27 R.I. Gen. Laws § 27-41-69. Post-payment audits: Health Maintenance Organization Act – Rhode Island

Status: Enacted
Year Enacted: 2006
Year Amended: 2017
File: Download

Except as otherwise provided herein, any review, audit, or investigation by a health maintenance organization 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.

Return to Database Search

© 2018- The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Associated Litigation:

No items found