S.3552 (Breslin)/A.7128 (Morelle)
No-Fault; Unauthorized Providers
Summary: The bill addresses certain abuses of the no-fault insurance system by permitting the Superintendent
to prohibit a provider of health services from demanding or requesting payment for health services
rendered under Article 51 of the Insurance Law (No-Fault) if the Superintendent determines that the
provider has engaged in certain activities. Specifics include:
- Insurance Law § 5109(b) is amended to permit the Superintendent to prohibit a provider
of health services from demanding payment for health services rendered under Article 51
of the Insurance Law, for a period not exceeding three years, if the Superintendent determines,
after notice and hearing, that the provider of health services:
- (1) has admitted to
or been found guilty of professional misconduct
in connection with health services rendered under Article
51;
- (2) solicited, or employed
another person to solicit for the provider
or another person or entity, professional treatment, examination
or care of a person in connection with any claim under
Article 51;
- (3) refused to appear
before, or answer any question upon request
of the Superintendent, or refused to produce any relevant
information concerning the provider's conduct in connection
with health services rendered under Article 51;
- (4) engaged in a pattern
of billing for health services alleged to have
been rendered under Article 51 which were not rendered, or
engaged in a pattern of billing for unnecessary health services;
- (5) utilized unlicensed
persons to render health services under Article
51;
- (6) utilized licensed
persons to render health services, when rendering
the health services is beyond the authorized scope of the
person's license;
- (7) ceded ownership,
operation or control of a business entity that
provides health services to a person not licensed to render the
health services for which the entity is legally authorized to provide,
unless otherwise permitted by law;
- (8) committed a fraudulent
insurance act as defined in Penal Law § 176.05;
- (9) has been convicted
of a crime involving fraudulent or dishonest
practices; or
- (10) violated any provision
of Article 51 or regulations promulgated
thereunder.
- Insurance Law § 5109(c) is amended to state that a provider of health services shall
not demand or request payment for any health services under Article 51 that are rendered during
the term of the prohibition ordered by the Superintendent pursuant to Insurance Law § 5109(b).
- Insurance Law § 5109(d) is amended to require the Superintendent to maintain a database
containing a list of providers of health services that the Superintendent has prohibited from
demanding or requesting payment for health services rendered under Article 51, and to make this
information available to the public.
- Insurance Law § 5109(e) is amended to permit the Superintendent to levy a civil penalty
not exceeding $50,000 on any provider of health services that the Superintendent prohibits from
demanding or requesting payment for health services pursuant to Insurance Law § 5109(b).
- Former Insurance Law § 5109(e), relettered as subsection (t), is amended to state that nothing
in Insurance Law § 5109 shall be construed as limiting in any respect the powers and duties
of the Commissioners of Health and Education and the Superintendent to investigate instances
of misconduct by a provider of health services and take appropriate action pursuant to any other
provision of law. Moreover, the bill provides that a determination rendered by the Superintendent
pursuant to Insurance Law § 5109(b) does not bind the Commissioner of Health or the Commissioner
of Education in a professional discipline proceeding related to the same conduct.
Section 3 of the bill provides for an immediate effective date.