Medical Bill Factoring and Altering Medical Bills

[LOGO] KAY IVEY GOVERNOR MARK FOWLER COMMISSIONER STATE OF ALABAMA DEPARTMENT OF INSURANCE 201 MONROE STREET, SUITE 502 POST OFFICE BOX 303351 MONTGOMERY, ALABAMA 36130-3351 TELEPHONE: (334) 269-3550 FACSIMILE: (334) 241-4192 INTERNET: www.aldoi.gov DEPUTY COMMISSIONERS JIMMY W. GUNN LARRY CHAPMAN CHIEF EXAMINER SHEILA TRAVIS STATE FIRE MARSHAL SCOTT F. PILGREEN GENERAL COUNSEL REYN NORMAN # BULLETIN NO. 2023-02 TO: All property and casualty insurers admitted or doing business in Alabama FROM: Mark Fowler Commissioner of Insurance Mark Fowler DATE: May 4, 2023 RE: Medical bill factoring and altering medical bills EFFECTIVE: Immediately The Commissioner of Insurance has determined as follows: 1. The business of properly factoring medical bills is not deemed to be business of "insurance" as defined in the Insurance Code [Ala. Code Tit. 27]. Proper factoring occurs when a medical provider issues a bill and a factor purchases, from the medical provider, the right to collect the billing from the patient. 2. Medical billing issued, modified and/or augmented by a third party in such a manner as to reflect charges exceeding those originally billed by the treating providers and done with reasonable anticipation that such billing may be submitted to a health or liability insurer as a bona fide bill can be "insurance fraud" as defined in Ala. Code § 27-12A-2 subjecting a person or business entity to possible criminal liability. The Department's Fraud Bureau, the insurance fraud unit created under authority of Ala. Code § 27-12A-40, may conduct inquiries or investigate allegations and cause prosecution of insurance fraud. MF/JFM/ct Alabama Department of Insurance Established 1897