P.R. Laws tit. 24, § 7044
Every insurer, health service organization or any other entity that renders health services in Puerto Rico, contracting with the Administration and other entities of the Government of Puerto Rico, shall be bound to provide the latter with any information requested, and in the event of noncompliance, it shall be subject to the penalties provided under § 257 of Title 26, known as the “Insurance Code of Puerto Rico”.
If, after the Administration has verified the information furnished, it arises that a Medicaid Program beneficiary is also a private health plan beneficiary or that the services rendered should have been paid by a third party or health plan financed by the Government, other than the Medicaid Program, the Administration or its duly authorized Subcontractor, shall initiate a payment recovery action against the beneficiary’s primary plan and such information shall be sent to the Medicaid Office. The beneficiary shall not be responsible for such payment. None of the provisions of this Act shall be construed as a waiver of confidentiality under the “Health Insurance Portability and Accountability Act (HIPAA)”. Provided, That a payment recovery action shall be initiated within two (2) years as of the rendering of services to the beneficiary.
History —Sept. 7, 1993, No. 72, added as Art. VIII, § 4 on Dec. 30, 2010, No. 227, § 1.