In Government Employees Ins. Co. v. Avanguard Med. Group,1 the issue presented on appeal was whether a no-fault insurer was required to pay no-fault medical benefits to an office-based surgical (OBS) facility not accredited under Public Health Law Article 28.
The relevant facts of the case are as follows: The defendant medical facility was a physician-owned facility accredited under Public Health Law 230, and provided out-patient surgical facility services, such as use of the operating room and staff, necessary for the performance of certain surgical procedures. The OBS facility bills responsible insurers similarly to how hospitals and ambulatory surgery facilities licensed under Article 28 bill for their services, that is, in addition to and separate from the surgical services performed and billed by the treating physicians. In this case, the plaintiff no-fault insurer received bills for OBS facility services from the defendant facility rendered to many different patients, totaling approximately $1.3 million.
