New York Laws
Article 44 - Health Maintenance Organizations
4414 - Health Care Compliance Programs.

§ 4414. Health care compliance programs. 1. The commissioner, after
consultation with the superintendent of financial services, shall by
regulation establish standards and criteria for compliance programs to
be implemented by persons providing coverage or coverage and service
pursuant to any public or governmentally-sponsored or supported plan for
health care coverage or services. Such regulations shall include
provisions for the design and implementation of programs or processes to
prevent, detect and address instances of fraud and abuse. Such
regulations shall take into account the nature of the entity's business
and the size of its enrolled population. The commissioner and the
superintendent of financial services shall accept programs and processes
implemented pursuant to section four hundred nine of the insurance law
as satisfying the obligations of this section and the regulations
promulgated thereunder when such programs and processes incorporate the
objectives contemplated by this section.

2. Notwithstanding any provisions of section twelve of this chapter to
the contrary, penalties collected from any health maintenance
organization certified pursuant to this article resulting from a
violation of the health maintenance organization's mental health and
substance use disorder parity compliance program shall be deposited into
the behavioral health parity compliance fund as established pursuant to
section ninety-nine-hh of the state finance law.

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