S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  3354

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            January 22, 2015
                               ___________

Introduced  by  M.  of  A. GOTTFRIED, LAVINE, MAGNARELLI, GALEF, PAULIN,
  SCHIMEL, HIKIND,  LIFTON,  JAFFEE,  ZEBROWSKI,  MONTESANO,  McDONOUGH,
  SCARBOROUGH,  BROOK-KRASNY  --  Multi-Sponsored by -- M. of A. COLTON,
  GLICK, McDONALD, 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  ASSEM-
BLY, 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  INTEN-
TIONAL 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.
  S 2. This act shall take effect immediately.




 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03132-01-5