S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  7128

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             March 23, 2009
                               ___________

Introduced  by M. of A. MORELLE, SPANO -- Multi-Sponsored by -- M. of A.
  GALEF, GREENE, JOHN, MAGEE -- (at request of the New York State Insur-
  ance Department) -- read once and referred to the Committee on  Insur-
  ance

AN ACT to amend the insurance law, in relation to unauthorized providers
  of health services

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The opening paragraph of section 5102 of the insurance  law
is amended and a new subsection (n) is added to read as follows:
  In this [chapter] ARTICLE:
  (N) "PROVIDER OF HEALTH SERVICES" MEANS A PERSON OR ENTITY WHO RENDERS
HEALTH SERVICES.
  S 2. Section 5109 of the insurance law, as added by chapter 423 of the
laws of 2005, is amended to read as follows:
  S  5109.  Unauthorized  providers  of health services. (a) [The super-
intendent, 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 authori-
zation 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  inves-
tigated  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]
AS  USED  IN  THIS  SECTION, "HEALTH SERVICES" MEANS SERVICES, SUPPLIES,
THERAPIES OR OTHER TREATMENTS AS SPECIFIED IN SUBPARAGRAPH (I), (II)  OR

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07511-05-9
              

A. 7128                             2

(IV)  OF  PARAGRAPH  ONE  OF SUBSECTION (A) OF SECTION FIVE THOUSAND ONE
HUNDRED TWO OF THIS ARTICLE.
  (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]  THE  SUPERINTENDENT  MAY  PROHIBIT  A
provider  of  health  services  FROM DEMANDING OR REQUESTING PAYMENT FOR
HEALTH SERVICES RENDERED UNDER THIS ARTICLE, 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 [or other]
misconduct, AS DEFINED  IN  THE  EDUCATION  LAW,  [or  incompetency]  in
connection  with  [medical] HEALTH 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)]  (2)  solicited,  or [has] employed another PERSON to solicit for
[himself or herself] THE PROVIDER OF HEALTH SERVICES  or  [for]  another
PERSON  OR  ENTITY,  professional  treatment, examination or care of [an
injured] A person in connection with any claim under this article; [or
  (4) has] (3) refused to appear before, or  [to]  answer  ANY  QUESTION
upon  request of, the [commissioner of health, the] superintendent[,] or
any duly authorized officer of [the] THIS state, [any  legal  question,]
or  REFUSED  to produce any relevant information concerning [his or her]
THE conduct OF THE  PROVIDER  OF  HEALTH  SERVICES  in  connection  with
[rendering medical] HEALTH services RENDERED under this article; [or
  (5) has] (4) engaged in [patterns] A PATTERN of billing for:
  (A)  HEALTH  services [which] ALLEGED TO HAVE BEEN RENDERED UNDER THIS
ARTICLE, WHEN THE HEALTH SERVICES were not [provided.] RENDERED; OR
  (B) UNNECESSARY HEALTH SERVICES;
  (5) UTILIZED UNLICENSED PERSONS TO RENDER HEALTH SERVICES  UNDER  THIS
ARTICLE, WHEN ONLY A PERSON LICENSED IN THIS STATE MAY RENDER THE HEALTH
SERVICES;
  (6)  UTILIZED LICENSED PERSONS TO RENDER HEALTH SERVICES, WHEN RENDER-
ING THE HEALTH SERVICES IS BEYOND THE AUTHORIZED SCOPE OF  THE  PERSON'S
LICENSE;
  (7) CEDED OWNERSHIP, OPERATION OR CONTROL OF A BUSINESS ENTITY AUTHOR-
IZED  TO  PROVIDE  PROFESSIONAL HEALTH SERVICES IN THIS STATE, INCLUDING
BUT NOT LIMITED TO  A  PROFESSIONAL  SERVICE  CORPORATION,  PROFESSIONAL
LIMITED  LIABILITY  COMPANY OR REGISTERED LIMITED LIABILITY PARTNERSHIP,
TO A PERSON NOT LICENSED TO RENDER THE HEALTH  SERVICES  FOR  WHICH  THE
ENTITY  IS  LEGALLY  AUTHORIZED  TO PROVIDE, EXCEPT WHERE THE UNLICENSED
PERSON'S OWNERSHIP, OPERATION OR CONTROL IS OTHERWISE PERMITTED BY LAW;
  (8) COMMITTED A FRAUDULENT INSURANCE ACT AS DEFINED IN SECTION  176.05
OF THE PENAL LAW;
  (9)  HAS  BEEN  CONVICTED OF A CRIME INVOLVING FRAUDULENT OR DISHONEST
PRACTICES; OR
  (10) VIOLATED ANY PROVISION OF THIS ARTICLE OR REGULATIONS PROMULGATED
THEREUNDER.
  (c) [Providers] A PROVIDER of  health  services  shall  [refrain  from
subsequently treating for remuneration, as a private patient, any person
seeking  medical treatment] NOT DEMAND OR REQUEST PAYMENT FOR ANY HEALTH

A. 7128                             3

SERVICES 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] THAT ARE RENDERED DURING THE TERM OF THE PROHIBITION
ORDERED BY  THE  SUPERINTENDENT  PURSUANT  TO  SUBSECTION  (B)  OF  THIS
SECTION.  THE PROHIBITION ORDERED BY THE SUPERINTENDENT MAY BE a defense
in any action by [such] THE provider OF HEALTH SERVICES 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] SUCH HEALTH SERVICES.
  (d)  The  [commissioner  of  health and the commissioner of education]
SUPERINTENDENT shall maintain [and regularly update] a database contain-
ing a list of providers of health services prohibited  by  this  section
from  demanding or requesting any payment for health services [connected
to a claim] RENDERED under this article and shall make [such] THE infor-
mation available to the public [by means of a website and by a toll free
number].
  (E) THE SUPERINTENDENT MAY LEVY A CIVIL PENALTY  NOT  EXCEEDING  FIFTY
THOUSAND DOLLARS ON ANY PROVIDER OF HEALTH SERVICES THAT THE SUPERINTEN-
DENT  PROHIBITS FROM DEMANDING OR REQUESTING PAYMENT FOR HEALTH SERVICES
PURSUANT TO SUBSECTION (B) OF THIS SECTION. ANY  CIVIL  PENALTY  IMPOSED
FOR  A  FRAUDULENT  INSURANCE  ACT,  AS DEFINED IN SECTION 176.05 OF THE
PENAL LAW, SHALL BE LEVIED PURSUANT TO ARTICLE FOUR OF THIS CHAPTER.
  [(e)] (F) Nothing in this section shall be construed  as  limiting  in
any respect the powers and duties of the commissioner of health, commis-
sioner  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] OF HEALTH SERVICES AND TAKE APPROPRI-
ATE ACTION PURSUANT TO ANY OTHER PROVISION OF LAW.   A DETERMINATION  OF
THE  SUPERINTENDENT PURSUANT TO SUBSECTION (B) OF THIS SECTION SHALL NOT
BE BINDING UPON THE COMMISSIONER OF HEALTH OR THE COMMISSIONER OF EDUCA-
TION IN A  PROFESSIONAL  DISCIPLINE  PROCEEDING  RELATING  TO  THE  SAME
CONDUCT.
  S 3. This act shall take effect immediately.