§ 25-21,247.Health care payor or employee; immunity from criminal or civil liability; when.

Insurers, health maintenance organizations, Medicare and Medicaid, self-insured employers that provide their own health benefits, and third-party administrators who handle health care payments all fall within this section’s broad definition of “health care payor.” Fraud in health care billing often surfaces only when payors compare notes, and this section clears a path for that comparison. A health care payor or its employee with reasonable cause to believe there has been a violation of the statutes governing certain insurance-related offenses, or a fraudulent insurance act under the Insurance Fraud Act, may discuss or inquire about that suspected violation with other health care payors.

The protection runs in both directions: a payor who raises the inquiry and a payor who responds to it are both covered. Anyone who discusses, inquires, or responds under this section is immune from criminal penalty and from civil liability for slander, libel, defamation, or breach of the physician-patient privilege — the very claims that a person accused of fraud might otherwise threaten to use against a payor that flagged the suspicion.

That immunity carries a condition. It applies only when the discussion, inquiry, or response is made in good faith and without reckless disregard for the truth. A payor that spreads an accusation it knows is baseless, or that ignores obvious signs the accusation is false, falls outside the section’s protection.