§ 4414 — Health care compliance programs

§ 4414. Health care compliance programs. 1. The commissioner, after\nconsultation with the superintendent of financial services, shall by\nregulation establish standards and criteria for compliance programs to\nbe implemented by persons providing coverage or coverage and service\npursuant to any public or governmentally-sponsored or supported plan for\nhealth care coverage or services. Such regulations shall include\nprovisions for the design and implementation of programs or processes to\nprevent, detect and address instances of fraud and abuse. Such\nregulations shall take into account the nature of the entity's business\nand the size of its enrolled population. The commissioner and the\nsuperintendent of financial services shall accept programs and processes\nimplemented pursuant to section four hundred nine of the insurance law\nas satisfying the obligations of this section and the regulations\npromulgated thereunder when such programs and processes incorporate the\nobjectives contemplated by this section.\n 2. Notwithstanding any provisions of section twelve of this chapter to\nthe contrary, penalties collected from any health maintenance\norganization certified pursuant to this article resulting from a\nviolation of the health maintenance organization's mental health and\nsubstance use disorder parity compliance program shall be deposited into\nthe behavioral health parity compliance fund as established pursuant to\nsection ninety-nine-hh of the state finance law.\n