85(R) - 2017
Relating to the use of extrapolation by a health maintenance organization or an insurer to audit claims.
From the LBB: no significant fiscal implication to the state is anticipated.
HB 1649 would amend the Insurance Code to prohibit a health insurance organization from using extrapolation, an estimate of audit results for a large group of claims not reviewed by the insurance organization, to complete an audit of participating physicians or providers. Any additional payment due to a physician or provider or any refund due to the health insurance organization must be based on actual over payment or underpayment and may not be based on extrapolation.
Vote Recommendation Notes
This bill violates our free market and limited government principles by prohibiting an audit practice by private insurance organizations. It is not a proper role of government to regulate auditing practices of a voluntary agreement for services between insurance organizations and participating providers. For these reasons, we oppose HB 1649.