When Licensed Professionals Commit Insurance Fraud

Doctors

Consider, for example, that about a year-and-a-half ago, 18 doctors and other health service providers took a hit to their pocketbooks when the New York Department of Financial Services (DFS) announced that it was banning them from billing New York's no-fault auto insurance system. (N.Y. Ins. Law ' 5101 et seq.; 11 N.Y.C.R.R. ' 65 et seq. Under New York's no-fault law, every vehicle registered in New York is required to have no-fault automobile insurance, which enables the driver and passengers of a registered and insured vehicle to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, regardless of fault. The law requires prompt payment for medical treatment, thereby obviating the need for claimants to file personal injury lawsuits in order to be reimbursed. Patients can assign their right to reimbursement from an insurance company to others, including medical clinics that provide treatment for their injuries. The law also requires that all medical clinics in the state be incorporated, owned, operated, or controlled by a licensed medical practitioner to be eligible for no-fault reimbursement. Insurance companies need not honor claims for medical treatments from a medical clinic that is not actually owned, operated, and controlled by a licensed medical practitioner.)