N.Y. Comp. Codes R. & Regs. tit. 11 § 68.8

Current through Register Vol. 46, No. 51, December 18, 2024

Section 68.8 - Insurers' reports relating to health providers

(a) Insurers shall report any pattern of overcharging, excessive treatment or any other improper actions by a health provider, within 30 days after such insurer has knowledge of such pattern to the No-Fault Unit, Property Bureau, New York State Insurance Department, 25 Beaver Street, New York, NY 10004, and to the following:

(1) Complaints about:

(i) Physicians and physicians' assistants.

New York State Department of Health

Office of Professional Medical Conduct

433 River Street, Suite 303

Troy, NY 12180

(ii) Hospitals.

New York State Department of Health

Centralized Hospital Intake Program

433 River Street, 6th Floor

Troy, NY 12180

(iii) Other health providers. (Complaint should be sent to the nearest office based on the location of the health provider.)

Central Administration

Office of Professional Discipline

New York State Education Department

475 Park Avenue South, 2nd Floor

New York, NY 10016-6901

Albany

Office of Professional Discipline

New York State Education Department

80 Wolf Road, 2nd Floor

Albany, NY 12205-2643

Brooklyn, Staten Island

Office of Professional Discipline

New York State Education Department

196 Montague Street, 4th Floor

Brooklyn, NY 11201

Buffalo

Office of Professional Discipline

New York State Education Department

295 Main Street, Suite 756

Buffalo, NY 14203

Bronx/Queens

Office of Professional Discipline

New York State Education Department

2400 Halsey Avenue

Bronx, NY 10461

Mid-Hudson Region

Office of Professional Discipline

New York State Education Department

One Gateway Plaza, 3rd Floor

Port Chester, NY 10573

Nassau/Suffolk

Office of Professional Discipline

New York State Education Department

1121 Walt Whitman Road, Suite 301

Melville, NY 11747

Manhattan

Office of Professional Discipline

New York State Education Department

163 West 125th Street, Room 819

New York, NY 10027

Syracuse

Office of Professional Discipline

New York State Education Department

State Tower Building

108 South Warren Street, Suite 320

Syracuse, NY 13202

Rochester

Office of Professional Discipline

New York State Education Department

220 Idlewood Road, Room 106

Rochester, NY 14618

(b) A pattern of overcharging, excessive treatment or any other improper actions is present when such actions involve three or more patients. In determining whether a pattern of overcharging exists, insurers shall not consider as overcharging any charge which is based upon:

(1) a "BR" or "by special agreement" unit value listing in the medical fee schedule;

(2) the presence of unique circumstances or the performance of an unusual procedure, as authorized by section 68.5 of this Part; or

(3) the provider's determination of an appropriate fee consistent with permissible charges for comparable or similar procedures, as authorized by section 68.6 of this Part.

Insurers must designate a claims person in each no-fault claim processing office to maintain a master file of each instance of overcharging, excessive treatment or any other improper action on the part of a health service provider. Notwithstanding the above, insurers shall report any known instance where the claimant has paid the provider the difference between the provider's charge and the maximum allowable fee or where the provider has charged for treatment not rendered.

(c) Reports alleging a pattern of overcharging shall be subject to a hearing by the department in accordance with Part 4 of this Title.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 68.8