Bill S1659-2011

Decreases amounts of payments wrongfully received for health care fraud

Decreases certain amounts of payments wrongfully received that would trigger higher degrees of the crime of health care fraud.

Details

Actions

  • Jun 21, 2012: referred to codes
  • Jun 21, 2012: DELIVERED TO ASSEMBLY
  • Jun 21, 2012: PASSED SENATE
  • May 21, 2012: ADVANCED TO THIRD READING
  • May 16, 2012: 2ND REPORT CAL.
  • May 15, 2012: 1ST REPORT CAL.765
  • Jan 4, 2012: REFERRED TO CODES
  • Jan 11, 2011: REFERRED TO CODES

Meetings

Calendars

Votes

VOTE: COMMITTEE VOTE: - Codes - May 15, 2012
Ayes (14): Saland, DeFrancisco, Flanagan, Fuschillo, Gallivan, Lanza, Nozzolio, O'Mara, Gianaris, Huntley, Parker, Perkins, Squadron, Espaillat
Ayes W/R (1): Duane
Nays (1): Golden

Memo

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.


Text

STATE OF NEW YORK ________________________________________________________________________ 1659 2011-2012 Regular Sessions IN SENATE January 11, 2011 ___________
Introduced by Sen. SAMPSON -- read twice and ordered printed, and when printed to be committed to the Committee on Codes AN ACT to amend the penal law, in relation to health care fraud THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 177.10 of the penal law, as added by chapter 442 of the laws of 2006, is amended to read as follows: S 177.10 Health care fraud in the fourth degree. A person is guilty of health care fraud in the fourth degree when such person, on one or more occasions, commits the crime of health care fraud in the fifth degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds [three] ONE thousand dollars in the aggregate. Health care fraud in the fourth degree is a class E felony. S 2. Section 177.15 of the penal law, as added by chapter 442 of the laws of 2006, is amended to read as follows: S 177.15 Health care fraud in the third degree. A person is guilty of health care fraud in the third degree when such person, on one or more occasions, commits the crime of health care fraud in the fifth degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds [ten] FIVE thousand dollars in the aggregate. Health care fraud in the third degree is a class D felony. S 3. Section 177.20 of the penal law, as added by chapter 442 of the laws of 2006, is amended to read as follows: S 177.20 Health care fraud in the second degree. A person is guilty of health care fraud in the second degree when such person, on one or more occasions, commits the crime of health care fraud in the fifth degree and the payment or portion of the payment wrongfully
received, as the case may be, from a single health plan, in a period of not more than one year, exceeds [fifty] TWENTY-FIVE thousand dollars in the aggregate. Health care fraud in the second degree is a class C felony. S 4. Section 177.25 of the penal law, as added by chapter 442 of the laws of 2006, is amended to read as follows: S 177.25 Health care fraud in the first degree. A person is guilty of health care fraud in the first degree when such person, on one or more occasions, commits the crime of health care fraud in the fifth degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds [one million] FIVE HUNDRED THOUSAND dollars in the aggregate. Health care fraud in the first degree is a class B felony. S 5. This act shall take effect immediately.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Discuss!

blog comments powered by Disqus