Subject Numbers Regarding Health Provider Authorizations

Revises Subject Number 046-853, issued May 5, 2016. Revised text is in bold italics.

May 16, 2016

Dr. Eugene Gosy of Gosy & Associates in Williamsville, New York is the subject of criminal proceedings and may no longer treat workers' compensation patients. [Temporary Suspension of Dr. Eugene Jeno Gosy's Authorization to Treat Injured Workers Effective May 6, 2016] His medical practice included numerous injured workers seeking treatment for pain management. This abrupt discontinuance of critical pain management services leaves many injured workers without a Board authorized medical provider to continue medically necessary treatment.

60 Day Suspension of Requirement that Provider be Board Authorized

Due to this pressing medical need and the potential difficulty for injured workers previously under Dr. Gosy's care to see an authorized medical provider, some rules governing medical care are suspended until July 5th 2016 for Dr. Gosy's patients in need of interim care for pain management as follows:

• During this 60 day period, patients who are currently under the care of Dr. Gosy and unable to obtain necessary medical care from a Board authorized provider may treat with the patient's primary care or treating provider.
• A primary care or treating provider who is not Board authorized may provide interim care in accordance with sound medical practices and New York State Law.
• Insurance carriers and employers, shall pay such primary care or treating providers at the medical fee schedule rate for medical treatment and care even though such provider does not possess authorization from the Board to treat injured workers.
• A primary care or treating provider includes a physician possessing a current valid and unrestricted medical license in the State or a nurse practitioner or physician's assistant employed in such physician's practice. NOTE: All medical bills must be submitted by the employer physician.

Medical Reporting Requirements

A primary care or treating provider treating a former patient of Dr. Gosy should submit to the claimant's carrier a CMS-1500 with a detailed narrative report or office note instead of one of the prescribed C-4 forms. The CMS-1500 must be supplemented with a narrative report or office note that contains sufficient detail as to the diagnosis, treatment rendered and the medical need for the treatment. An insurance carrier or employer may not refuse to pay a medical bill presented for treatment reported on the CMS-1500 and a sufficiently detailed narrative report or office note.

Pharmacy Networks

Prescriptions obtained from a primary care or treating provider during this 60 day period must be filled in accordance with the Board pharmacy rules including use of a pharmacy network if required by the insurance carrier or employer.

Questions

For assistance in confirming a patient's eligibility for medical care or any other information concerning medical treatment, please contact the Board's Medical Director's Office at (800) 781-2362 or wcbmedicaldirectorsoffice@wcb.ny.gov.