Pending Fraud Legislation

Insurance Fraud - Enacted/Pending/Dead

 

The Coalition Against Insurance Fraud tracks legislation pertaining to insurance fraud. This link will take you their most recent posting.
Additional links will be added as they are identified.

 

Washington State Representatives have recently passed SHB 1103.  The bill has now moved to the Senate Health & Long Term Care Committee.  KUDOS to the State Reps.  This bill is close to becoming a model for the rest of the country.  The bill moves the disciplinary actions from the individual Boards and Commissions to the Secretary of the Department of Health.  The bill still needs a little fine tuning.  We have recommended the following changes:

Sec 7 (11) should also include "insurance carriers." Our premiums are based on the cost of heath care. We are ultimately the "consumer," not the insurance company. We have yet to see a disciplinary action by a Board that REQUIRED restitution to the insurance carrier.

This bill has recently been referred to Health & Long-Term Care in the Senate. We strongly urge your support of this bill. For too long we have seen disciplinary actions by the various Boards and Commissions that are, quite frankly, a joke. Allowing the Boards and Commissions to discipline their peers, is like the wolf guarding the hen house. There is no consistency in disciplinary actions between the Boards and Commissions. Furthermore, if the provider simply makes an "Alfred Plea," he/she gets off with paying $1500 for the cost of the investigation and a slap on the wrist. They may be required to take a "class" or have another provider shadow them...but there is little to no follow up to confirm that these requirements ACTUALLY took place.

These providers are responsible for the PUBLIC health. They should not be given an opportunity to plead out of an investigation, so they can return to their patients to do it all over again. By law, they are allowed to plead (even in a civil investigation), but an appropriate disciplinary action should be made appropriate to the unprofessional conduct committed.

 

Sec 9 (2) should be revised to fully comply with the intent to "ensure quality..." otherwise, this is simply a cop out. It's too easy for the provider to take this deal and walk away! The Department's responsibility is to protect the public, not give the professional an easy deal.

About a year ago, we learned of a case where someone had stolen an identity in order to obtain a nursing license in WA. Some months AFTER the license was issued, it was revoked. However, NO legal action was taken against the person who had stolen the identity (and TREATED patients), just a revocation. How ridiculous!

One further item that needs to be added to this legislation is the requirement that all INSURANCE companies SHALL report. Insurance companies are the first to recognize possible violations of the Unprofessional Conduct statutes. The chiropractic WAC's are currently the only code that requires an insurance company to report.

We have not referenced the current statutes against this bill, so we assume that these statutes would not override the existing statutes that require courts & malpractice insurance carriers to report. If they do, then those statutes should remain intact.

This bill is so close to being a model for the rest of the country. We hope you will consider these changes and support this important legislation.

We'll be following this legislation closely.  Report to follow.

 

NEW YORK Senator Bill Larkin has sponsored S00644 making it a Class E felony to forge an insurance identification card or certificate or to be in possession of a forged identifcation card or certificate with with "knowledge that it is forged and with intent to defraud, deceive or injure another..."   The bill has passed the Senate and has now been referred to the Codes Committee.