2013 New York Consolidated Laws
ISC - Insurance
Article 51 - (5101 - 5109) COMPREHENSIVE MOTOR VEHICLE INSURANCE REPARATIONS
5109 - Unauthorized providers of health services.


NY Ins L § 5109 (2012) What's This?
 
    §   5109.   Unauthorized   providers   of  health  services.  (a)  The
  superintendent, in consultation with the commissioner of health and  the
  commissioner of education, shall by regulation, promulgate standards and
  procedures   for   investigating   and   suspending   or   removing  the
  authorization for providers of health  services  to  demand  or  request
  payment  for health services as specified in paragraph one of subsection
  (a) of section five thousand  one  hundred  two  of  this  article  upon
  findings  reached  after  investigation  pursuant  to this section. Such
  regulations shall ensure the same or  greater  due  process  provisions,
  including  notice  and  opportunity  to  be  heard,  as  those  afforded
  physicians investigated under article two of the  workers'  compensation
  law  and  shall  include provision for notice to all providers of health
  services of the provisions of this section and  regulations  promulgated
  thereunder at least ninety days in advance of the effective date of such
  regulations.
    (b) The commissioner of health and the commissioner of education shall
  provide  a list of the names of all providers of health services who the
  commissioner of health and the commissioner  of  education  shall  deem,
  after  reasonable investigation, not authorized to demand or request any
  payment for medical services in connection with  any  claim  under  this
  article because such provider of health services:
    (1)   has   been   guilty  of  professional  or  other  misconduct  or
  incompetency in connection with medical  services  rendered  under  this
  article; or
    (2)  has  exceeded the limits of his or her professional competence in
  rendering medical care under this article or has knowingly made a  false
  statement  or representation as to a material fact in any medical report
  made in connection with any claim under this article; or
    (3) solicited, or has employed  another  to  solicit  for  himself  or
  herself  or  for another, professional treatment, examination or care of
  an injured person in connection with any claim under this article; or
    (4) has refused to appear before, or to answer upon  request  of,  the
  commissioner  of  health,  the  superintendent,  or  any duly authorized
  officer of the state, any legal question, or  to  produce  any  relevant
  information  concerning  his or her conduct in connection with rendering
  medical services under this article; or
    (5) has engaged in patterns of billing for  services  which  were  not
  provided.
    (c)  Providers  of  health  services  shall  refrain from subsequently
  treating for remuneration, as a  private  patient,  any  person  seeking
  medical  treatment  under this article if such provider pursuant to this
  section has been prohibited from demanding or requesting any payment for
  medical services under this article. An injured claimant so  treated  or
  examined  may raise this as a defense in any action by such provider for
  payment for treatment rendered at any time after such provider has  been
  prohibited  from demanding or requesting payment for medical services in
  connection with any claim under this article.
    (d) The commissioner of health and the commissioner of education shall
  maintain and regularly update a database containing a list of  providers
  of  health  services  prohibited  by  this  section  from  demanding  or
  requesting any payment for health services connected to  a  claim  under
  this  article and shall make such information available to the public by
  means of a website and by a toll free number.
    (e) Nothing in this section shall be  construed  as  limiting  in  any
  respect   the   powers   and  duties  of  the  commissioner  of  health,
  commissioner of education or the superintendent to investigate instances
  of misconduct by a health care provider and, after a  hearing  and  upon
  written  notice  to  the provider, to temporarily prohibit a provider of

  health services under such investigation from  demanding  or  requesting
  any  payment  for  medical  services under this article for up to ninety
  days from the date of such notice.

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