Testimony Opposing HB 895: Prohibiting Extrapolation

The Texas Association of Health Plans opposes HB 895, which limits the ability of health plans to recover overpayments to providers as a result of fraud, waste, or abuse. HB 895 prohibits the use of extrapolation in the commercial market. Tools such as extrapolation support health plans’ efforts to review paid claims to ensure provider payment integrity. HB 895 will have a chilling effect on health care integrity efforts.

Abusive overbilling in health care is challenging to spot. Plans often have to review thousands of claims to uncover abusive billing practices. As a result, health care insurance companies put in place comprehensive fraud detection and prevention policies, including extrapolation policies. Health plans use up-to-date anti-fraud systems and protocols that expose abusive billing practices and necessitate recoupment in order to protect consumers and small businesses.

See the full letter.

Become a Member

Membership with TAHP is an invaluable tool for integrating, building relationships, exchanging information and best practices, and promoting your services. You will be well-armed with the most timely and accurate information, strong relationships with key Texas leaders, and access to seasoned policy and regulatory experts.