Posted on May 19, 2017
In the last two weeks, auto no-fault insurance reform has been back in the headlines, which has led to no shortage of discussion of some key points of dissention among stakeholders. For years, hospitals have been fighting fiercely to protect medical coverage and recovery services for residents catastrophically injured in auto accidents. Our hospitals and health systems keep their doors open 24 hours a day, 365 days a year and staff their emergency departments and operating rooms with highly specialized clinicians for a reason: to save the lives of people who are rushed in with life-threatening injuries. The care those people get after they leave the hospital is just as critical for their long-term well-being.
For years, insurers, providers, patient advocates and trial attorneys have debated how to ensure our system — which offers the best patient protection in the country — remains affordable. A recent series of articles in the Detroit Free Press dove deeply into what we at the MHA believe is a core driver of cost in the system: fraud and abuse. Especially in urban centers like Detroit, people who are in even the most minor of car accidents are aggressively pursued by bad actors who seek to exploit them, arrange for unnecessary diagnostic services and therapies, and ultimately defraud the system and drive up premiums for others.
On May 16, the Coalition Protecting Auto No-fault (CPAN) announced a new proposal to change no-fault that includes provider fee schedules, anti-fraud efforts and new requirements for insurers who wish to raise premiums. The MHA, which is no longer a CPAN member, has a board-endorsed position on no-fault — and one of its core elements is supporting a vigorous anti-fraud effort. However, we do not support government fee schedules for providers. Why? Well, partially because it doesn’t matter to what dollar amount you limit an MRI charge, because there are nefarious providers who will simply perform 10 exams instead of two to earn their keep. This example gets to the heart of why hospitals believe provider fee schedules and limits on medical benefits are simply slapping Band-Aids on the problem of affordability. These proposed changes hurt real victims with lifelong injuries and threaten access to care — and simultaneously, they do nothing to ensure affordable auto insurance premiums.
A day after the CPAN announcement, House Republicans introduced a series of four bills designed to tighten and eliminate eligibility for no-fault payments from the assigned claims program for pedestrians and passengers who don’t have no-fault coverage of their own. With less than 18 hours’ notice, the bills were scheduled for a hearing the next morning. Although it is likely the legislation could be amended to protect the rights of those injured and uninsured, this is yet another proposal that fails to get to the deep problems of fraud in our no-fault system.
The Detroit Free Press series hammers home a point that we’ve made for years: that hospitals providing lifesaving care to accident victims and needed recovery services are not the poison pill in the no-fault system. The problem lies largely in fraud and abuse that, left unchecked, will continue to threaten access and coverage for our most vulnerable accident survivors. We will continue to work with our elected officials to educate them about the value our no-fault system affords Michiganders, to protect coverage and care for the seriously injured, and to root out fraud and abuse.
Michigan Health & Hospital Association
Posted in: Top Issues - Healthcare