§ 19. Reasonable charges for medicare beneficiaries.
1.No physician\nlicensed under article one hundred thirty-one of the education law shall\ncharge from a beneficiary of health insurance under title XVIII of the\nfederal social security act (medicare) any amount in excess of the\nfollowing limitations:\n (a) Effective January first, nineteen hundred ninety-one, a\nphysician's charge shall not exceed one hundred fifteen percent of the\nreasonable charge for that service as determined by the United States\nsecretary for health and human services.\n (b) Beginning January first, nineteen hundred ninety-three, a\nphysician's charge shall not exceed one hundred ten percent of the\nreasonable charge for that service as determined by the United States\nsecretary for health and human servic
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§ 19. Reasonable charges for medicare beneficiaries. 1. No physician\nlicensed under article one hundred thirty-one of the education law shall\ncharge from a beneficiary of health insurance under title XVIII of the\nfederal social security act (medicare) any amount in excess of the\nfollowing limitations:\n (a) Effective January first, nineteen hundred ninety-one, a\nphysician's charge shall not exceed one hundred fifteen percent of the\nreasonable charge for that service as determined by the United States\nsecretary for health and human services.\n (b) Beginning January first, nineteen hundred ninety-three, a\nphysician's charge shall not exceed one hundred ten percent of the\nreasonable charge for that service as determined by the United States\nsecretary for health and human services, provided however, that if the\nstatewide percentage of medicare part B claims billed at or below the\nreasonable charge as determined by the United States secretary for\nhealth and human services for federal fiscal year nineteen hundred\neighty-nine fails to increase by five percentage points for federal\nfiscal year nineteen hundred ninety-two, such physician's charge shall,\nthereafter, not exceed one hundred five percent of the reasonable charge\nas determined by the United States secretary for health and human\nservices. If, in any subsequent federal fiscal year, such statewide\npercentage of medicare part B claims billed at or below such reasonable\ncharge fails to maintain such five percentage point increase,\nphysician's charge shall thereafter not exceed one hundred five percent\nof the reasonable charge as determined by the United States secretary\nfor health and human services.\n 2. The charge limitation set forth in subdivision one of this section\nshall not apply if the service which such beneficiary is to be billed is\neither an office or home visit as set forth in procedure codes 90000\nthrough 90170 in the Physician Current Procedural Terminology 4th\nEdition 1989.\n 3. The state office for the aging shall, through agreement with\ncarriers and/or intermediaries contracted with by the federal government\nin this state pursuant to title XVIII of the federal social security act\n(medicare), obtain the percentages of physician's bills submitted at or\nbelow the reasonable charge as established by the United States\nsecretary for health and human services, and shall issue a report by\nDecember first, nineteen hundred ninety-two and every December first,\nthereafter, stating whether the percentage of bills submitted at or\nbelow such reasonable charge for federal fiscal year nineteen hundred\nninety-two increased by five percentage points over the statewide\npercentage of bills submitted at or below such reasonable charge for\nfederal fiscal year nineteen hundred eighty-nine and whether such\npercentage has been maintained for each successive federal fiscal year\nafter nineteen hundred ninety-two.\n 4. Notwithstanding any inconsistent provision of this chapter, a\nphysician who is determined, after opportunity for a hearing, to have\nviolated the provisions of this section shall be subject for the first\nviolation to a fine of not more than one thousand dollars nor less than\nthe greater of three times the amount collected, or, if not collected,\nthree times the amount charged, in excess of the limitations set forth\nin subdivision one of this section, and, for each additional violation\ncommitted within five years of the date of an immediately preceding\nviolation of this section, to a fine of not more than five thousand\ndollars nor less than the greater of one thousand dollars or three times\nthe amount collected, or, if not collected, three times the amount\ncharged, in excess of the limitations set forth in subdivision one of\nthis section; provided, however, that in no event shall the fine for an\nindividual violation of this section be greater than five thousand\ndollars. In addition, where the provisions of this section have been\nviolated, the physician shall refund to the beneficiary the amount\ncollected in excess of the limitations set forth in subdivision one of\nthis section.\n