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Francis J. Serbaroli Francis J. Serbaroli

In its continuing efforts to maximize revenue collection, New York state continues to aggressively audit insurers to determine if they have accurately paid statutory surcharges on bills for medical services provided to patients by licensed facilities such as hospitals, clinics, ambulatory surgery centers, and other providers. These surcharges were mandated by the Health Care Reform Act of 1996 (HCRA) (Ch. 639 Laws of 1996), and they apply not just to traditional health insurers and managed care plans, but to all insurers that provide coverage for medical services provided in health care facilities. These include property and casualty insurers, Workers’ Compensation carriers, automobile no-fault insurers, and others. They also apply to hospitals and other licensed facilities. We offer here a primer on the HCRA surcharges, how these audits are being carried out, and pitfalls to avoid.

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