Mass. Gen. Laws ch. 175, sec. 113V — MA Code / Part I / Title XXII / Chapter 175 / Section 113V
Overutilization of practice or fraud involving automobile insurance claims; medical licensing boards; investigations
Status: in_force

Section 113V. (a) For purposes of this section, the following words shall have the following meaning:— ''Automobile Insurers Bureau of Massachusetts'', the rating organization licensed by the commissioner under section 8 of chapter 175A, or its successor. ''Commissioner'', the commissioner of insurance. ''Insurance fraud bureau'', a bureau authorized by chapter 338 of the acts of 1990, or its successor. ''Medical licensing boards'', the board of registration in medicine and those boards of registration and examination in the department of public health which relate to medical or health care providers. (b) At least annually, the medical licensing boards that receive funding pursuant to paragraph (3) of subsection (d) shall review the data made available to them by the Automobile Insurers Bureau of Massachusetts for indication of overutilization of practice or fraud involving automobile insurance claims by individual practitioners or by provider groups. Where overutilization of practice or fraud involving automobile insurance claims by 1 or more licensees is suspected, the board shall conduct an investigation. If the investigation results in evidence that a pattern of fraud, overutilization of practice, or professional misconduct exists, the medical licensing boards shall initiate professional disciplinary proceedings to determine whether that practitioner's or provider group's license should be suspended, revoked, or be subjected to some other appropriate penalty. (c) If a licensee subject to the jurisdiction of the medical licensing boards has been convicted of insurance fraud, the medical licensing boards shall immediately initiate professional disciplinary proceedings to determine whether the applicable license should be suspended, revoked, or subjected to some other appropriate remedy. (d)(1) The costs of this program shall be paid by the Automobile Insurers Bureau of Massachusetts and not passed on to holders of automobile insurance policies in the commonwealth. Each insurer licensed in the commonwealth to write a motor vehicle liability policy as defined in section 34A of chapter 90 shall pay the Automobile Insurers Bureau of Massachusetts an amount equal to 10 cents for each private passenger motor vehicle liability policy written as of December 31 of the preceding year, according to the records of the Automobile Insurers Bureau of Massachusetts. On or before March 1 of each year, the Automobile Insurers Bureau of Massachusetts shall remit the total amount paid under this subsection to the commissioner. An insurer shall not include the assessment paid under this section in any data used to fix and establish rates under section 113B of chapter 175. (2) On or before March 1 of each year, the commissioner shall consult with an advisory group consisting of the attorney general or his designee, a district attorney or his designee to be appointed by the attorney general, a representative of the insurance fraud bureau, and 2 members of the public to be appointed by the governor on how the funds paid under subsection (1) should be distributed. Within 60 days of the receipt of said moneys, the commissioner shall allocate and distribute moneys to the medical licensing boards on an analysis of the likelihood of overutilization of practice or fraud relating to automobile related injuries by practitioners under each medical licensing board's jurisdiction and the needs of each applicable board for the use of the funds after disbursement. (3) The funds collected pursuant to paragraph (1) shall be used solely by the health care fraud unit of the department of public health, the disciplinary unit of the board of registration in medicine and other medical licensing boards for the investigation of overutilization of practice or fraud involving automobile insurance claims. Any funds not expended by the various medical licensing boards within 12 months of their receipt shall be returned to the commissioner who shall keep the funds in a separate account. These funds shall be made available to the medical licensing boards during the next calendar year in accordance with this subsection. (e) Any data made available to or received by the medical licensing boards from the Automobile Insurers Bureau of Massachusetts pursuant to this act shall not be considered a ''public record'' as defined in clause Twenty-sixth of section 7 of chapter 4. (f) In the absence of fraud or bad faith, an insurer or employee or agent thereof, member of said insurance fraud bureau or an employee or an agent thereof, member of said medical licensing boards or an employee or agent thereof, member of said Automobile Insurers Bureau of Massachusetts or an employee or agent thereof, or other person subject to this section, shall not be subject to criminal or civil liability, and no civil cause of action of any nature shall arise against such person for any information relating to suspected over-treatment or fraudulent insurance transactions furnished to medical provider licensing boards or the insurance fraud bureau, their agents and employees pursuant to this section. Nothing herein is intended to abrogate or modify in any way common law privilege of immunity heretofore enjoyed by any person.

Section 113V. (a) For purposes of this section, the following words shall have the following meaning:—

''Automobile Insurers Bureau of Massachusetts'', the rating organization licensed by the commissioner under section 8 of chapter 175A, or its successor.

''Commissioner'', the commissioner of insurance.

''Insurance fraud bureau'', a bureau authorized by chapter 338 of the acts of 1990, or its successor.

''Medical licensing boards'', the board of registration in medicine and those boards of registration and examination in the department of public health which relate to medical or health care providers.

(b) At least annually, the medical licensing boards that receive funding pursuant to paragraph (3) of subsection (d) shall review the data made available to them by the Automobile Insurers Bureau of Massachusetts for indication of overutilization of practice or fraud involving automobile insurance claims by individual practitioners or by provider groups. Where overutilization of practice or fraud involving automobile insurance claims by 1 or more licensees is suspected, the board shall conduct an investigation. If the investigation results in evidence that a pattern of fraud, overutilization of practice, or professional misconduct exists, the medical licensing boards shall initiate professional disciplinary proceedings to determine whether that practitioner's or provider group's license should be suspended, revoked, or be subjected to some other appropriate penalty.

(c) If a licensee subject to the jurisdiction of the medical licensing boards has been convicted of insurance fraud, the medical licensing boards shall immediately initiate professional disciplinary proceedings to determine whether the applicable license should be suspended, revoked, or subjected to some other appropriate remedy.

(d)(1) The costs of this program shall be paid by the Automobile Insurers Bureau of Massachusetts and not passed on to holders of automobile insurance policies in the commonwealth. Each insurer licensed in the commonwealth to write a motor vehicle liability policy as defined in section 34A of chapter 90 shall pay the Automobile Insurers Bureau of Massachusetts an amount equal to 10 cents for each private passenger motor vehicle liability policy written as of December 31 of the preceding year, according to the records of the Automobile Insurers Bureau of Massachusetts. On or before March 1 of each year, the Automobile Insurers Bureau of Massachusetts shall remit the total amount paid under this subsection to the commissioner. An insurer shall not include the assessment paid under this section in any data used to fix and establish rates under section 113B of chapter 175.

(2) On or before March 1 of each year, the commissioner shall consult with an advisory group consisting of the attorney general or his designee, a district attorney or his designee to be appointed by the attorney general, a representative of the insurance fraud bureau, and 2 members of the public to be appointed by the governor on how the funds paid under subsection (1) should be distributed. Within 60 days of the receipt of said moneys, the commissioner shall allocate and distribute moneys to the medical licensing boards on an analysis of the likelihood of overutilization of practice or fraud relating to automobile related injuries by practitioners under each medical licensing board's jurisdiction and the needs of each applicable board for the use of the funds after disbursement.

(3) The funds collected pursuant to paragraph (1) shall be used solely by the health care fraud unit of the department of public health, the disciplinary unit of the board of registration in medicine and other medical licensing boards for the investigation of overutilization of practice or fraud involving automobile insurance claims. Any funds not expended by the various medical licensing boards within 12 months of their receipt shall be returned to the commissioner who shall keep the funds in a separate account. These funds shall be made available to the medical licensing boards during the next calendar year in accordance with this subsection.

(e) Any data made available to or received by the medical licensing boards from the Automobile Insurers Bureau of Massachusetts pursuant to this act shall not be considered a ''public record'' as defined in clause Twenty-sixth of section 7 of chapter 4.

(f) In the absence of fraud or bad faith, an insurer or employee or agent thereof, member of said insurance fraud bureau or an employee or an agent thereof, member of said medical licensing boards or an employee or agent thereof, member of said Automobile Insurers Bureau of Massachusetts or an employee or agent thereof, or other person subject to this section, shall not be subject to criminal or civil liability, and no civil cause of action of any nature shall arise against such person for any information relating to suspected over-treatment or fraudulent insurance transactions furnished to medical provider licensing boards or the insurance fraud bureau, their agents and employees pursuant to this section. Nothing herein is intended to abrogate or modify in any way common law privilege of immunity heretofore enjoyed by any person.