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Who cares
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Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Relates to insurer recovery from health care providers
In Assembly Committee · Insurance · Sponsor Richard Gottfried
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to insurer recovery from health care providers
Purpose or general idea of bill
To enable fair and equitable resolution of allegations by insurers that a health care professional has been overpaid for a benefit claim.
Summary of specific provisions
The bill would amend section 3224-b of the insurance law to prohibit the use of extrapolation to determine amounts overpaid except in instances where there is a reasonable belief of fraud or intentional misconduct, to prohibit threats of retribution against health care professionals who challenge allegations of overpayment, and to require health plans to initiate overpayment proceedings within 12 months (instead of the current 24) of the payment.
Justification
In some instances, health plans use the practice of extrapolation of a relatively few claims to determine overpayment amounts that can stretch into tens of thousands, and perhaps even hundreds of thousands, of dollars. Contesting a refund demand is difficult, and results in extraordinary legal and other expert costs. As a result, health care providers are often intimidated into settling the dispute. It can be burdensome and harassing to require a physician to defend bills submitted and paid two years back. Health plans should act expeditiously if they have reasonable demands for recouping overpayments.
Prior legislative history
2010: A.10850 - referred to Insurance Committee 2011-2012: A.1538 - referred to Insurance Committee
Fiscal implications
None.
Effective date
Immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.