Decreases amounts of payments wrongfully received for health care fraud

1 Co-sponsor

• Kevin S. Parker

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.