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Morrison Mahoney partner Robert A. Stern discusses the recently revised proposed amendment to Regulation 83 that would limit reimbursement of no-fault health care services provided outside of New York State to a maximum of that provided under the applicable New York No-fault fee schedule

New schemes have emerged and expanded into yet more-sophisticated versions involving medical equipment, medical clinics, laundering of ill-gotten profits, illicit claims for medical pain drugs, and false nerve testing. The article, published in the Journal of Insurance Fraud in America (JIFA) for the Coalition Against Insurance Fraud, discusses the trends in the context of no-fault coverage.

As of July 1, 2016, Tennessee will become the first state to require companies to notify consumers of data breaches in which their personal information was breached, even if that information was encrypted. On March 24, 2016 Tennessee's Governor Bill Haslam signed SB2005/HB1631, amending Tennessee's Identity Theft Deterrence Act the "ACT") (Tenn. Code § 47-18-2107) to eliminate its safe-harbor for encrypted information. With the amendments, companies with customers in Tennessee will be required to notify those customers if their personal information has been compromised, whether or not such information is encrypted (generally defined as unusable, unreadable, or indecipherable to an unauthorized person through a security technology or methodology generally accepted in the field of information security.

On March 31, 2016, in the matter of Government Employees Ins Co v Avanguard Medical Group PLLC(--- N.E.3d ----, 2016 WL 1247701 (N.Y.), 2016 N.Y. Slip Op. 02473), the Court of Appeals held that, unlike hospitals and ambulatory surgery centers that are regulated under Article 28 and licensed by New York State through the Department of Health, office based surgery centers, which are not licensed by the State, are not entitled to reimbursement of facility fees.

On March 29, 2016, in the matter of Liberty Mutual Fire Insurance Company, et al. v Isaac Shapson, et al. (13-cv-05046-ENV-PK), Judge Eric N. Vitaliano of the United States District Court for the Eastern District of New York rejected medical professional corporations' attempt to invoke the doctrine of Primary Jurisdiction to stay Liberty Mutual's fraud-based affirmative recovery action pending an investigation by the New York State Department of Financial Services ("DFS"). Defendants argued that under section 5109 of the Insurance Law, which authorizes the DFS to investigate and de-authorize health providers from submitting claims through the No-fault system, Liberty Mutual's action should be stayed pending an investigation and determination by DFS as to whether the professional corporations at issue were fraudulently incorporated. In general, the doctrine of primary jurisdiction applies in instances where, although a claim may be brought in court, an administrative agency is imbued with special competence to determine an issue that is the subject of the court claim and, therefore, should decide that issue before proceeding in court.