The No-Fault Regulations, 11 NYCRR 65-3.16(12), provide:
A provider of health care services is not eligible for reimbursement under section 5102(a)(1) of the Insurance Law if the provider fails to meet any applicable New York State or local licensing requirement necessary to perform such service in New York or meet any applicable licensing requirement necessary to perform such service in any other state in which such service is performed.
This provision, arguably buried in a section of the Regulations devoted to and entitled “Measurement of No-Fault Benefits,” has been the subject of several landmark decisions and has been cited as the basis for numerous investigations of, and demands for additional verification from, medical professional corporations who submit claims for no-fault insurance reimbursement.
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