While eliminating fraudulent claims is the stated goal of recently proposed P.I.P legislative bills, many of the proposed provisions would only give insurers the upper hand, according to healthcare executives.
Industry sources are sounding the alarm, calling for opposition to ill-advised and unnecessary changes. Many of the provisions of the various proposed bills put a heavy burden on hospitals and providers, while giving insurers new ways to deny or delay lawful claims.
The South Florida Hospital and Healthcare Association has added the PIP issue to its 2011 legislative agenda, opposing “efforts to change personal injury protection (PIP) laws that would seek to limit fees charged by attorneys and paid for by insurance companies for the recovery of legitimate PIP reimbursement to hospitals and other healthcare providers.” Healthcare attorneys advise that the proposed provisions would restrict the right of hospitals and providers to access the courts by drastically capping attorneys’ fees and requiring additional demand letters, and would make it impractical for them to take on these cases.
Among the provisions that have been floated in the various bills:
• Requiring Physicians and Providers to be subject to examinations under oath (EUOs) and requiring that clinics submit to onsite inspections by the insurance companies before benefits can be paid.
• Allowing the insurer to toll claims for an additional 120 days when they have reasonable belief that a claim is fraudulent. Industry sources say insurers frequently allege “fraud” as a delay tactic, an abuse this provision would only make easier.
• Creating a new fraud task force comprised of the Chief Financial Officer, two insurance company representatives, two local law enforcement representatives and two state attorneys – with no representative for the consumers or medical profession.
Hospitals and providers say what’s needed is tougher enforcement of laws already on the books, not the vesting of unconstitutional “private police powers” with insurers. The Florida Department of Law Enforcement already has the ability to act on any evidence of fraudulent conduct, they note.
While some of these bills and provisions may be off the table by SFHN’s publication date, the push by insurers to gain further advantage will continue. Stay tuned – and let your legislators know of your concerns. (Visit www.southfloridahospitalnews.com and click Legislative Contacts in the left hand column.)
