Relates to the determination of overpayment recovery amounts for health care providers; provides certain requirements be met when the process known as extrapolation will be used.
STATE OF NEW YORK
________________________________________________________________________
2303
2015-2016 Regular Sessions
IN SENATE
January 22, 2015
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to determination of over-
payments to health care providers by extrapolation
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 2 of subsection (b) of section 3224-b of the
2 insurance law, as amended by chapter 237 of the laws of 2009, is amended
3 to read as follows:
4 (2) A health plan shall provide a health care provider with the oppor-
5 tunity to challenge an overpayment recovery, including the sharing of
6 claims information, and shall establish written policies and procedures
7 for health care providers to follow to challenge an overpayment recov-
8 ery. Such challenge shall set forth the specific grounds on which the
9 provider is challenging the overpayment recovery. In the event that the
10 process known as extrapolation will be used in determining whether
11 health care providers have received overpayments from a health care
12 plan, the health care plan shall comply with the following requirements:
13 (A) advise the health care provider with written notice that extrapo-
14 lation will be utilized;
15 (B) apply a valid statistical methodology that uses stratified random
16 sampling methods to assure a fair evaluation of the claims subject to
17 audit;
18 (C) advise the health care provider as to the type of methodology
19 used;
20 (D) provide the health care provider sixty business days to appeal the
21 audit findings; and
22 (E) in the event of an appeal of the audit findings, the health care
23 provider may seek a review of the findings by a mutually agreed upon
24 independent third party auditor. The cost of a third party review shall
25 be shared equally between the parties.
26 § 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03090-01-5
