Skip to Content

Session Law

2004

Jump to:

Chapter 464 AN ACT FURTHER PREVENTING INSURANCE FRAUD IN THE COMMONWEALTH.

Whereas, The deferred operation of this act would tend to defeat its purpose, which is to prevent insurance fraud in the commonwealth, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 112 of the General Laws is hereby amended by inserting after section 23M the following section:-

Section 23M 1/2. (a) The board shall promulgate regulations necessary to regulate and inspect the practice settings of its licensees and may require the practice settings to be licensed by the board if the practice settings are not regulated by the department of public health. Fees for the licensing of any practice setting and renewals thereof shall be determined by the secretary of administration pursuant to section 3B of chapter 7 and shall be deposited in the Division of Professional Licensure Trust Fund established by section 35V of chapter 10.

(b) This section shall not apply to a physical therapist who owns and operates the practice, does not employ a physical therapist and is not in partnership with any other physical therapist.

SECTION 2. Section 23P 1/2 of said chapter 112, as appearing in the 2002 Official Edition, is hereby amended by adding the following 3 paragraphs:-

A physical therapist or physical therapist assistant whose license, certificate, registration or authority relating to the practice is suspended for more than 1 year for professional misconduct with regard to insurance claims shall not own, operate, practice in, or be employed by any chiropractic or physical therapy office, clinic, or other place designated to the practice of chiropractic or physical therapy until the license is reinstated by the board.

A physical therapist or physical therapist assistant whose license, certificate, registration or authority relating to the practice is suspended for a second offense with regard to insurance claims shall have his license permanently revoked.

A physical therapist or physical therapist assistant whose license, certificate, registration or authority relating to the practice is revoked with regard to insurance claims shall not own, operate, practice in, or be employed by any chiropractic or physical therapy office, clinic, or other place designated to the practice of chiropractic or physical therapy.

SECTION 3. Section 89 of said chapter 112, as so appearing, is hereby amended by inserting after the definition of "Chiropractic" the following definition:-

"Chiropractic facility", a place, office, clinic or establishment in which chiropractic treatment is provided or in which business and patient records related to chiropractic treatment are used or stored which has been registered by the board pursuant to section 94A.

SECTION 4. Said chapter 112 is hereby further amended by inserting after section 94 the following section:-

Section 94A. (a) A person shall not engage in the practice of chiropractic except in a licensed chiropractic facility and provided the person is licensed by the board pursuant to section 91 or 92.

(b) The board may authorize 1 or more licensed chiropractors, or any person employing a licensed chiropractor, to operate a licensed chiropractic facility if the facility satisfies the requirements established by the board by regulations, and upon payment to the board of an annual fee. The board shall promulgate regulations necessary to ensure the safe and lawful practice of chiropractic.

(c) A chiropractic facility shall not be licensed or operated unless the board has in its records the name and license number of the licensed chiropractor who is the chiropractor of record for that chiropractic facility. The chiropractor of record for the licensed chiropractic facility shall be responsible for operating the chiropractic facility in compliance with the laws of the commonwealth and the rules and regulations of the board.

(d) Each licensed chiropractic facility may be inspected by the board or its agents to determine its compliance with the laws of the commonwealth and the rules and regulations of the board. The chiropractor of record shall be responsible for cooperating with the inspection and any investigations conducted by the board or its agents. Upon request, the chiropractor of record shall provide the board or its agents with access to and, if requested, copies of any records, charts, reports, treatment notes, billing records, x-rays, test results, reviews, assessments, papers, correspondence and any other data or material. Any party required to provide documents in compliance with this section shall not be liable in any civil or criminal action for providing documents to the board.

(e) A license issued by the board for a chiropractic facility shall be valid only for the location named therein, and shall not be transferable. A license or renewal issued to a chiropractic facility shall expire on the date the director of the division of professional licensure determines. Fees for licenses and renewals thereof shall be determined by the secretary of administration pursuant to section 3B of chapter 7 and shall be deposited in the Division of Professional Licensure Trust Fund established by section 35V of chapter 10.

(f) This section shall not apply to a chiropractor who owns and operates the practice, does not employ a chiropractor and is not in partnership with any other chiropractor.

SECTION 5. Section 95 of said chapter 112, as so appearing, is hereby amended by adding the following 3 paragraphs:-

A chiropractor whose license, certificate, registration, or authority relating to the practice is suspended for more than 1 year for professional misconduct with regard to insurance claims shall not own, operate, practice in, or be employed by any chiropractic or physical therapy office, clinic, or other place designated to the practice of chiropractic medicine or physical therapy until the license is reinstated by the board.

A chiropractor whose license, certificate, registration, or authority relating to the practice is suspended for a second offense with regard to insurance claims shall have the license permanently revoked.

A chiropractor whose license, certificate, registration, or authority relating to the practice is revoked with regard to insurance claims shall not own, operate, practice in, or be employed by any chiropractic or physical therapy office, clinic, or other place designated to the practice of chiropractic or physical therapy.

SECTION 6. Chapter 175 of the General Laws is hereby amended by inserting after section 113U the following section:-

Section 113V. (a) For purposes of this section, the following words shall have the following meaning:-

"Automobile Insurers Bureau of Massachusetts", the rating organization licensed by the commissioner under section 8 of chapter 175A, or its successor.

"Commissioner", the commissioner of insurance.

"Insurance fraud bureau", a bureau authorized by chapter 338 of the acts of 1990, or its successor.

"Medical licensing boards", the board of registration in medicine and those boards of registration and examination in the division of professional licensure which relate to medical or health care providers.

(b) At least annually, the medical licensing boards that receive funding pursuant to paragraph (3) of subsection (d) shall review the data made available to them by the Automobile Insurers Bureau of Massachusetts for indication of overutilization of practice or fraud involving automobile insurance claims by individual practitioners or by provider groups. Where overutilization of practice or fraud involving automobile insurance claims by 1 or more licensees is suspected, the board shall conduct an investigation. If the investigation results in evidence that a pattern of fraud, overutilization of practice, or professional misconduct exists, the medical licensing boards shall initiate professional disciplinary proceedings to determine whether that practitioner's or provider group's license should be suspended, revoked, or be subjected to some other appropriate penalty.

(c) If a licensee subject to the jurisdiction of the medical licensing boards has been convicted of insurance fraud, the medical licensing boards shall immediately initiate professional disciplinary proceedings to determine whether the applicable license should be suspended, revoked, or subjected to some other appropriate remedy.

(d)(1) The costs of this program shall be paid by the Automobile Insurers Bureau of Massachusetts and not passed on to holders of automobile insurance policies in the commonwealth. Each insurer licensed in the commonwealth to write a motor vehicle liability policy as defined in section 34A of chapter 90 shall pay the Automobile Insurers Bureau of Massachusetts an amount equal to 10 cents for each private passenger motor vehicle liability policy written as of December 31 of the preceding year, according to the records of the Automobile Insurers Bureau of Massachusetts. On or before March 1 of each year, the Automobile Insurers Bureau of Massachusetts shall remit the total amount paid under this subsection to the commissioner. An insurer shall not include the assessment paid under this section in any data used to fix and establish rates under section 113B of chapter 175.

(2) On or before March 1 of each year, the commissioner shall consult with an advisory group consisting of the attorney general or his designee, a district attorney or his designee to be appointed by the attorney general, a representative of the insurance fraud bureau, and 2 members of the public to be appointed by the governor on how the funds paid under subsection (1) should be distributed. Within 60 days of the receipt of said moneys, the commissioner shall allocate and distribute moneys to the medical licensing boards on an analysis of the likelihood of overutilization of practice or fraud relating to automobile related injuries by practitioners under each medical licensing board's jurisdiction and the needs of each applicable board for the use of the funds after disbursement.

(3) The funds collected pursuant to paragraph (1) shall be used solely by the health care fraud unit of the division of professional licensure, the disciplinary unit of the board of registration in medicine and other medical licensing boards for the investigation of overutilization of practice or fraud involving automobile insurance claims. Any funds not expended by the various medical licensing boards within 12 months of their receipt shall be returned to the commissioner who shall keep the funds in a separate account. These funds shall be made available to the medical licensing boards during the next calendar year in accordance with this subsection.

(e) Any data made available to or received by the medical licensing boards from the Automobile Insurers Bureau of Massachusetts pursuant to this act shall not be considered a "public record" as defined in clause Twenty-sixth of section 7 of chapter 4.

(f) In the absence of fraud or bad faith, an insurer or employee or agent thereof, member of said insurance fraud bureau or an employee or an agent thereof, member of said medical licensing boards or an employee or agent thereof, member of said Automobile Insurers Bureau of Massachusetts or an employee or agent thereof, or other person subject to this section, shall not be subject to criminal or civil liability, and no civil cause of action of any nature shall arise against such person for any information relating to suspected over-treatment or fraudulent insurance transactions furnished to medical provider licensing boards or the insurance fraud bureau, their agents and employees pursuant to this section. Nothing herein is intended to abrogate or modify in any way common law privilege of immunity heretofore enjoyed by any person.

SECTION 7. Chapter 266 of the General Laws is hereby amended by inserting after section 111B the following section:-

Section 111C. (a) As used in this section, the following words shall have the following meanings:-

"Provider", an attorney, a health care professional licensed pursuant to chapter 112, an owner or operator of a health care practice or facility, any person who creates the impression that he or his practice or facility can provide legal or health care services, or any person employed or acting on behalf of any of the aforementioned persons.

"Public media", telephone directories, professional directories, newspapers and other periodicals, radio and television, billboards and mailed or electronically transmitted written communications that do not involve in-person contact with a specific prospective client, patient or customer.

"Runner", a person who, for a pecuniary benefit, procures or attempts to procure a client, patient or customer at the direction of, request of, or in cooperation with a provider whose purpose is to seek to fraudulently obtain benefits under a contract of insurance or fraudulently assert a claim against an insured or an insurance carrier for providing services to the client, patient or customer. "Runner" shall not include a person who procures or attempts to procure clients, patients or customers for a provider through public media or a person who refers clients, patients or customers to a provider as otherwise authorized by law.

(b) Whoever knowingly acts as a runner or uses, solicits, directs, hires or employs another to act as a runner for the purpose of defrauding an insured or an insurance carrier shall be punished by imprisonment in the state prison for not more than 5 years, by imprisonment in a jail or house of correction for not less than 6 months nor more than 2 1/2 years or by a fine of not less than $1,000 nor more than $4,000.

SECTION 8. Section 23B of chapter 112 of the General Laws, as appearing in the 2002 Official Edition, is hereby amended by striking out the paragraph contained in lines 17 through 26, inclusive, and inserting in place thereof the following paragraph:-

Licenses shall expire every 2 years on the birth anniversary of the licensee. Licensees shall pay to the board a renewal fee determined by the secretary of administration and finance. The board may require specific continuing education as a condition of license renewal. The board may provide for the late renewal of a license that has lapsed and may require the payment of a late fee, an examination, continuing education, and supervised experience before issuing the renewed license. For purposes of implementing the transition to birthday renewals, for licenses renewing on or about January 2006, the board may issue licenses that expire in less than 2 years.

Approved January 3, 2005.

Error