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Amend SB 418 as follows:
(1) On page 11, insert the following between lines 11 and 12
and renumber subsequent sections accordingly:
(g) A claim by a physician, provider or institutional
provider is not a clean claim if the insurer reasonably and in good
faith believes that it might have been submitted fraudulently. An
insurer may take appropriate measures to detect, investigate,
prevent payment of, and report as required by law, claims that an
insurer in good faith reasonably suspects may be fraudulent in
nature. Claims that in good faith of the insurer fall under
reasonable suspicion of having been submitted fraudulently are not
subject to the other provisions of this section 3C and must be
treated in accordance with the insurer's established anti-fraud
procedures and with state and/or federal laws and regulations
pertaining to the investigation and reporting of suspected
insurance fraud.
(2) On page 26 insert the following between lines 19 and 20:
(h) A claim by a physician, provider or institutional
provider is not a clean claim if the health maintenance
organization reasonably and in good faith believes that it might
have been submitted fraudulently. A health maintenance
organization may take appropriate measures to detect, investigate
prevent payment of, and report as required by law, claims that an
insurer in good faith reasonably suspects may be fraudulent in
nature. Claims that in good faith of the health maintenance
organization fall under reasonable suspicion of having been
submitted fraudulently are not subject to the other provisions of
this chapter and must be treated in accordance with the insurer's
established anti-fraud procedures and with state and/or federal
laws and regulations pertaining to the investigation and reporting
of suspected insurance fraud.