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NC state law about billing for sexual assault exams

The North Carolina Legislative Building, with state seal in foreground, is pictured in March 2021.

The North Carolina Legislative Building, with state seal in foreground, is pictured in March 2021.

North Carolina lawmakers are considering how to make sure sexual assault survivors won’t be billed for forensic exams.

Adding a financial penalty isn’t in current legislation that moved through a Senate committee on Tuesday, but could be part of it when it reaches the floor as early as Thursday. The proposed legislation comes less than two weeks before the North Carolina General Assembly is expected to finish its legislative session.

Dozens of major hospitals and medical offices across the state may have been sending the bills to patients’ insurance companies to pay for them, instead of the Department of Public Safety, as required by law, The News & Observer reported earlier this month.

Supporters of House Bill 626 offer two solutions to the problem: financially penalize medical providers who wrongly bill patients or their insurance; and make a specific code for the forensic exam, also known as a rape kit.

HB 626 unanimously passed the House in 2021 by a 111-0 vote. That bill, sponsored by NC Rep. Billy Richardson, a Cumberland County Democrat, would impose a $25,000 civil penalty per infraction of improper billing.

The North Carolina Coalition Against Sexual Assault has been advocating for stricter requirements for a decade. Executive Director Monika Johnson-Hostler told The N&O this month that the state hasn’t been able to decide how all hospitals can be responsible for billing correctly, and both a penalty and medical billing code would make sure bills were always sent directly to DPS.

After the committee on Tuesday, Johnson-Hostler said she is “optimistic that this will move the needle.”

North Carolina Coalition Against Sexual Assault Executive Director Monika Johnson-Hostler addresses lawmakers during a Senate Judiciary Committee meeting on Tuesday, June 21, 2022 in Raleigh. Dawn Baumgartner Vaughan

A version of HB 626 is now in the new version of House Bill 674, called “Require DNA for Various Convictions,” which also increases circumstances when DNA samples are taken. It passed through the Senate Judiciary Committee on Tuesday. Richardson spoke in favor of the bill, noting that the House version of the billing legislation included a penalty. Otherwise, this latest version brings the state law in line with federal law requirements.

Chances of a financial penalty for wrong billing

After the meeting, Sen. Danny Britt, a Robeson County Republican and chair of the Judiciary Committee, told The N&O he “absolutely” supports a financial penalty to enforce the law.

He said the penalty, and possibly the billing code proposal, could come up as an amendment when it goes to the Senate for a floor vote. Or if the Senate passes it without an amendment, it could be changed in another committee process before getting green-lighted by the House.

“The penalty is one of the things I talked to [Richardson] about adding to this,” Britt said. “We’ve just got to figure out what the penalty will be. Current law already says they can’t do it.”

State Treasurer Dale Folwell told The N&O on Tuesday that his office has always been a proponent of a penalty for medical providers billing survivors and insurance for the assault exams.

“I think that given the trauma these females have already been through, and the courage they demonstrated to even go and get the care they need,” any delay in the legislative process should not “keep us from doing what’s right,” he said.

Folwell is a vocal proponent of more transparency in hospital billing.

“There’s nothing that should be more nauseating or make your readers more angry than this story, which is important but a tiny tip of the iceberg,” he said.

Costs of forensic exams

The state’s Rape Victim Assistance Program pays for the cost of forensic exams, though the current amount is set at $800. Senators discussed possibly increasing the amount.

Sen. Natasha Marcus, a Mecklenburg County Democrat, said during the committee that sexual assault victims should not be billed for processing their own exam, and advocated for increasing the $800 cap “so it’s fully reimbursed,” making it so there isn’t a need to bill the person at all.

The Victim Assistance Program paid for 1,376 sexual assault claims in the 2020-21 fiscal year, according to an email between DPS and the treasurer’s office obtained by The N&O.

Britt said lawmakers are working with the Department of Health and Human Services about how they might designate the forensic exams with a billing code. Next stop for the bill is the Senate Rules Committee on Wednesday, which means it could go to a floor vote on Thursday.

For more North Carolina government and politics news, listen to the Under the Dome politics podcast from The News & Observer and the NC Insider. You can find it at or wherever you get your podcasts.

This story was originally published June 21, 2022 3:11 PM.

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Dawn Baumgartner Vaughan covers North Carolina state government and politics at The News & Observer. She previously covered Durham, and has received the McClatchy President’s Award, NC Open Government Coalition Sunshine Award and several North Carolina Press Association awards, including for politics and investigative reporting.


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