N.Y. Pub. Health Law § 4414
Health care compliance programs
Redline — January 1, 2015 → current.View current text →
Current — January 1, 2021
As of January 1, 2015
§ 4414. Health care compliance programs. The commissioner of health,\nafter consultation with the superintendent of financial services, shall\nby regulation establish standards and criteria for compliance programs\nto be implemented by persons providing coverage or coverage and service\npursuant to any public or governmentally-sponsored or supported plan for\nhealth care coverage or services. Such regulations shall include\nprovisions for the design and implementation of programs or processes to\nprevent, detect and address instances of fraud and abuse. Such\nregulations shall take into account the nature of the entity's business\nand the size of its enrolled population. The commissioner of health and\nthe superintendent of financial services shall accept programs and\nprocesses implemented pursuant to section four hundred nine of the\ninsurance law as satisfying the obligations of this section and the\nregulations promulgated thereunder when such programs and processes\nincorporate the objectives contemplated by this section.\n
§ 4414. Health care compliance programs. 1. The commissioner, after\nconsultation with the superintendent of financial services, shall by\nregulation establish standards and criteria for compliance programs to\nbe implemented by persons providing coverage or coverage and service\npursuant to any public or governmentally-sponsored or supported plan for\nhealth care coverage or services. Such regulations shall include\nprovisions for the design and implementation of programs or processes to\nprevent, detect and address instances of fraud and abuse. Such\nregulations shall take into account the nature of the entity's business\nand the size of its enrolled population. The commissioner and the\nsuperintendent of financial services shall accept programs and processes\nimplemented pursuant to section four hundred nine of the insurance law\nas satisfying the obligations of this section and the regulations\npromulgated thereunder when such programs and processes incorporate the\nobjectives contemplated by this section.\n 2. Notwithstanding any provisions of section twelve of this chapter to\nthe contrary, penalties collected from any health maintenance\norganization certified pursuant to this article resulting from a\nviolation of the health maintenance organization's mental health and\nsubstance use disorder parity compliance program shall be deposited into\nthe behavioral health parity compliance fund as established pursuant to\nsection ninety-nine-hh of the state finance law.\n
Official source: NYS Open Legislation (New York State Senate). Reproduced from public-domain New York statutes; confirm against the official source for the current text. Not legal advice.