Filed Under:Agent Broker, E&S/Specialty Business

NY Targets Doctors Suspected of PIP Fraud

Misconduct Results in Possible Decertification

Doctors conspiring to cheat New York’s no-fault personal injury protection (PIP) system are writing a prescription for trouble, and perhaps professional suicide.

A rigorous statewide initiative is underway to close medical offices billing for services that are either wholly unnecessary or never rendered to auto accident victims. Under the new regulation, physicians engaging in unscrupulous billing practices to siphon funds from New York’s PIP system will ostensibly turn themselves into pariahs, at least in the professional sense.

Investigators also cite anecdotal evidence of doctors "renting" their tax ID number to fraudulent medical practices that submit bogus bills to insurers.  

The regulation mandates that DFS will have to send a list of any medical providers suspected of no-fault fraud to the Departments of Health (DOH) and the State Education Department (SED) for their review. DFS will then conduct hearings. Providers found to have violated the law will be banned from participating in the no-fault payment system. In appropriate cases, DOH and SED may rescind any medical licenses and law enforcement will decide whether criminal charges should be filed.

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