N.Y. WKC Law § 13-D — New York Code / Act WKC / Article 2 / Section 13-D
Removal of providers from lists of those authorized to render medical care or to conduct independent medical examinations
Status: in_force

* § 13-d. Removal of providers from lists of those authorized to\nrender medical care or to conduct independent medical examinations. 1.\nThe medical society of the county in which the physician's office is\nlocated at the time or a board designated by such county society or a\nboard representing duly licensed physicians of any other school of\nmedical practice in such county shall investigate, hear and make\nfindings with respect to all charges as to professional or other\nmisconduct of any authorized physician as herein provided under rules\nand procedure to be prescribed by the medical appeals unit, and shall\nreport evidence of such misconduct, with their findings and\nrecommendation with respect thereto, to the chair. Failure to commence\nsuch investigation within sixty days from the date the charges are\nreferred to the society by the chair or submit findings and\nrecommendations relating to the charges within one hundred eighty days\nfrom the date the charges are referred shall empower the chair to\nappoint, as a hearing officer, a member of the board, employee, or other\nqualified hearing officer to hear and report on the charges to the\nchair. A qualified hearing officer, who is neither a member of the\nboard, or employee thereof shall be paid at a reasonable per diem rate\nto be fixed by the chair.\n  Such investigation, hearing, findings, recommendation and report may\nbe made by the society or board of an adjoining county upon the request\nof the medical society of the county in which the alleged misconduct or\ninfraction of this chapter occurred, subject to the time limit and\nconditions set forth herein. The medical appeals unit shall review the\nfindings and recommendation of such medical society or board, or hearing\nofficer appointed by the chair upon application of the accused physician\nand may reopen the matter and receive further evidence. The findings,\ndecision and recommendation of such society, board or hearing officer\nappointed by the chair or medical appeals unit shall be advisory to the\nchair only, and shall not be binding or conclusive upon him or her.\n  2. The chair shall remove from the list of providers authorized to\nrender medical care under this chapter, or to conduct independent\nmedical examinations in accordance with paragraph (b) of subdivision\nfour of section thirteen-a of this article, the name of any provider who\nhe or she shall find after reasonable investigation is disqualified\nbecause such provider:\n  (a) has been guilty of professional or other misconduct or\nincompetency in connection with rendering medical services under the\nlaw; or\n  (b) has exceeded the limits of his or her professional competence in\nrendering medical care or in conducting independent medical examinations\nunder the law, or has made materially false statements regarding his or\nher qualifications in his or her application for the recommendation of\nthe medical society or board as provided in section thirteen-b of this\narticle; or\n  (c) has failed to transmit copies of medical reports to claimant's\nattorney or licensed representative as provided in subdivision (f) of\nsection thirteen of this article; or has failed to submit full and\ntruthful medical reports of all his or her findings to the employer, and\ndirectly to the chair or the board within the time limits provided in\nsubdivision four of section thirteen-a of this article with the\nexception of injuries which do not require (1) more than ordinary first\naid or more than two treatments by a provider or person rendering first\naid, or (2) loss of time from regular duties of one day beyond the\nworking day or shift; or\n  (d) knowingly made a false statement or representation as to a\nmaterial fact in any medical report made pursuant to this chapter or in\ntestifying or otherwise providing information for the purposes of this\nchapter; or\n  (e) has solicited, or has employed another to solicit for himself or\nherself or for another, professional treatment, examination or care of\nan injured employee in connection with any claim under this chapter; or\n  (f) has refused to appear before, to testify, to submit to a\ndeposition, or to answer upon request of, the chair, board, medical\nappeals unit or any duly authorized officer of the state, any legal\nquestion, or to produce any relevant book or paper concerning his or her\nconduct under any authorization granted to him or her under this\nchapter; or\n  (g) has directly or indirectly requested, received or participated in\nthe division, transference, assignment, rebating, splitting or refunding\nof a fee for, or has directly or indirectly requested, received or\nprofited by means of a credit or other valuable consideration as a\ncommission, discount or gratuity in connection with the furnishing of\nmedical or surgical care, an independent medical examination, diagnosis\nor treatment or service, including X-ray examination and treatment, or\nfor or in connection with the sale, rental, supplying or furnishing of\nclinical laboratory services or supplies, X-ray laboratory services or\nsupplies, inhalation therapy service or equipment, ambulance service,\nhospital or medical supplies, physiotherapy or other therapeutic service\nor equipment, artificial limbs, teeth or eyes, orthopedic or surgical\nappliances or supplies, optical appliances, supplies or equipment,\ndevices for aid of hearing, drugs, medication or medical supplies, or\nany other goods, services or supplies prescribed for medical diagnosis,\ncare or treatment, under this chapter; except that reasonable payment,\nnot exceeding the technical component fee permitted in the medical fee\nschedule, established under this chapter for X-ray examinations,\ndiagnosis or treatment, may be made by a provider duly authorized as a\nroentgenologist to any hospital furnishing facilities and equipment for\nsuch examination, diagnosis or treatment, provided such hospital does\nnot also submit a charge for the same services. Nothing contained in\nthis paragraph shall prohibit such providers who practice as partners,\nin groups or as a professional corporation or as a university faculty\npractice corporation from pooling fees and moneys received, either by\nthe partnership, professional corporation, university faculty practice\ncorporation or group by the individual members thereof, for professional\nservices furnished by any individual professional member, or employee of\nsuch partnership, corporation or group, nor shall the professionals\nconstituting the partnerships, corporations, or groups be prohibited\nfrom sharing, dividing or apportioning the fees and moneys received by\nthem or by the partnership, corporation or group in accordance with a\npartnership or other agreement.\n  3. Any person who violates or attempts to violate, and any person who\naids another to violate or attempts to induce him or her to violate the\nprovisions of paragraph (g) of subdivision two of this section shall be\nguilty of a misdemeanor.\n  4. Nothing in this section shall be construed as limiting in any\nrespect the power or duty of the chair to investigate instances of\nmisconduct, either before or after investigation by a medical society or\nboard as herein provided, or to temporarily suspend the authorization of\nany provider that he or she may believe to be guilty of such misconduct.\n  5. Whenever the department of health or the department of education\nshall conduct an investigation with respect to charges of professional\nor other misconduct by a provider which results in a report,\ndetermination or consent order that includes a finding of professional\nor other misconduct or incompetency by such provider, the chair shall\nhave full power and authority to temporarily suspend, revoke or\notherwise limit the authorization under this chapter of any provider\nupon such finding by the department of health or the department of\neducation that the provider has been guilty of professional or other\nmisconduct. The recommendations of the department of health or the\ndepartment of education shall be advisory to the chair only and shall\nnot be binding or conclusive upon the chair.\n  * NB Effective until January 1, 2028\n  * § 13-d. Placement of providers on the exclusion list. 1. In\naccordance with this section, the chair shall publish and maintain an\nexclusion list of providers currently disqualified from rendering\nmedical care or treatment under this chapter or disqualified from\nconducting independent medical examinations in accordance with paragraph\n(b) of subdivision four of section thirteen-a and section one hundred\nthirty-seven of this chapter.\n  2. The exclusion list shall include the name of any provider who is\nfound after reasonable investigation to be disqualified because such\nprovider:\n  (a) has been guilty of professional or other misconduct or\nincompetency in connection with rendering medical services under the\nlaw; or\n  (b) has exceeded the limits of their professional competence in\nrendering medical care or treatment or in conducting independent medical\nexaminations under the law, or has, as applicable, made materially false\nstatements regarding their qualifications in their application; or\n  (c) has failed to transmit copies of medical reports to claimant's\nattorney or licensed representative as provided in subdivision (f) of\nsection thirteen of this article; or has failed to submit full and\ntruthful medical reports of all their findings to the employer, and\ndirectly to the chair or the board within the time limits provided in\nsubdivision four of section thirteen-a of this article with the\nexception of injuries which do not require (1) more than ordinary first\naid or more than two treatments by a provider or person rendering first\naid, or (2) loss of time from regular duties of one day beyond the\nworking day or shift; or\n  (d) knowingly made a false statement or representation as to a\nmaterial fact in any medical report, or in any submission to the board,\nmade pursuant to this chapter or in testifying or otherwise providing\ninformation for the purposes of this chapter; or\n  (e) has solicited, or has employed another to solicit for either the\nprovider's own benefit themself or for another, professional treatment,\nexamination or care of an injured employee in connection with any claim\nunder this chapter; or\n  (f) has refused to appear before, to testify, to submit to a\ndeposition, or to answer upon request of, the chair, board, or any duly\nauthorized officer of the state, any legal question, or to produce any\nrelevant book or paper concerning their conduct in rendering medical\ncare or treatment or in the performance of an independent medical\nexamination under this chapter, including when a provider has accepted\npayments from both the health insurer and employer or carrier and failed\nto reimburse the health insurer after they are given notice; or\n  (g) has directly or indirectly requested, received or participated in\nthe division, transference, assignment, rebating, splitting or refunding\nof a fee for, or has directly or indirectly requested, received or\nprofited by means of a credit or other valuable consideration as a\ncommission, discount or gratuity in connection with the furnishing of\nmedical or surgical care, an independent medical examination, diagnosis\nor treatment or service, including X-ray examination and treatment, or\nfor or in connection with the sale, rental, supplying or furnishing of\nclinical laboratory services or supplies, X-ray laboratory services or\nsupplies, inhalation therapy service or equipment, ambulance service,\nhospital or medical supplies, physiotherapy or other therapeutic service\nor equipment, artificial limbs, teeth or eyes, orthopedic or surgical\nappliances or supplies, optical appliances, supplies or equipment,\ndevices for aid of hearing, drugs, medication or medical supplies, or\nany other goods, services or supplies prescribed for medical diagnosis,\ncare or treatment, under this chapter; except that reasonable payment,\nnot exceeding the technical component fee permitted in the medical fee\nschedule, established under this chapter for X-ray examinations,\ndiagnosis or treatment, may be made by a provider duly authorized as a\nroentgenologist to any hospital furnishing facilities and equipment for\nsuch examination, diagnosis or treatment, provided such hospital does\nnot also submit a charge for the same services. Nothing contained in\nthis paragraph shall prohibit such providers who practice as partners,\nin groups or as a professional corporation or as a university faculty\npractice corporation from pooling fees and moneys received, either by\nthe partnership, professional corporation, university faculty practice\ncorporation or group by the individual members thereof, for professional\nservices furnished by any individual professional member, or employee of\nsuch partnership, corporation or group, nor shall the professionals\nconstituting the partnerships, corporations, or groups be prohibited\nfrom sharing, dividing or apportioning the fees and moneys received by\nthem or by the partnership, corporation or group in accordance with a\npartnership or other agreement; or\n  (h) has demonstrated a repeated failure to follow the laws of this\nchapter and applicable laws, regulations, and guidance, including any\napplicable New York medical treatment guidelines and the official New\nYork medical fee schedule(s); or\n  (i) has misrepresented their credentials; or\n  (j) has failed to timely complete any trainings required by the chair;\nor\n  (k) had previously lost the privilege to treat injured workers by\nbeing suspended, removed, denied authorization, or by voluntarily\nresigning their authorization under this chapter prior to January first,\ntwo thousand twenty-eight, and whose authorization had not been restored\nprior to January first, two thousand twenty-eight.\n  3. Any person who violates or attempts to violate, and any person who\naids another to violate or attempts to induce them to violate the\nprovisions of paragraph (g) of subdivision two of this section shall be\nguilty of a misdemeanor.\n  4. Nothing in this section shall be construed as limiting in any\nrespect the power or duty of the chair to investigate instances of\nmisconduct, either before or after investigation by a medical society or\nboard as herein provided, or to add any provider to the exclusion list\nthat the chair or the chair's designee may believe to be guilty of such\nmisconduct.\n  5. Whenever the department of health or the department of education\nshall conduct an investigation with respect to charges of professional\nor other misconduct by a provider which results in a report,\ndetermination or consent order that includes a finding of professional\nor other misconduct or incompetency by such provider, the chair shall\nhave full power and authority to add any provider to the exclusion list\nupon such finding by the department of health or the department of\neducation that the provider has been guilty of professional or other\nmisconduct. The recommendations of the department of health or the\ndepartment of education shall be advisory to the chair only and shall\nnot be binding or conclusive upon the chair.\n  6. The chair may promulgate regulations to effectuate the publication\nand maintenance of the exclusion list. Providers on the exclusion list\nmay petition the board to be taken off the exclusion list in a format\nprescribed by the chair.\n  * NB Effective January 1, 2028\n