Section 20-900
§ 20-900 Definitions. For the purposes of this chapter, the following
terms shall have the following meanings:
1. "Clinic" shall mean any private, non-residential medical facility
or practice, other than a hospital as defined in article 28 of the
public health law, which provides health care services in the city of
New York relating to injuries sustained as a result of motor vehicle
accidents.
2. "Control", including the terms "controlling", "controlled by" and
"under common control by or with", shall mean the possession, direct or
indirect, of the power to direct or cause the direction of the
management and policies of an institution, whether through ownership of
voting securities, by contract or otherwise.
3. "Health care provider" shall mean any physician or other health
care professional, including, but not limited to, dentists, nurses,
x-ray technicians, physical or occupational therapists, massage
therapists, acupuncturists, chiropractors and mental health service
professionals, licensed to practice in New York state.
4. "Health care services" shall mean any health or mental health
services provided by a health care provider relating to injuries
sustained as a result of an actual or alleged motor vehicle accident,
including but not limited to medical, hospital, surgical, nursing,
dental, ambulance, x-ray, diagnostic, prescription drug, prosthetic,
psychiatric, massage, acupuncture, chiropractic, and physical or
occupational therapy and rehabilitation services.
5. "Insured" shall mean any person who owns a policy of insurance
issued by a no-fault motor vehicle insurer that insures against losses
or liabilities arising out of the ownership, operation, or use of a
motor vehicle.
6. "Medical benefits" shall mean full or partial payments for health
care services.
7. "Motor vehicle" shall mean any vehicle operated upon a public
highway or public street propelled by any power other than muscular
power.
8. "No-fault insurance medical clinic" shall mean any clinic that is
subject to the requirements of this chapter.
9. "No-fault motor vehicle insurance medical claim" shall mean any
claim for medical benefits submitted to a no-fault motor vehicle insurer
under a policy issued by such no-fault motor vehicle insurer pursuant to
article 51 of the New York state insurance law, which provides "first
party benefits" as that term is defined in section 5102(b) of such
article.
10. "No-fault motor vehicle insurer" shall mean any insurer, company,
corporation, partnership or other individual or entity authorized to
transact or transacting business in New York state, or controlling or
controlled by or under common control by or with such insurer, company,
corporation, partnership or other individual or entity, which sells
policies of insurance that insure against losses or liabilities arising
out of the ownership, operation, or use of a motor vehicle.
11. "Owner" shall mean any owner, manager, operator or other person or
persons having control of a clinic and any authorized agent thereof.
12. "Runner" shall mean any person who, for a pecuniary benefit,
procures or attempts to procure a client, patient or customer when such
person knows, or a reasonable person would know, that the purpose of an
owner of a no-fault motor vehicle insurance medical clinic is to falsely
or fraudulently: (i) obtain medical benefits from a no-fault motor
vehicle insurer; or (ii) assert a claim against an insured or a no-fault
motor vehicle insurer for the provision of health care services to such
client, patient or customer; provided, however, that such term shall not
include a person who procures or attempts to procure clients, patients
or customers through public media or a person who refers clients,
patients or customers as authorized by law. Nothing in this chapter
shall be deemed to prohibit an agent, broker or employee of a health
maintenance organization from seeking to sell health maintenance
organization coverage or health insurance coverage to any individual or
group.
Section 20-901
§ 20-901 Reports. a. Where fifty percent or more of the billings for
medical benefits filed by any clinic within the preceding twelve months
were no-fault motor vehicle insurance medical claims, the owner of such
clinic shall submit a report to the department pursuant to paragraph c
of this subdivision.
b. Where fifty percent or more of the billings for medical benefits
filed by all clinics owned by the same owner within the preceding twelve
months were no-fault motor vehicle insurance medical claims, the owner
of such clinics shall submit a report to the department pursuant to
paragraph c of this subdivision.
c. Beginning December 1, 2006, any report to the department required
by this section shall include: (i) the name, physical address and
telephone number of each clinic under the control of such clinic's
owner; (ii) the name, address and telephone number of all owners of each
clinic; (iii) the name, address and telephone number of any management
company hired by each clinic, if applicable; and (iv) the percentage of
total medical bills filed within the preceding twelve months that were
no-fault motor vehicle insurance medical claims, disaggregated by
clinic, where applicable. Any owner of a no-fault insurance medical
clinic shall attach to such report a sworn statement stating that: (1)
within the preceding twelve months, no-fault motor vehicle insurance
claims comprised fifty percent or more of the total billings of an
individual clinic or all clinics owned by such owner; provided, however,
that the department shall not require disclosure of the actual amount of
no-fault insurance medical claims billed by any such clinic; and (2)
such clinic does not use, solicit, direct, hire or employ any runners.
Section 20-902
§ 20-902 Prohibited acts. a. No owner of a no-fault insurance medical
clinic shall use, solicit, direct, hire or employ any runner.
b. No person shall act as a runner.
Section 20-903
§ 20-903 Rules. The commissioner shall promulgate any rules as may be
necessary for the purposes of implementing and enforcing this chapter.
Section 20-904
§ 20-904 Violations and penalties. a. Any person who violates section
20-901 of this chapter shall be subject to a civil penalty of not less
than one thousand dollars nor more than ten thousand dollars for each
violation; provided, however, that the commissioner shall issue a
written warning in lieu of a civil penalty where the commissioner finds
that such person violated such section due to his or her reasonable
belief that the percentage of billings for no-fault motor vehicle
insurance medical claims filed by his or her clinic or clinics was not
at or above fifty percent during the preceding twelve months.
b. Any person who violates paragraph a of section 20-902 of this
chapter shall be guilty of a misdemeanor and shall be subject to a civil
penalty of not less than ten thousand dollars for each runner used,
solicited, directed, hired or employed, or a term of imprisonment not to
exceed one year, or both.
c. Any person who violates paragraph b of section 20-902 of this
chapter shall be guilty of a misdemeanor and shall be subject to a civil
penalty of not less than ten thousand dollars for each violation, or a
term of imprisonment not to exceed one year, or both.
d. Nothing in this section shall be construed to limit the imposition
of any other penalty that may be imposed pursuant to any other law, rule
or regulation.
Section 20-905
§ 20-905 Enforcement. The department shall enforce the provisions of
this chapter. A proceeding to recover any civil penalty authorized
pursuant to section 20-904 of this chapter shall be commenced by the
service of a notice of violation returnable to the administrative
tribunal of the department. The notice of violation or copy thereof when
filled in and served shall constitute notice of the violation charged.
The administrative tribunal shall have the power to render decisions and
to impose the remedies and penalties provided for in section 20-904 of
this chapter, in addition to any other remedies or penalties provided
for the enforcement of such provisions under any other law including,
but not limited to, civil or criminal actions or proceedings.
To the extent possible under law, Friends of Devin Balkind for Public Advocate has waived all copyright and related or neighboring rights to New York City Administrative Code. This work is published from: United States.
Special thanks to Benjarmin Kallos and Thom Neale who made this content publicly available as a bulk download.