The state’s Department of Financial Services (DFS) is attempting to beat the plague of no-fault system fraud.
The department is making reforms at the state level to help to eliminate the tremendous number of loopholes that are making the no-fault New York insurance system for auto coverage a highly abused program.
These new regulations are meant to take aim at the issue of doctors who are receiving healthcare payments for services that are not actually being provided, as well as technical problems that are frequently used to stop a decision from being made about a claim, or that will keep a fraudulent claim open.
Regulation 68 would change the state auto coverage law by setting new procedures for making claims.
The DFS has stated that this new regulation will halt the current common practice by insurers of having to pay for treatments regardless of whether or not they were actually provided, or of having to pay a larger amount than the set fee schedule for a service that was performed. It also stops healthcare service providers from being able to simply ignore the requests that insurers make for proof that the treatments they are providing are actually medically necessary.
This regulation will also eliminate the loophole that gives arbitrators and courts the ability to force New York insurance companies to make payments for fraudulent claims just because of minor processing paperwork errors made by the insurer.
According to Benjamin Lawsky, the superintendent of the DFS, these new regulations make certain that policyholders will be able to obtain timely and appropriate treatment for their legitimate injuries, while making it much more difficult for the scams from “medical mills” to make fraudulent claims that cause premiums to skyrocket.
Fraud Costs NY co-spokesperson, Kristina Baldwin, who is also the Property Casualty Insurers Association of America assistant vice president, said that “If implemented, these regulatory changes will help close the glaring loopholes that allow criminals to rip off the system and control the ensuing costs which are passed on to drivers by way of higher premiums.”
The draft regulation proposal will be required to follow the typical process for making New York insurance rules.