Regular Sessions
I N A S S E M B L Y
January 27, 2009
___________
Introduced by M. of A. BRADLEY, DelMONTE, BING, FIELDS, GUNTHER, GALEF,
BENEDETTO, CLARK, MAGNARELLI, SCHIMEL -- Multi-Sponsored by -- M. of
A. BOYLAND, BRENNAN, COLTON, GOTTFRIED, JEFFRIES, KOON, LATIMER, McEN-
ENY, PERRY, SWEENEY, WEISENBERG -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to overpayments to 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 a new paragraph 2-a to read as follows:
(2-A) IF A PROVIDER OF A HEALTH CARE PLAN ALLEGES FRAUD OR OTHER
INTENTIONAL MISCONDUCT, OR ABUSIVE BILLING TO SEEK RECOVERY OF AN OVER-
PAYMENT PURSUANT TO PARAGRAPH TWO OF THIS SUBSECTION MORE THAN
TWENTY-FOUR MONTHS AFTER THE ORIGINAL PAYMENT WAS RECEIVED BY THE HEALTH
CARE PROVIDER, AND IT IS FOUND THAT SUCH PAYMENT OR PAYMENTS IN DISPUTE
WERE NOT THE RESULT OF FRAUD OR OTHER INTENTIONAL MISCONDUCT OR ABUSIVE
BILLING, SUCH PROVIDER OF THE HEALTH CARE PLAN SHALL BE RESPONSIBLE FOR
THE REASONABLE LEGAL FEES OF THE HEALTH CARE PROVIDER CONNECTED WITH THE
DEFENSE OF THE ALLEGATIONS THAT THERE WAS AN OVERPAYMENT. THE DEPARTMENT
SHALL FINE ANY PROVIDER OF A HEALTH CARE PLAN FOUND TO HAVE KNOWINGLY,
WILLFULLY OR RECKLESSLY MADE FALSE CHARGES UNDER THIS SECTION IN AN
AMOUNT OF UP TO FIVE THOUSAND DOLLARS PER PAYMENT THAT IS FALSELY
CHARGED TO HAVE BEEN THE RESULT OF FRAUD OR OTHER INTENTIONAL MISCONDUCT
OR ABUSIVE BILLING.
S 2. This act shall take effect immediately.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03361-01-9
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