2021 New York Laws
ISC - Insurance
Article 51 - Comprehensive Motor Vehicle Insurance Reparations
5109 - Unauthorized Providers of Health Services.

Universal Citation: NY Ins L § 5109 (2021)
§   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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