New York No-Fault Regulations 11 NYCRR Subpart 65-5: Unauthorized Providers Of Health Services

11 NYCRR 65-5.5: Report of hearing and findings

Text of 11 NYCRR 65-5.5 (Insurance Regulation 68-E) as published by the New York State Department of Financial Services, checked against the Department's list of amendments through October 4, 2026.

This is an unofficial copy. The official text is in the New York Codes, Rules and Regulations. Decisions apply the version in force at the time of the claim, which may differ from the current text.

Decisions citing this section · Plain-text version (Markdown)

(a) Pending a final determination by the superintendent, Commissioner of Health, or Commissioner of Education, if the superintendent or noticing commissioner believes that the provider has engaged in any activity set forth in Insurance Law section 5109(b), then the superintendent or noticing commissioner may temporarily prohibit the provider from demanding or requesting any payment for medical services under Insurance Law article 51 for up to 90 days from the date of the notice of such temporary prohibition pursuant to Insurance Law section 5109(e).

(b) The hearing officer shall issue to the superintendent or noticing commissioner the report described in section 65-5.4(b) of this Subpart, with a recommendation. The superintendent or noticing commissioner may adopt, modify, remand, or reject the hearing officer’s report and recommendation.

(c) (1) Upon consideration of the hearing officer’s report and recommendation, the superintendent or noticing commissioner may issue a final order prohibiting the provider from demanding or requesting any payment for medical services in connection with any claim under Insurance Law article 51 and requiring the provider to refrain from subsequently treating, for remuneration, as a private patient, any person seeking medical treatment under Insurance Law article 51, for a period specified by the superintendent or noticing commissioner.

(2) If the superintendent or noticing commissioner issues a final order prohibiting the provider from demanding or requesting any payment for medical services in connection with any claim under Insurance Law article 51 and requiring the provider to refrain from subsequently treating, for remuneration, as a private patient, any person seeking medical treatment under Insurance Law article 51, for a period longer than three years, then the provider may, after the expiration of three years, submit a written application to the superintendent or noticing commissioner requesting that the superintendent or noticing commissioner reconsider his or her order. The written application shall explain why revising the order would not jeopardize the health, safety, and welfare of the people of this State.

Historical note

Sec. filed: March 9, 2012 as emergency measure; June 6, 2012 as emergency measure; Aug. 31, 2012 as emergency measure; Nov. 28, 2012 as emergency measure; Feb. 25, 2013 as emergency measure; May 24, 2013 as emergency measure; July 22, 2013 as emergency measure; Sept. 19, 2013 as emergency measure; Oct. 24, 2013 eff. Nov. 13, 2013.