11 CRR-NY 68.8NY-CRR
11 CRR-NY 68.8
11 CRR-NY 68.8
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 Department of Financial Services, One State 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.
11 CRR-NY 68.8
Current through May 31, 2021
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