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Assembly Bill A870

2021-2022 Legislative Session

Relates to insurer recovery from health care providers

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Archive: Last Bill Status - In Assembly Committee

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2021-A870 (ACTIVE) - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3224-b, Ins L
Versions Introduced in Other Legislative Sessions:
2009-2010: A10850
2011-2012: A1538
2013-2014: A5145
2015-2016: A3354
2017-2018: A3115
2019-2020: A2899

2021-A870 (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.

2021-A870 (ACTIVE) - Bill Text download pdf 

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    870
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by M. of A. GOTTFRIED, MAGNARELLI, GALEF, PAULIN, ZEBROWSKI,
   MONTESANO, McDONOUGH, ABINANTI --  Multi-Sponsored  by  --  M.  of  A.
   COLTON,  GLICK,  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. 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.
   § 2. This act shall take effect immediately.
 
 
 
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD00233-01-1

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