N.Y. Workers' Compensation Law § 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.

* NB Effective until January 1, 2028

* § 13-d. Placement of providers on the exclusion list. 1. In

accordance with this section, the chair shall publish and maintain an

exclusion list of providers currently disqualified from rendering

medical care or treatment under this chapter or disqualified from

conducting independent medical examinations in accordance with paragraph

(b) of subdivision four of section thirteen-a and section one hundred

thirty-seven of this chapter.

2. The exclusion list shall include the name of any provider who is

found after reasonable investigation to be 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 their professional competence in

rendering medical care or treatment or in conducting independent medical

examinations under the law, or has, as applicable, made materially false

statements regarding their qualifications in their application; 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 their 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, or in any submission to the board,

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 either the

provider's own benefit themself 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, or any duly

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

relevant book or paper concerning their conduct in rendering medical

care or treatment or in the performance of an independent medical

examination under this chapter, including when a provider has accepted

payments from both the health insurer and employer or carrier and failed

to reimburse the health insurer after they are given notice; 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; or

(h) has demonstrated a repeated failure to follow the laws of this

chapter and applicable laws, regulations, and guidance, including any

applicable New York medical treatment guidelines and the official New

York medical fee schedule(s); or

(i) has misrepresented their credentials; or

(j) has failed to timely complete any trainings required by the chair;

or

(k) had previously lost the privilege to treat injured workers by

being suspended, removed, denied authorization, or by voluntarily

resigning their authorization under this chapter prior to January first,

two thousand twenty-eight, and whose authorization had not been restored

prior to January first, two thousand twenty-eight.

3. Any person who violates or attempts to violate, and any person who

aids another to violate or attempts to induce them 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 add any provider to the exclusion list

that the chair or the chair's designee 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 add any provider to the exclusion list

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.

6. The chair may promulgate regulations to effectuate the publication

and maintenance of the exclusion list. Providers on the exclusion list

may petition the board to be taken off the exclusion list in a format

prescribed by the chair.

* NB Effective January 1, 2028