This bill proposes updates to current statutes by adding new requirements for health care insurers and property or casualty insurers regarding the notification of potential fraud. Specifically, if a health insurer observes that the number of claims filed by a health care provider exceeds the number of patients that provider could reasonably treat in a day, the insurer must notify the Department of Insurance and Financial Institutions (DIFI) and the relevant licensing board. Similarly, property or casualty insurers are required to report any claims activities that suggest possible fraud to DIFI and the applicable board.

Additionally, the bill introduces definitions for "health care provider" and "health insurer," clarifying that a health care provider is a licensed, registered, or certified professional under state law, while a health insurer encompasses various types of disability and health care service organizations. These insertions aim to enhance oversight and accountability in the insurance industry, particularly in relation to health care claims and potential fraudulent activities.

Statutes affected:
Introduced Version: 20-243
House Engrossed Version: 20-466.06