N.Y. Public Health Law Section 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 Insurance Law § 409 (Fraud prevention plans and special investigations units)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 § 12 (Violations of health laws or regulations)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 State Finance Law § 99-HH (Criminal justice discovery compensation fund)section ninety-nine-hh of the state finance law.

Source: Section 4414 — Health care compliance programs, https://www.­nysenate.­gov/legislation/laws/PBH/4414 (updated Apr. 17, 2020; accessed Jul. 13, 2024).

4400
Statement of policy and purposes
4401
Definitions
4402
Health maintenance organizations
4403
Health maintenance organizations
4403‑A
Special purpose certificate of authority
4403‑B
Development of comprehensive health services plans
4403‑C
Comprehensive HIV special needs plan certification
4403‑D
Special needs managed care plans
4403‑E
Primary care partial capitation providers
4403‑F
Managed long term care plans
4403‑G
Developmental disability individual support and care coordination organizations
4404
Health maintenance organizations
4405
Health maintenance organizations
4405‑A
Immunizations against poliomyelitis, mumps, measles, diphtheria and rubella
4405‑B
Duty to report
4406
Health maintenance organizations
4406‑A
Arbitration provisions of health maintenance organization contracts
4406‑B
Primary and preventive obstetric and gynecologic care
4406‑C
Prohibitions
4406‑D
Health care professional applications and terminations
4406‑E
Access to end of life care
4406‑F
Maternal depression screenings
4406‑G
Telehealth delivery of services
4406‑H
Health care facility applications
4406‑I
Utilization review determinations for medically fragile children
4407
Health maintenance organizations
4408
Disclosure of information
4408‑A
Integrated delivery systems
4408‑A*2
Grievance procedure
4409
Health maintenance organizations
4410
Health maintenance organizations
4411
Construction
4412
Separability
4413
Savings clause
4414
Health care compliance programs
4416
Excess reserves of certain health maintenance organizations

Accessed:
Jul. 13, 2024

Last modified:
Apr. 17, 2020

§ 4414’s source at nysenate​.gov

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