2025 Session
Last amended: 2020 session
§ 62M.12 — Prohibition of Inappropriate Incentives
Plain-Language Summary
People who review medical claims cannot be paid bonuses or incentives based on how many claims they deny. Review organizations can set performance standards based on medical quality, but they cannot reward reviewers for making more denials.
62M.12 PROHIBITION OF INAPPROPRIATE INCENTIVES.
No individual who is performing utilization review may receive any financial incentive based on the number of adverse determinations made by such individual, provided that utilization review organizations may establish medically appropriate performance standards. This prohibition does not apply to financial incentives established between health plan companies and providers.
History:
1992 c 574 s 12; 1999 c 239 s 30; 2020 c 114 art 2 s 16
History: History: 1992 c 574 s 12; 1999 c 239 s 30; 2020 c 114 art 2 s 16
Practical Notes
This law protects patients by making sure that the people deciding whether to approve or deny your medical care are not financially motivated to deny claims. If you suspect a review organization is pressuring its staff to deny claims, this may be a violation of state law.