CA AB1092

Allows specialized health care service plans providing only vision care services to use statistically reliable methods to investigate suspected fraud and recover overpayments, subject to department approval as part of their antifrax plan.

Requires written notice of suspected fraud to providers that includes the statistical methodology used, description of the claim universe, explanation of findings, and detailed information for each claim in the sample, with a 45 working day dispute period.

Limits statistical analysis to claims paid within 365 days, with notice required within 60 days of the latest claim payment date.

Permits offset of uncontested overpayments against current claim submissions only if provider fails to reimburse within 45 working days and the plan provides 10 working days advance written notice.

Does not apply to claims submitted by physicians for medical or surgical services outside an optometrist's scope of practice.