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.
Interesting Quotes
Declining Profits for HMOs
"This was the second year of declining profits after six years of steady profit growth. The reason is health care expenses went up, but HMOs were unable to raise premiums accordingly due to increasing competition in the managed care industry. This means that, in order to avoid further profit declines, HMOs are now under pressure to raise rates, cut medical services or both."
-- Martin Weiss, chairman of Weiss Rating Inc. as quoted by AOL News on August 4, 1997.
The Real Meaning of the Medical Caduceus?
"Some elements of the medical industry remain constant, however. Pediatricians will continue to use lollipops as tongue-depressors and some old jokes regarding the profession will remain timely. The emblem of the profession will continue to be the caduceus, which PhDs describe as the staff of Aesculapius. MDs, on the other hand, will continue to see it as two lawyers dancing around a Maypole."
What's Up, Doc. Direct: the Magazine of Direct Marketing Management, May 15, 1997.