N.Y. Workers' Compensation Law Section 13-D
Removal of providers from lists of those authorized to render medical care or to conduct independent medical examinations


1.

The medical society of the county in which the physician’s office is located at the time or a board designated by such county society or a board representing duly licensed physicians of any other school of medical practice in such county shall investigate, hear and make findings with respect to all charges as to professional or other misconduct of any authorized physician as herein provided under rules and procedure to be prescribed by the medical appeals unit, and shall report evidence of such misconduct, with their findings and recommendation with respect thereto, to the chair. Failure to commence such investigation within sixty days from the date the charges are referred to the society by the chair or submit findings and recommendations relating to the charges within one hundred eighty days from the date the charges are referred shall empower the chair to appoint, as a hearing officer, a member of the board, employee, or other qualified hearing officer to hear and report on the charges to the chair. A qualified hearing officer, who is neither a member of the board, or employee thereof shall be paid at a reasonable per diem rate to be fixed by the chair. Such investigation, hearing, findings, recommendation and report may be made by the society or board of an adjoining county upon the request of the medical society of the county in which the alleged misconduct or infraction of this chapter occurred, subject to the time limit and conditions set forth herein. The medical appeals unit shall review the findings and recommendation of such medical society or board, or hearing officer appointed by the chair upon application of the accused physician and may reopen the matter and receive further evidence. The findings, decision and recommendation of such society, board or hearing officer appointed by the chair or medical appeals unit shall be advisory to the chair only, and shall not be binding or conclusive upon him or her.

2.

The chair shall remove from the list of providers authorized to render medical care under this chapter, or to conduct independent medical examinations in accordance with paragraph (b) of subdivision four of § 13-A (Selection of authorized physician by employee)section thirteen-a of this article, the name of any provider who he or she shall find after reasonable investigation is disqualified because such provider:

(a)

has been guilty of professional or other misconduct or incompetency in connection with rendering medical services under the law; or

(b)

has exceeded the limits of his or her professional competence in rendering medical care or in conducting independent medical examinations under the law, or has made materially false statements regarding his or her qualifications in his or her application for the recommendation of the medical society or board as provided in § 13-B (Authorization of providers, medical bureaus and laboratories by the chair)section thirteen-b of this article; or

(c)

has failed to transmit copies of medical reports to claimant’s attorney or licensed representative as provided in subdivision (f) of § 13 (Treatment and care of injured employees)section thirteen of this article; or has failed to submit full and truthful medical reports of all his or her findings to the employer, and directly to the chair or the board within the time limits provided in subdivision four of § 13-A (Selection of authorized physician by employee)section thirteen-a of this article with the exception of injuries which do not require (1) more than ordinary first aid or more than two treatments by a provider or person rendering first aid, or

(2)

loss of time from regular duties of one day beyond the working day or shift; or

(d)

knowingly made a false statement or representation as to a material fact in any medical report made pursuant to this chapter or in testifying or otherwise providing information for the purposes of this chapter; or

(e)

has solicited, or has employed another to solicit for himself or herself or for another, professional treatment, examination or care of an injured employee in connection with any claim under this chapter; or

(f)

has refused to appear before, to testify, to submit to a deposition, or to answer upon request of, the chair, board, medical appeals unit or any duly authorized officer of the state, any legal question, or to produce any relevant book or paper concerning his or her conduct under any authorization granted to him or her under this chapter; or

(g)

has directly or indirectly requested, received or participated in the division, transference, assignment, rebating, splitting or refunding of a fee for, or has directly or indirectly requested, received or profited by means of a credit or other valuable consideration as a commission, discount or gratuity in connection with the furnishing of medical or surgical care, an independent medical examination, diagnosis or treatment or service, including X-ray examination and treatment, or for or in connection with the sale, rental, supplying or furnishing of clinical laboratory services or supplies, X-ray laboratory services or supplies, inhalation therapy service or equipment, ambulance service, hospital or medical supplies, physiotherapy or other therapeutic service or equipment, artificial limbs, teeth or eyes, orthopedic or surgical appliances or supplies, optical appliances, supplies or equipment, devices for aid of hearing, drugs, medication or medical supplies, or any other goods, services or supplies prescribed for medical diagnosis, care or treatment, under this chapter; except that reasonable payment, not exceeding the technical component fee permitted in the medical fee schedule, established under this chapter for X-ray examinations, diagnosis or treatment, may be made by a provider duly authorized as a roentgenologist to any hospital furnishing facilities and equipment for such examination, diagnosis or treatment, provided such hospital does not also submit a charge for the same services. Nothing contained in this paragraph shall prohibit such providers who practice as partners, in groups or as a professional corporation or as a university faculty practice corporation from pooling fees and moneys received, either by the partnership, professional corporation, university faculty practice corporation or group by the individual members thereof, for professional services furnished by any individual professional member, or employee of such partnership, corporation or group, nor shall the professionals constituting the partnerships, corporations, or groups be prohibited from sharing, dividing or apportioning the fees and moneys received by them or by the partnership, corporation or group in accordance with a partnership or other agreement.

3.

Any person who violates or attempts to violate, and any person who aids another to violate or attempts to induce him or her to violate the provisions of paragraph (g) of subdivision two of this section shall be guilty of a misdemeanor.

4.

Nothing in this section shall be construed as limiting in any respect the power or duty of the chair to investigate instances of misconduct, either before or after investigation by a medical society or board as herein provided, or to temporarily suspend the authorization of any provider that he or she may believe to be guilty of such misconduct.

5.

Whenever the department of health or the department of education shall conduct an investigation with respect to charges of professional or other misconduct by a provider which results in a report, determination or consent order that includes a finding of professional or other misconduct or incompetency by such provider, the chair shall have full power and authority to temporarily suspend, revoke or otherwise limit the authorization under this chapter of any provider upon such finding by the department of health or the department of education that the provider has been guilty of professional or other misconduct. The recommendations of the department of health or the department of education shall be advisory to the chair only and shall not be binding or conclusive upon the chair.

Source: Section 13-D — Removal of providers from lists of those authorized to render medical care or to conduct independent medical examinations, https://www.­nysenate.­gov/legislation/laws/WKC/13-D (updated Jan. 10, 2020; accessed Jul. 20, 2024).

9
Definitions
10
Liability for compensation
11
Alternative remedy
12
Compensation not allowed for first seven days
13
Treatment and care of injured employees
13‑A
Selection of authorized physician by employee
13‑AA
Medical appeals unit
13‑B
Authorization of providers, medical bureaus and laboratories by the chair
13‑C
Licensing of compensation medical bureaus and laboratories
13‑D
Removal of providers from lists of those authorized to render medical care or to conduct independent medical examinations
13‑E
Revocation of licenses of compensation medical bureaus and laboratories
13‑F
Payment of medical fees
13‑G
Payment of bills for medical care
13‑H
Ombudsman for injured workers
13‑I
Solicitation prohibited
13‑J
Medical or surgical treatment by insurance carriers and employers
13‑K
Care and treatment of injured employees by duly licensed podiatrists
13‑L
Care and treatment of injured employees by duly licensed chiropractors
13‑M
Care and treatment of injured employees by duly licensed psychologists
13‑N
Mandatory registration of entities which derive income from independent medical examinations
13‑O
Pharmaceutical fee schedule
13‑P
Comprehensive prescription drug formulary
14
Weekly wages basis of compensation
14‑A
Double compensation and death benefits when minors illegally employed
15
Schedule in case of disability
15‑A
Assessment on insolvent group self-insured trusts
16
Death benefits
16‑A
Death benefits due to diesel exposure
17
Noncitizens
17‑A
Limited English proficiency
18
Notice of injury or death
18‑A
Notice: The New York Jockey Injury Compensation Fund, Inc
18‑B
Notice
18‑C
Independent livery bases
19
Physical examination
19‑A
Physicians not to accept fees from carriers
19‑B
Treatment by physicians in employ of board
19‑C
Actions against health services personnel
20
Determination of claims for compensation
21
Presumptions
21‑A
Temporary payment of compensation
22
Modification of awards, decisions or orders
23
Appeals
23‑A
Mistakes, defects and irregularities
24
Costs and fees
24‑A
Representation before the workers’ compensation board
25
Compensation, how payable
25‑A
Procedure and payment of compensation in certain claims
25‑B
Awards to non-residents: Non-resident compensation fund
26
Enforcement of payment in default
26‑A
Procedure and payment of compensation in claims against uninsured defaulting employers
27
Depositing future payments in the aggregate trust fund
27‑A
Investments in obligations of designated public benefit corporations
27‑B
Amortization of gains or losses
27‑C
Appropriations to the aggregate trust fund
28
Limitation of right to compensation
29
Remedies of employees
30
Revenues or benefits from other sources not to affect compensation
31
Agreement for contribution by employee void
32
Waiver agreements
32‑A
Waivers of specific coverage prohibited
33
Assignments
34
Preferences
35
Safety net

Accessed:
Jul. 20, 2024

Last modified:
Jan. 10, 2020

§ 13-D’s source at nysenate​.gov

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