Reform Agenda
Legislative reforms are needed to reduce costs associated with fraud.
Our Legislative Agenda:
- Encourages Fast and Fair Dispute Settlement by requiring medical providers to submit disputed no-fault claims to arbitration. Arbitration provides a very effective alternative to going through the court system.
- Supports Adequate Time for Fraud Investigations by modifying the “30-day rule” to allow more time to investigate suspicious claims and eliminate the “preclusion” of an insurer’s defenses to a claim for non-substantive technical errors. We support efforts to fight fraud and allow insurers to conduct thorough investigations. Fraud fighting efforts help to keep insurance costs down.
- Institutes Tougher Penalties for Insurance Fraud by enforcing laws already in place to decertify health care providers who commit no-fault insurance fraud and outlaw the practice of using so-called “runners” who recruit individuals or even staged accidents to enable fraudulent medical claims. We want to increase public safety and lower insurance costs by making it a felony for criminals to steer accident victims towards unnecessary medical treatments.
- Combats Excessive Medical Charges by requiring health care providers to submit evidence that the services billed were medically necessary, priced according to the fee schedule as required by the no-fault law and provided by a properly licensed practitioner. Over the years, no-fault case law in New York has shifted that burden of proof to the insurer to the point whereby a medical provider needs only provide a bill to establish their claim for benefits and requires the insurer to engage in a time consuming “verification” process to ensure that the charges were made in accordance with the law. This promotes an environment for excessive charges and billing disputes. We also want to create fair standards regarding acceptable alternative treatments for accident-related injuries. Implementing medical protocols will result in more consistent charges for similar treatments and services as well as less debate over abusive or improper billing. This reform could reduce the number of arbitration hearings and the amount of litigation, and lower the cost of medical care for everyone.