What's happening
This bill prohibits health plans from using extrapolation to determine overpayments without provider consent and bans retaliation against providers who challenge overpayments, except in cases of suspected fraud or intentional misconduct.
Why it matters
Limits insurer power. By banning the use of extrapolation to determine overpayments unless the provider agrees, the bill reduces the ability of health plans to use statistical methods that may overstate how much a provider owes, potentially making audits fairer for providers.
Protects providers from retaliation. The prohibition on health plans threatening sanctions or disciplinary reports against providers who dispute overpayments (unless there’s suspected fraud or intentional misconduct) encourages providers to challenge questionable payment demands without fear of professional harm.
Imposes strong penalties on insurers. The $50,000 fine per violation acts as a significant deterrent against improper retaliation, signaling that the state takes provider protections seriously and that insurers must comply or face costly consequences.
Shifts dispute dynamics. By requiring more concrete evidence (such as actual fraud or intentional misconduct) before insurers can use aggressive tactics, the bill may help rebalance negotiations and disputes, giving providers more leverage in challenging health plan decisions.
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Who cares
Headline styles
Protect Doctors From Insurers
Plain English, a few words. Used as the page title.
Sponsors
10 Co-sponsors
3 Multi-sponsors
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.
Protect Providers From Insurer Threats
In Senate Committee · Insurance · Sponsor Gustavo Rivera
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2899
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
Introduced by M. of A. GOTTFRIED, MAGNARELLI, GALEF, PAULIN, LIFTON, JAFFEE, ZEBROWSKI, MONTESANO, McDONOUGH, ABINANTI, D'URSO -- 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 Assembly, 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 intentional 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.
LBD03433-01-9
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.