Pocketing Insurance checks: Proposed bill puts ‘bad actors on notice’ to pay up

Investigations

Pennsylvania law allows insurers to pay members directly for EMS services when it is out of network, but some patients choose to pocket the check instead of paying.

“This bill is actually going to make it theft,” state Rep. Rob Kauffman (R-89th District) said.

Kauffman represents Franklin County but says his bill would help EMS services and other emergency agencies across the state collect payment. 

Cumberland Goodwill EMS is based in Carlisle and lost over $220,000 last year from patients pocketing insurance checks. 

“We are very excited that the Legislature is taking this seriously,” Nathan Harig, assistant chief of Cumberland Goodwill EMS said in a previous report with ABC27 News. “It is not fair to the other patients out there that are paying their bills to see a rate rise because someone isn’t paying.”

The problem was recognized by the Senate Resolution 6 Commission which released the SR6 report. In it, members say EMS is “woefully lacking in funding.”

The report includes more than 20 recommendations to address the crisis facing both fire and EMS services. Among its recommendations, permitting direct reimbursement to EMS and fire agencies which would require legislation.

Kauffman says his bill will make the law crystal clear, making it “theft by failure to make required disposition of funds received” under Section 3927 of Title 18. Violators could face fines and possible jail time.

“Having this in law is going to put those bad actors on notice and say enough is enough. When the call comes out, they are coming to see you and they are coming to take you to the hospital, so you better submit the check to the ambulance company when you get it,” said Kauffman. 

House Bill 82 was referred to the Judiciary Committee. 

Insurance companies argue they want to encourage EMS to become providers so better rates can be negotiated for members. EMS services say the negotiated rates don’t cover costs.

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