Pennsylvania law Section 1797 addresses the issue of payment for unnecessary medical treatments or services provided by healthcare providers. If a provider is found to have billed for unnecessary care, they must return the payment with interest, and the law clarifies the review process and related references. It aims to protect insured individuals from paying for unneeded medical expenses.
It covers the rules regarding payment for unnecessary medical treatments and the provider's obligation to refund such payments with interest if billed inappropriately.
The provider must return the payment with 12% interest within 30 days, and the insured is not responsible for paying for unnecessary services.
Yes, the Legislative Budget and Finance Committee is authorized to review the law's impact, starting by December 1, 1991, with biennial reviews possible.
It applies to providers who are determined by a court or PRO to have billed for unnecessary treatment, ensuring protections for insured individuals.