Senate Commerce Committee Statement to Senate, No. 2031 — State of New Jersey (June 20, 2022)

Summary

A Senate Commerce Committee statement to the Senate on Senate Bill No. 2031, State of New Jersey, dated June 20, 2022, reporting the bill favorably. The bill sets a process for barring certain health care providers from collecting reimbursement under the personal injury protection (PIP) coverage of an automobile insurance policy. The Commissioner of Banking and Insurance is to adopt standards, give at least 90 days' notice, and may investigate providers reasonably believed to have engaged in listed conduct, such as professional misconduct, false statements in PIP medical reports or patterns of billing for services never rendered. After notice and an opportunity to be heard, the commissioner may suspend or bar a provider, and the list of barred providers is to be made public by website and toll free number.

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SENATE COMMERCE COMMITTEE

STATEMENT TO

SENATE, No.
2031

STATE
OF NEW JERSEY

DATED: JUNE
20, 2022

The
Senate Commerce Committee reports favorably Senate Bill No. 2031.

This
bill establishes a process by which certain health care providers can be barred
from collecting reimbursement from the medical expense benefits under the
personal injury protection (PIP) coverage of an automobile insurance policy.

Specifically,
the bill provides that the Commissioner of Banking and Insurance (the
“commissioner”), in consultation with the Commissioner of Health and Senior
Services and the Director of the Division of Consumer Affairs in the Department
of Law and Public Safety, shall, by regulation, promulgate standards and
procedures for investigating and, as appropriate, temporarily suspending or
barring a health care provider from demanding, requesting or receiving
reimbursement for services or equipment for which payment is to be made by an
automobile insurer under PIP coverage. The bill requires the commissioner to
ensure adequate due process protection to health care providers, including
notice and opportunity to be heard, and to provide notice to health care
providers at least 90 days in advance of the effective date of the regulations
implementing the bill.

The
bill establishes a process in which the commissioner, either by his own
initiative or based on the recommendation of the Commissioner of Health and
Senior Services or the Director of the Division of Consumer Affairs, may
conduct an investigation into any health care provider who the commissioner
reasonably believes:

(1) may
be guilty of professional misconduct, incompetence, or negligence;

(2)
exceeded the limits of his or her professional competence in rendering medical
care or may have knowingly made a false statement or representation as to a
material fact in any medical report under PIP;

(3) has
solicited, or has employed another to solicit for himself or herself or for another,
professional treatment, examination or care of an injured person in connection
with certain claims;

(4) has
refused to appear before, or to answer upon request of, the Commissioner of
Banking and Insurance, the Commissioner of Health and Senior Services, the
Director of the Division of Consumer Affairs, or any duly authorized officer of
the State, any legal question, or to produce any relevant information
concerning his or her conduct in connection with rendering medical services; or

(5) has
engaged in patterns of billing for services which were never rendered, are of
no diagnostic value or are medically unnecessary.

The
bill then requires the commissioner to notify any health care provider being
investigated and provide the health care provider with adequate notice and
opportunity to be heard. Under the bill, the commissioner is then required to
make a determination, based on the investigation and the health care provider’s
response, whether to temporarily suspend or bar the health care provider from
demanding, requesting or receiving reimbursement for services or equipment for
which payment is to be made by an automobile insurer under PIP coverage.

The
bill also requires the commissioner to compile a list of those health care
providers who are barred from collecting reimbursement under the bill. Health
care providers who are barred from collecting reimbursement under the bill are
prohibited from subsequently treating for remuneration, as a private patient,
any person seeking medical treatment under personal injury protection
coverage. An injured claimant so treated or examined is permitted to raise
this as a defense in any action by that health care provider for payment for
treatment rendered at any time after that health care provider has been barred
from demanding or requesting payment for medical services pursuant to this
section.

The
bill also provides that the commissioner, the Commissioner of Health and Senior
Services and the Director of the Division of Consumer Affairs shall make the
list of health care providers who are barred from reimbursement under the
bill’s provisions available to the public by means of a website and by a toll
free number.

The
bill also permits the commissioner, while conducting an investigation pursuant
to the bill and, after a hearing and upon written notice to the provider, to
temporarily suspend a health care provider from demanding, requesting or
receiving any reimbursement for services or equipment for medical expense
benefits for which payment is to be made by an automobile insurer under PIP
coverage.

The
bill is not intended to affect or alter the provisions of P.L.1989, c.19
(C.45:9-22.4 et seq.), which pertain to referrals of patients by practitioners.

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