HF 2316

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to commerce; health-related boards;
regulating insurance fraud investigations; regulating
excessive claims; providing practice standards for
no-fault auto injuries; providing for a no-fault
insurance medical cost study; amending Minnesota
Statutes 2004, section 45.0135, by adding a
subdivision; proposing coding for new law in Minnesota
Statutes, chapter 65B.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2004, section 45.0135, is
amended by adding a subdivision to read:

new text begin Subd. 8. new text end

new text begin Investigations; health-related boards. new text end

new text begin (a) The
Division of Insurance Fraud Prevention shall consult with the
appropriate health-related board when a licensee, licensed under
chapter 147, 148, 148B, or 150A, is suspected of insurance fraud.
new text end

new text begin (b) In order for an investigation to proceed, the board
shall review the evidence submitted by the Division of Insurance
Fraud Prevention and respond to the Division of Insurance Fraud
Prevention within 60 calendar days of sufficient evidence being
presented to the board. If the response of the board is in the
affirmative, the Division of Insurance Fraud Prevention may
proceed with the investigation. Notwithstanding the limitations
of chapter 13, the Department of Commerce and the health-related
boards may freely exchange information until the investigation
is resolved. The decision of the board that insufficient
grounds exist to continue an investigation does not prohibit the
presentation of additional evidence to the board and review by
the board at a future time.
new text end

new text begin (c) The board may revoke, suspend, condition, limit,
restrict, or qualify a license to practice when clear and
convincing evidence indicates the licensee has committed
insurance fraud or subsequent to a conviction relating to fraud.
new text end

new text begin (d) Costs incurred by the Department of Commerce shall be
taken from existing funds appropriated to the Division of
Insurance Fraud Prevention. Costs for the initial review by the
board shall be taken from existing board funds. Subsequent
board investigations may be funded in part or in whole by the
licensee in the event of a conviction relating to fraud or from
insurance proceeds that are required to be repaid as a result of
a conviction.
new text end

Sec. 2.

new text begin [65B.665] EXCESSIVE CLAIMS; HEALTH-RELATED
BOARDS.
new text end

new text begin Insurers may bring excessive claims to the attention of the
appropriate health-related board under chapter 147, 148, 148B,
or 150A. The board shall respond to an insurer that brings a
claim before the board within 60 calendar days as to whether or
not the board agrees that a claim is excessive. Upon finding
that a claim is excessive, the insurer is relieved of its duty
to pay the claim, and neither the person who was treated nor the
person's guardian, nor the state shall be billed for payment.
If a pattern of excessive charges is determined by the board,
the board may limit the right of the licensee to bill for
payment for no-fault accident claims for a specified period of
time, or the board may impose some other sanction it deems
appropriate. The insurer shall make available sufficient funds
to provide for review of the claims that are submitted on a
cost-based per review basis. The cost of the review may vary
based on the complexity of the review. The boards shall report
on excessive claims annually to the legislature beginning
December 1, 2006.
new text end

Sec. 3. new text begin HEALTH-RELATED BOARDS; NO-FAULT AUTOMOBILE
INJURIES.
new text end

new text begin The health-related boards under Minnesota Statutes, chapter
148, shall establish practice standards for treating patients
with injuries sustained in no-fault automobile accidents and
update the standards periodically as appropriate. Each board
shall report these standards to the legislative committees with
jurisdiction over the public health occupations by January 15,
2006, and shall report subsequent changes periodically
thereafter. If a board has existing standards, nothing in this
section requires a board to establish new standards.
new text end

Sec. 4. new text begin NO-FAULT INSURANCE MEDICAL COST STUDY.
new text end

new text begin The commissioner of commerce, the health-related boards
under Minnesota Statutes, chapter 148, professional provider
associations, and automobile insurance carriers that offer
no-fault insurance under Minnesota Statutes, sections 65B.41 to
65B.71, shall study the medical costs associated with no-fault
automobile accidents and report to the legislative committees
with jurisdiction over the public health boards and commerce on
any high medical cost outliers by January 15, 2006. For the
purposes of this section, "outliers" means any health providers
whose total charges for treating specific conditions or injuries
sustained as a result of no-fault automobile accidents are at
any time found to be above the 95th percentile or consistently
above the 90th percentile.
new text end