N.Y. Pub. Health Law § 4915

Current through 2024 NY Law Chapter 457

Section 4915 - Prohibited practices

An external appeal agent shall not, with respect to external appeal activities, permit or provide compensation or anything of value to its employees, agents, or contractors based on:

1. either a percentage of the amount by which a claim is reduced for payment or the number of claims or the cost of services for which the person has denied authorization or payment; or

2. any other method that encourages the upholding of an adverse determination.

N.Y. Pub. Health Law § 4915