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S00873 Summary:

BILL NOS00873
 
SAME ASSAME AS A02899
 
SPONSORRIVERA
 
COSPNSRSEPULVEDA
 
MLTSPNSR
 
Amd 3224-b, Ins L
 
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.
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S00873 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           873
 
                               2019-2020 Regular Sessions
 
                    IN SENATE
 
                                     January 9, 2019
                                       ___________
 
        Introduced by Sens. RIVERA, SEPULVEDA -- 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:
 
     1    Section  1.  Subsection  (b) of section 3224-b of the insurance law is
     2  amended by adding two new paragraphs 6 and 7 to read as follows:
     3    (6) A health plan shall not determine an  overpayment  amount  through
     4  the  use  of  extrapolation  except  with the consent of the health care
     5  provider, except where there is a reasonable belief of fraud  or  inten-
     6  tional misconduct.
     7    (7)  A  health  care  plan  may not threaten to sanction a health care
     8  provider including a report to a relevant disciplinary body as a  result
     9  of  a  health  care  provider  challenging an alleged overpayment except
    10  where there is a reasonable belief of fraud or intentional misconduct. A
    11  health care plan found to have violated this paragraph shall be  subject
    12  to a fine of fifty thousand dollars per violation.
    13    § 2. This act shall take effect immediately.
 
 
 
 
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03433-01-9
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