Filed Under:, Investigative

NY Targets Doctors Suspected of PIP Fraud

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 under way 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.

Early Diagnosis 
DFS already has identified 135 medical providers whose billing practices have raised concerns regarding possible no-fault fraud through audits and information obtained from law enforcement and insurers. As part of an ongoing investigation, letters are being sent to all 135 medical providers demanding a response and information. According to the department, failure to answer the letters may automatically lead to the medical provider being banned from the no-fault system.

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

“I applaud Superintendent Lawsky and stand ready to support him in his fight to crack down on no-fault fraud and the criminals who profit from this illegal enterprise,” added Senator James L. Seward, chair of the Senate Insurance Committee, in a separate statement. “Activating this powerful tool to decertify doctors who cheat the system is long overdue. I sponsored this reform in 2005 and am pleased the superintendent is taking steps to implement it—helping fight fraud and get insurance rates under control.”

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