MSSNY Joins with Patient and Provider Groups to Reduce Health Insurer Audit Abuse
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MSSNY has joined with several other provider and patient advocacy groups in support of legislation (A.3365, Lavine/S.5209, Scarcella-Spanton) to substantially reduce the time frame for health insurance plans to recoup payments made to physicians and other health care providers for patient care delivered. This legislation would help to reduce the unfair circumstances where a physician is left without recourse for payment when a health insurer demands repayment long after the time that care was provided alleging that the patient was not insured at the time of service.
The bill would also importantly help to reduce the gamesmanship and abusive audits that have been long been a tactic by some health plans and their third party recover contractors, where physicians receive demands to pay back hundreds of thousands of dollars based upon review and extrapolation of but a few past paid claims over several years. The longer the time has elapsed since care was provided and payment made, the harder it is to fight the allegation. These abusive and intimidating audit tactics, which can cost a physician tens of thousands of dollars in legal fees to fight, can have the effect of driving physicians out of community patient care and must be stopped.
We thank Assembly member Lavine and Senator Scarcella-Spanton for advancing this important legislation. The bill has been referred to the Assembly and Senate Insurance Committees.
