New York's highest court of appeals has held that no-fault insurers cannot deny no-fault benefits where they unilaterally determine that a provider has committed misconduct based upon alleged fraudulent conduct. The Court held that this authority belongs solely to state regulators, specifically New York's Board of Regents, which oversees professional licensing and discipline. This follows a similar recent ruling in Florida reported in this publication.
Congress Seeks Your Opinion on Medicare
The American Chiropractic Association (ACA) has alerted us that the U.S. House Energy and Commerce Committee is conducting a review of the Medicare program. The House is working with the Health Care Financing Administration (HCFA), the agency responsible for the Medicare program, to "eliminate waste, mismanagement and bureaucratic delays" in the program.
The ACA, you'll recall, is suing the HCFA over its Medicare+ regulations, which is Medicare's managed care plan.
The House Energy and Commerce Committee has set up a web page to survey Medicare providers. That website is: www.house.gov/commerce/hcfasurvey.htm. The survey covers such areas as problems in filing claims; understanding regulations; the relationship between provider and carriers; audits; and appeals.
It's not every day that Congress asks for specific input about your practice. Take this opportunity to report your experience with the Medicare program.
You'll particularly like survey question 11: "As a provider of health care, what recommendations would you make to Congress on how we can improve our federal health care delivery system? Please provide specifics."