N.Y. ISC Law § 5109 — New York Code / Act ISC / Article 51 / Section 5109
Unauthorized providers of health services
Status: in_force

§ 5109. Unauthorized providers of health services. (a) The\nsuperintendent, in consultation with the commissioner of health and the\ncommissioner of education, shall by regulation, promulgate standards and\nprocedures for investigating and suspending or removing the\nauthorization for providers of health services to demand or request\npayment for health services as specified in paragraph one of subsection\n(a) of section five thousand one hundred two of this article upon\nfindings reached after investigation pursuant to this section. Such\nregulations shall ensure the same or greater due process provisions,\nincluding notice and opportunity to be heard, as those afforded\nphysicians investigated under article two of the workers' compensation\nlaw and shall include provision for notice to all providers of health\nservices of the provisions of this section and regulations promulgated\nthereunder at least ninety days in advance of the effective date of such\nregulations.\n  (b) The commissioner of health and the commissioner of education shall\nprovide a list of the names of all providers of health services who the\ncommissioner of health and the commissioner of education shall deem,\nafter reasonable investigation, not authorized to demand or request any\npayment for medical services in connection with any claim under this\narticle because such provider of health services:\n  (1) has been guilty of professional or other misconduct or\nincompetency in connection with medical services rendered under this\narticle; or\n  (2) has exceeded the limits of his or her professional competence in\nrendering medical care under this article or has knowingly made a false\nstatement or representation as to a material fact in any medical report\nmade in connection with any claim under this article; or\n  (3) solicited, or has employed another to solicit for himself or\nherself or for another, professional treatment, examination or care of\nan injured person in connection with any claim under this article; or\n  (4) has refused to appear before, or to answer upon request of, the\ncommissioner of health, the superintendent, or any duly authorized\nofficer of the state, any legal question, or to produce any relevant\ninformation concerning his or her conduct in connection with rendering\nmedical services under this article; or\n  (5) has engaged in patterns of billing for services which were not\nprovided.\n  (c) Providers of health services shall refrain from subsequently\ntreating for remuneration, as a private patient, any person seeking\nmedical treatment under this article if such provider pursuant to this\nsection has been prohibited from demanding or requesting any payment for\nmedical services under this article. An injured claimant so treated or\nexamined may raise this as a defense in any action by such provider for\npayment for treatment rendered at any time after such provider has been\nprohibited from demanding or requesting payment for medical services in\nconnection with any claim under this article.\n  (d) The commissioner of health and the commissioner of education shall\nmaintain and regularly update a database containing a list of providers\nof health services prohibited by this section from demanding or\nrequesting any payment for health services connected to a claim under\nthis article and shall make such information available to the public by\nmeans of a website and by a toll free number.\n  (e) Nothing in this section shall be construed as limiting in any\nrespect the powers and duties of the commissioner of health,\ncommissioner of education or the superintendent to investigate instances\nof misconduct by a health care provider and, after a hearing and upon\nwritten notice to the provider, to temporarily prohibit a provider of\nhealth services under such investigation from demanding or requesting\nany payment for medical services under this article for up to ninety\ndays from the date of such notice.\n