HLS 20RS-1008 ORIGINAL
2020 Regular Session
HOUSE BILL NO. 816
BY REPRESENTATIVE GAROFALO
INSURANCE CLAIMS: Provides relative to healthcare fraud
1 AN ACT
2To amend and reenact R.S. 22:1924(A)(3), relative to healthcare insurance fraud; to modify
3 definitions; to modify the requirement for issuance of written notice to cease certain
4 behavior; to provide for technical changes; and to provide for related matters.
5Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1924(A)(3) is hereby amended and reenacted to read as follows:
7 ยง1924. Prohibited activities and sanctions
8 A.
9 * * *
10 (3)(a) Knowingly and willfully committing health care healthcare fraud shall
11 be punishable as provided in Paragraph (1) of this Subsection.
12 (b) "Health care Healthcare fraud" shall mean, in conjunction with the
13 delivery of or payment for health care healthcare benefits, items, or services:
14 (i) To execute a scheme or artifice to defraud any health care healthcare
15 benefit program.
16 (ii) To obtain, by means of fraudulent claims, or false or fraudulent
17 pretenses, representations, or promises, any of the money or property owned by, or
18 under the custody or control of, any health care healthcare benefit program.
19 (c) For the purposes of this Paragraph, "knowingly and willfully" shall mean
20 to continue with a practice, after written notice to cease such practice from a health
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 20RS-1008 ORIGINAL
HB NO. 816
1 care healthcare benefit program by certified mail, return receipt requested, except
2 when the health care healthcare provider reasonably believes that such practice
3 materially complies with coding or billing standards as issued by the American
4 Medical Association, the United States Department of Health and Human Services,
5 the Centers for Medicare and Medicaid Services, or the Louisiana Medicaid
6 Program. For purposes of this Paragraph, "knowingly and willfully" continued
7 practices may be established by conduct. Notwithstanding any other provision of
8 this Paragraph, a healthcare benefit program provided by a property and casualty
9 insurance policy shall not be required to send to a healthcare provider written notice
10 to cease the activity of healthcare fraud.
11 * * *
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 816 Original 2020 Regular Session Garofalo
Abstract: Modifies definitions and exempts certain healthcare benefit programs from the
requirement of issuing written notice to providers to cease certain behavior.
Present law defines "knowingly and willfully" as continuing with a practice, after written
notice to cease such practice from a healthcare benefit program by certified mail, return
receipt requested, except when the healthcare provider reasonably believes that such practice
materially complies with coding or billing standards as issued by the American Medical
Association, the U.S. Dept. of Health and Human Services, the Centers for Medicare and
Medicaid Services, or the La. Medicaid Program.
Proposed law retains present law, but adds that practices continued "knowingly and
willfully" may be established by conduct.
Proposed law further adds that a healthcare benefit program provided by a property and
casualty insurance policy is not required to send written notice requesting a provider to cease
the activity of healthcare fraud.
(Amends R.S. 22:1924(A)(3))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.