On June 11, the New York Court of Appeals, in Andrew Carothers, M.D., P.C. v. Progressive Insurance Company, 2019 NY Slip Op 04643, decided that an insurer may withhold payment for services provided by a medical services corporation improperly controlled by non-physicians whether or not the medical services corporation acted fraudulently or with fraudulent intent.
The Court of Appeals
Continue Reading New York Court of Appeals Rules that an Insurer May Withhold Payments to a Medical Service Corporation Improperly Controlled by Non-Physicians without A Finding of Fraud
As Chris Kutner explained in his January 4, 2013 
Historically, health care services have been paid for by health insurance companies which accept monthly premium payments from employer groups and individuals. The premium for defined health care services is due whether the insureds under the policy use the benefits or not. Built into the premiums are additional administrative costs including fees paid to insurance brokers and general agents who