2023 New York Laws › WKC - Workers' Compensation › Article 2 - Compensation › 13-D - Removal of Providers From Lists of Those Authorized to Render Medical Care or to Conduct Independent Medical Examinations.

§  13-d. Removal of providers from lists of those authorized to render
medical care or to conduct  independent  medical  examinations.  1.  The
medical society of the county in which the physician's office is located
at  the  time  or  a  board designated by such county society or a board
representing duly licensed physicians of any  other  school  of  medical
practice  in  such county shall investigate, hear and make findings with
respect to all charges as to professional or  other  misconduct  of  any
authorized  physician as herein provided under rules and procedure to be
prescribed by the medical appeals unit, and  shall  report  evidence  of
such  misconduct,  with  their  findings and recommendation with respect
thereto, to the chair. Failure to  commence  such  investigation  within
sixty  days from the date the charges are referred to the society by the
chair or submit findings and recommendations  relating  to  the  charges
within  one  hundred  eighty days from the date the charges are referred
shall empower the chair to appoint, as a hearing officer,  a  member  of
the  board,  employee,  or  other  qualified hearing officer to hear and
report on the charges to the chair. A qualified hearing officer, who  is
neither  a  member  of the board, or employee thereof shall be paid at a
reasonable per diem rate to be fixed by the chair.
Such investigation, hearing, findings, recommendation and  report  may
be  made by the society or board of an adjoining county upon the request
of the medical society of the county in which the alleged misconduct  or
infraction  of  this  chapter  occurred,  subject  to the time limit and
conditions set forth herein. The medical appeals unit shall  review  the
findings and recommendation of such medical society or board, or hearing
officer appointed by the chair upon application of the accused physician
and  may  reopen  the matter and receive further evidence. The findings,
decision and recommendation of such society, board  or  hearing  officer
appointed  by the chair or medical appeals unit shall be advisory to the
chair only, and shall not be binding or conclusive upon him or her.
2. The chair shall remove from the list  of  providers  authorized  to
render  medical  care  under  this  chapter,  or  to conduct independent
medical examinations in accordance with  paragraph  (b)  of  subdivision
four of section thirteen-a of this article, the name of any provider who
he  or  she  shall  find  after reasonable investigation is disqualified
because such provider:
(a)  has  been  guilty  of  professional  or   other   misconduct   or
incompetency  in  connection  with  rendering medical services under the
law; or
(b) has exceeded the limits of his or her professional  competence  in
rendering medical care or in conducting independent medical examinations
under  the law, or has made materially false statements regarding his or
her qualifications in his or her application for the  recommendation  of
the  medical  society or board as provided in section thirteen-b of this
article; or
(c) has failed to transmit copies of  medical  reports  to  claimant's
attorney  or  licensed  representative as provided in subdivision (f) of
section thirteen of this article; or  has  failed  to  submit  full  and
truthful medical reports of all his or her findings to the employer, and
directly  to  the  chair or the board within the time limits provided in
subdivision  four  of  section  thirteen-a  of  this  article  with  the
exception  of injuries which do not require (1) more than ordinary first
aid or more than two treatments by a provider or person rendering  first
aid,  or  (2)  loss  of  time  from regular duties of one day beyond the
working day or shift; or
(d) knowingly made  a  false  statement  or  representation  as  to  a
material  fact in any medical report made pursuant to this chapter or in

testifying or otherwise providing information for the purposes  of  this
chapter; or
(e)  has  solicited, or has employed another to solicit for himself or
herself or for another, professional treatment, examination or  care  of
an injured employee in connection with any claim under this chapter; or
(f)  has  refused  to  appear  before,  to  testify,  to  submit  to a
deposition, or to answer upon request  of,  the  chair,  board,  medical
appeals  unit  or  any  duly  authorized officer of the state, any legal
question, or to produce any relevant book or paper concerning his or her
conduct under any  authorization  granted  to  him  or  her  under  this
chapter; or
(g)  has directly or indirectly requested, received or participated in
the division, transference, assignment, rebating, splitting or refunding
of a fee for, or has  directly  or  indirectly  requested,  received  or
profited  by  means  of  a  credit  or other valuable consideration as a
commission, discount or gratuity in connection with  the  furnishing  of
medical  or surgical care, an independent medical examination, diagnosis
or treatment or service, including X-ray examination and  treatment,  or
for  or  in connection with the sale, rental, supplying or furnishing of
clinical laboratory services or supplies, X-ray laboratory  services  or
supplies,  inhalation  therapy  service or equipment, ambulance service,
hospital or medical supplies, physiotherapy or other therapeutic service
or equipment, artificial limbs, teeth or eyes,  orthopedic  or  surgical
appliances  or  supplies,  optical  appliances,  supplies  or equipment,
devices for aid of hearing, drugs, medication or  medical  supplies,  or
any  other goods, services or supplies prescribed for medical diagnosis,
care or treatment, under this chapter; except that  reasonable  payment,
not  exceeding  the technical component fee permitted in the medical fee
schedule,  established  under  this  chapter  for  X-ray   examinations,
diagnosis  or  treatment, may be made by a provider duly authorized as a
roentgenologist to any hospital furnishing facilities and equipment  for
such  examination,  diagnosis  or treatment, provided such hospital does
not also submit a charge for the same  services.  Nothing  contained  in
this  paragraph  shall prohibit such providers who practice as partners,
in groups or as a professional corporation or as  a  university  faculty
practice  corporation  from  pooling fees and moneys received, either by
the partnership, professional corporation, university  faculty  practice
corporation or group by the individual members thereof, for professional
services furnished by any individual professional member, or employee of
such  partnership,  corporation  or  group,  nor shall the professionals
constituting the partnerships, corporations,  or  groups  be  prohibited
from  sharing,  dividing or apportioning the fees and moneys received by
them or by the partnership, corporation or group in  accordance  with  a
partnership or other agreement.
3.  Any person who violates or attempts to violate, and any person who
aids another to violate or attempts to induce him or her to violate  the
provisions  of paragraph (g) of subdivision two of this section shall be
guilty of a misdemeanor.
4. Nothing in this section shall  be  construed  as  limiting  in  any
respect  the  power  or  duty  of  the chair to investigate instances of
misconduct, either before or after investigation by a medical society or
board as herein provided, or to temporarily suspend the authorization of
any provider that he or she may believe to be guilty of such misconduct.
5. Whenever the department of health or the  department  of  education
shall  conduct  an investigation with respect to charges of professional
or  other  misconduct  by  a  provider  which  results  in   a   report,
determination  or  consent order that includes a finding of professional
or other misconduct or incompetency by such provider,  the  chair  shall

have  full  power  and  authority  to  temporarily  suspend,  revoke  or
otherwise limit the authorization under this  chapter  of  any  provider
upon  such  finding  by  the  department  of health or the department of
education  that  the  provider  has been guilty of professional or other
misconduct. The recommendations of  the  department  of  health  or  the
department  of  education  shall be advisory to the chair only and shall
not be binding or conclusive upon the chair.