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  Lumbermens Mut. Cas. Co. v A B Med. Servs., PLLC , 2020 NY Slip Op 07280 (1st Dept. 2020) “As an initial issue, 11 NYCRR 65-3.11 (a) limits no-fault medical billing to employees of the provider that submits claims for no-fault benefits. It is submitted that Supreme Court properly granted judgment in favor of plaintiffs, because the treating providers were independent contractors, as opposed to employees. The record supports a finding that the “degree of control exercised by the purported employer” ( Bynog v Cipriani Group , 1 NY3d 193 , 198 [2003]), “not only over the results produced but also over the means used to produce the results” ( Matter of O’Brien v Spitzer , 7 NY3d 239 , 242 [2006]), was insufficient to give rise to an employer-employee relationship. “Factors relevant to assessing control include whether the worker (1) worked at his [or her] convenience, (2) was free to engage in other employment, (3) received fringe benefits, (4) was on the employer’s payroll and (5) was o

CEDA HEALTH OF HIALEAH, LLC, etc., vs STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY   , 3D21-11 Similar to the 2012 NY regulatory changes, the Florida law prohibits billings for services not rendered.  See  FSA 627.736(5)(b)1.c.. The statute, when triggered, applies to all billings. The NY regulation only seems to apply to services that were billed but not provided. Here are the facts: ” Dr. Canizares testified that he did not have personal knowledge of the treatments, but that based on his review of the records, it appeared that two units of Current Procedural Terminology (“CPT”) code 97110 were mistakenly billed at $90.00 each instead of one unit of CPT code 97110 at $90.00 and one unit of CPT code 97112 at $95.00. Dr. Canizares attested that two units of code 97110 were billed, although only one unit was performed on the date of treatment, and that there was no entry for code 97112 although one unit was performed on that date” The question is whether the provider’s using 97110 twic

Pavlova v Nationwide Ins. , 2021 NY Slip Op 50213(U)(App. Term 2d Dept. 2021) “To establish its prima facie entitlement to summary judgment dismissing a complaint on the ground that a plaintiff’s assignor failed to appear for an EUO, an insurer must demonstrate, as a matter of law, that it twice duly demanded an EUO from the assignor, that the assignor twice failed to appear, and that the insurer issued a timely denial of the claims ( see Interboro Ins. Co. v Clennon , 113 AD3d 596, 597 [2014]). Contrary to the determination of the Civil Court, the affirmations of defendant’s counsel, as well as the transcripts of the EUOs, were sufficient to establish that plaintiff’s assignor had failed to appear for the EUOs. It is irrelevant whether plaintiff’s assignor was represented by counsel, as defendant was only required to mail the EUO scheduling letters to plaintiff’s assignor ( see  11 NYCRR 65-3.5 [e]; 3.6 [b]). Consequently, as plaintiff failed to raise a triable issue of fact in opposi

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