Fifteen years ago, the New York Court of Appeals ruled that a violation of a licensing requirement by a medical provider rendered the provider ineligible to be reimbursed by an insurance company for no-fault claims that had been assigned to the provider by an individual allegedly involved in an automobile accident. The court recognized that one such kind of licensing violation was the lack of ownership and/or control over a medical professional corporation by a licensed medical doctor, and it made clear that insurance carriers may look beyond the face of a medical professional corporation’s licensing documents to identify a failure to abide by state law in this regard.

Since the court’s decision in that case, State Farm Mutual Auto. Ins. Co. v. Mallela, 4 N.Y.3d 313 (2005) (in which the author and his firm represented the insurer)—the continuing strength of which the court confirmed last year in Andrew Carothers, M.D., P.C. v. Progressive Ins. Co., 33 N.Y.3d 389 (2019) (in which the author’s firm was among several counsel for the insurers)—no-fault insurance carriers have brought numerous actions against medical providers alleging fraud and related causes of action. In these lawsuits, typically filed in federal court, insurers have sought to claw back and recover payments they previously made to those providers and to bar their claims for additional payments.

This content has been archived. It is available through our partners, LexisNexis® and Bloomberg Law.

To view this content, please continue to their sites.

Not a Lexis Subscriber?
Subscribe Now

Not a Bloomberg Law Subscriber?
Subscribe Now

Why am I seeing this?

LexisNexis® and Bloomberg Law are third party online distributors of the broad collection of current and archived versions of ALM's legal news publications. LexisNexis® and Bloomberg Law customers are able to access and use ALM's content, including content from the National Law Journal, The American Lawyer, Legaltech News, The New York Law Journal, and Corporate Counsel, as well as other sources of legal information.

For questions call 1-877-256-2472 or contact us at [email protected]