Source: https://www.dfs.ny.gov/legal/leg_summ/2009/deptbill/S3552_No_Fault.htm
Timestamp: 2018-07-21 17:28:18
Document Index: 129417916

Matched Legal Cases: ['§ 5109', '§ 176', '§ 5109', '§ 5109', '§ 5109', '§ 5109', '§ 5109', '§ 5109', '§ 5109', '§ 5109']

Legislative Summary - Department Bill - 2009: "No-Fault; Unauthorized Providers" S. 3552 (Breslin)/A. 7128 (Morelle)
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.