NH| The New Hampshire Insurance Department Bulletin 25-084-AB provides updated guidance on mandatory reporting of suspected fraudulent billing activity by health care professionals, reminding all licensed carriers and producers of their obligation under RSA 41728 to report suspected insurance fraud to the Department’s fraud unit within 60 days. The bulletin outlines key compliance requirements for carriers and clarifies the relationship between fraud investigations and prompt-payment regulations.
Key Points:
- Carriers must promptly report suspected fraudulent claims by health care providers through the Online Fraud Reporting System (OFRS) via NAIC to qualify for exemptions from the state’s prompt-payment deadlines and to lawfully retroactively deny and recoup payments, even beyond the standard 12-month period.
- All carriers are required to maintain confidential, written policies and procedures for detecting and investigating fraud by health care professionals, including timely notification to the individuals concerned, in order to remain compliant with state regulations.