33-1-16.1. Excessive, fraudulent, or high-tech drug testing of certain individuals as fraudulent insurance act.

As used in this Code section, the term:#

1. (1)

   “High-tech drug testing” means testing an individual’s specimen for more than one substance and billing and receiving payment separately for each substance tested.#

2. (2)

   “Person” means an individual, any person who provides coverage under Code Section 33-1-14, and any owner, manager, medical practitioner, employee, or other party involved in a fraudulent insurance act prohibited by this Code section.#

1. (1)

   For purposes of this Code section, a person commits a fraudulent insurance act if he or she knowingly and with intent to defraud, presents, causes to be presented, or prepares with knowledge or belief that it will be presented, any billing for excessive testing, fraudulent testing, or high-tech drug testing in the treatment of the elderly, the disabled, or any individual affected by pain, substance abuse, addiction, or any related disorder, to or by an insurer, broker, or any agent thereof, or directly or indirectly to an insured or uninsured patient.#

2. (2)

   Such billing as provided for in paragraph (1) of this subsection shall include, but shall not be limited to:#

   1. (A)

      Upcoding that results in billing for more expensive services or procedures than were actually provided or performed;#

   2. (B)

      For patients undergoing drug abuse treatment, unbundling of such billing whereby a drug test from a single sample that detects a variety of narcotics is separated into multiple tests and billed separately;#

   3. (C)

      Billing an individual for multiple copayment amounts;#

   4. (D)

      Billing for drug testing that was not performed; and#

   5. (E)

      Billing for an excessive number of drug tests that are found to be medically unnecessary for the treatment.#

If, by his or her own inquiries or as a result of information received, the Commissioner has reason to believe that a person has engaged in or is engaging in a fraudulent insurance act under this Code section, the Commissioner shall have all the powers and duties pursuant to Code Section 33-1-16 to investigate such matter.#

A natural person convicted of a violation of this Code section shall be guilty of a misdemeanor and shall be punished by imprisonment for not more than 12 months, by a fine of not more than $1,000.00 per violation, or both.#

This Code section shall not supersede any investigation audit which involves fraud, willful misrepresentation, or abuse under Article 7 of Chapter 4 of Title 49 or any other statutory provisions which authorize investigation relating to insurance.#