N.Y. Insurance Law § 5109: Unauthorized providers of health services

§ 5109. Unauthorized providers of health services. (a) The

superintendent, in consultation with the commissioner of health and the

commissioner of education, shall by regulation, promulgate standards and

procedures for investigating and suspending or removing the

authorization for providers of health services to demand or request

payment for health services as specified in paragraph one of subsection

(a) of section five thousand one hundred two of this article upon

findings reached after investigation pursuant to this section. Such

regulations shall ensure the same or greater due process provisions,

including notice and opportunity to be heard, as those afforded

physicians investigated under article two of the workers' compensation

law and shall include provision for notice to all providers of health

services of the provisions of this section and regulations promulgated

thereunder at least ninety days in advance of the effective date of such

regulations.

(b) The commissioner of health and the commissioner of education shall

provide a list of the names of all providers of health services who the

commissioner of health and the commissioner of education shall deem,

after reasonable investigation, not authorized to demand or request any

payment for medical services in connection with any claim under this

article because such provider of health services:

(1) has been guilty of professional or other misconduct or

incompetency in connection with medical services rendered under this

article; or

(2) has exceeded the limits of his or her professional competence in

rendering medical care under this article or has knowingly made a false

statement or representation as to a material fact in any medical report

made in connection with any claim under this article; or

(3) solicited, or has employed another to solicit for himself or

herself or for another, professional treatment, examination or care of

an injured person in connection with any claim under this article; or

(4) has refused to appear before, or to answer upon request of, the

commissioner of health, the superintendent, or any duly authorized

officer of the state, any legal question, or to produce any relevant

information concerning his or her conduct in connection with rendering

medical services under this article; or

(5) has engaged in patterns of billing for services which were not

provided.

(c) Providers of health services shall refrain from subsequently

treating for remuneration, as a private patient, any person seeking

medical treatment under this article if such provider pursuant to this

section has been prohibited from demanding or requesting any payment for

medical services under this article. An injured claimant so treated or

examined may raise this as a defense in any action by such provider for

payment for treatment rendered at any time after such provider has been

prohibited from demanding or requesting payment for medical services in

connection with any claim under this article.

(d) The commissioner of health and the commissioner of education shall

maintain and regularly update a database containing a list of providers

of health services prohibited by this section from demanding or

requesting any payment for health services connected to a claim under

this article and shall make such information available to the public by

means of a website and by a toll free number.

(e) Nothing in this section shall be construed as limiting in any

respect the powers and duties of the commissioner of health,

commissioner of education or the superintendent to investigate instances

of misconduct by a health care provider and, after a hearing and upon

written notice to the provider, to temporarily prohibit a provider of

health services under such investigation from demanding or requesting

any payment for medical services under this article for up to ninety

days from the date of such notice.