Source: http://webserver.rilin.state.ri.us/Statutes/TITLE27/27-20/27-20-51.HTM
Timestamp: 2018-01-19 05:37:40
Document Index: 384042052

Matched Legal Cases: ['§ 27', '§ 27', '§ 3', '§ 3', '§ 3', '§ 3', '§ 3', '§ 3', '§ 3', '§ 3']

27-20-51
SECTION 27-20-51
§ 27-20-51. Post-payment audits.
(a) Except as otherwise provided herein, any review, audit, or investigation by a nonprofit medical service corporation of a health-care provider's claims that results in the recoupment or set-off of funds previously paid to the health-care provider in respect to such claims shall be completed no later than eighteen (18) months after the completed claims were initially paid. This section shall not restrict any review, audit, or investigation regarding claims that are submitted fraudulently; are known, or should have been known, by the health-care provider to be a pattern of inappropriate billing according to the standards for provider billing of their respective medical or dental specialties; are related to coordination of benefits; are duplicate claims; or are subject to any federal law or regulation that permits claims review beyond the period provided herein.
(c) For the purposes of this section, "health-care provider" means an individual clinician, either in practice independently or in a group, who provides health-care services, and any health-care facility, as defined in § 27-20-1, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.
(P.L. 2006, ch. 86, § 3; P.L. 2006, ch. 97, § 3; P.L. 2013, ch. 251, § 3; P.L. 2013, ch. 395, § 3; P.L. 2014, ch. 201, § 3; P.L. 2014, ch. 214, § 3; P.L. 2017, ch. 368, § 3; P.L. 2017, ch. 375, § 3.)