1.1 	A bill for an act
1.2 	relating to commerce; health-related boards;
1.3 	regulating insurance fraud investigations; regulating
1.4 	excessive claims; providing practice standards for
1.5 	no-fault auto injuries; providing for a no-fault
1.6 	insurance medical cost study; amending Minnesota
1.7 	Statutes 2004, section 45.0135, by adding a
1.8 	subdivision; proposing coding for new law in Minnesota
1.9 	Statutes, chapter 65B.
1.10 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.11 	Section 1. Minnesota Statutes 2004, section 45.0135, is
1.12 	amended by adding a subdivision to read:
1.13 		Subd. 8.Investigations; health-related boards. (a) The
1.14 	Division of Insurance Fraud Prevention shall consult with the
1.15 	appropriate health-related board when a licensee, licensed under
1.16 	chapter 147, 148, 148B, or 150A, is suspected of insurance fraud.
1.17 	(b) In order for an investigation to proceed, the board
1.18 	shall review the evidence submitted by the Division of Insurance
1.19 	Fraud Prevention and respond to the Division of Insurance Fraud
1.20 	Prevention within 60 calendar days of sufficient evidence being
1.21 	presented to the board.  If the response of the board is in the
1.22 	affirmative, the Division of Insurance Fraud Prevention may
1.23 	proceed with the investigation.  Notwithstanding the limitations
1.24 	of chapter 13, the Department of Commerce and the health-related
1.25 	boards may freely exchange information until the investigation
1.26 	is resolved.  The decision of the board that insufficient
1.27 	grounds exist to continue an investigation does not prohibit the
2.1 	presentation of additional evidence to the board and review by
2.2 	the board at a future time.
2.3 	(c) The board may revoke, suspend, condition, limit,
2.4 	restrict, or qualify a license to practice when clear and
2.5 	convincing evidence indicates the licensee has committed
2.6 	insurance fraud or subsequent to a conviction relating to fraud.
2.7 	(d) Costs incurred by the Department of Commerce shall be
2.8 	taken from existing funds appropriated to the Division of
2.9 	Insurance Fraud Prevention.  Costs for the initial review by the
2.10 	board shall be taken from existing board funds.  Subsequent
2.11 	board investigations may be funded in part or in whole by the
2.12 	licensee in the event of a conviction relating to fraud or from
2.13 	insurance proceeds that are required to be repaid as a result of
2.14 	a conviction.

2.15 	Sec. 2. [65B.665] EXCESSIVE CLAIMS; HEALTH-RELATED
2.16 	BOARDS.
2.17 	Insurers may bring excessive claims to the attention of the
2.18 	appropriate health-related board under chapter 147, 148, 148B,
2.19 	or 150A.  The board shall respond to an insurer that brings a
2.20 	claim before the board within 60 calendar days as to whether or
2.21 	not the board agrees that a claim is excessive.  Upon finding
2.22 	that a claim is excessive, the insurer is relieved of its duty
2.23 	to pay the claim, and neither the person who was treated nor the
2.24 	person's guardian, nor the state shall be billed for payment.
2.25 	If a pattern of excessive charges is determined by the board,
2.26 	the board may limit the right of the licensee to bill for
2.27 	payment for no-fault accident claims for a specified period of
2.28 	time, or the board may impose some other sanction it deems
2.29 	appropriate.  The insurer shall make available sufficient funds
2.30 	to provide for review of the claims that are submitted on a
2.31 	cost-based per review basis.  The cost of the review may vary
2.32 	based on the complexity of the review.  The boards shall report
2.33 	on excessive claims annually to the legislature beginning
2.34 	December 1, 2006.

2.35 	Sec. 3. HEALTH-RELATED BOARDS; NO-FAULT AUTOMOBILE
2.36 	INJURIES.
 3.1 	The health-related boards under Minnesota Statutes, chapter
3.2 	148, shall establish practice standards for treating patients
3.3 	with injuries sustained in no-fault automobile accidents and
3.4 	update the standards periodically as appropriate.  Each board
3.5 	shall report these standards to the legislative committees with
3.6 	jurisdiction over the public health occupations by January 15,
3.7 	2006, and shall report subsequent changes periodically
3.8 	thereafter.  If a board has existing standards, nothing in this
3.9 	section requires a board to establish new standards.

3.10 	Sec. 4. NO-FAULT INSURANCE MEDICAL COST STUDY.
 3.11 	The commissioner of commerce, the health-related boards
3.12 	under Minnesota Statutes, chapter 148, professional provider
3.13 	associations, and automobile insurance carriers that offer
3.14 	no-fault insurance under Minnesota Statutes, sections 65B.41 to
3.15 	65B.71, shall study the medical costs associated with no-fault
3.16 	automobile accidents and report to the legislative committees
3.17 	with jurisdiction over the public health boards and commerce on
3.18 	any high medical cost outliers by January 15, 2006.  For the
3.19 	purposes of this section, "outliers" means any health providers
3.20 	whose total charges for treating specific conditions or injuries
3.21 	sustained as a result of no-fault automobile accidents are at
3.22 	any time found to be above the 95th percentile or consistently
3.23 	above the 90th percentile.