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
Give 'em a Pill
"The physician would rather please the patient who expects an antibiotic than not use the drug."
-- Dr. William Hueston Primary investigator in a study comparing the use of antibiotics in fee-for-service vs. HMOs.
As quoted in Managed Healthcare, October 1997.
Long-Term Failure Rates
"Long-term failure rates after operations for back pain are as high as 30% for lumbar arthrodesis and 37% for discectomy."
Source: To reoperate or not? Spine Letter, Volume 4, Number 3.
Cut It Again Sam?
"The risk for subsequent reoperation on the lumbar spine after a lumbar disc operation seems higher than previously assumed. This should be taken into account when sharing information with the patient about the postoperative prognosis."
-- Seppo Seitsalo,MD, noted researcher quoted in The Back Letter, Volume 12, Number 8, 1997
Slowing Cost of Health Care
"Over the longer run, managed care could be far more potent - if it changes fundamental forces driving costs. Managed care can't delay the aging of the baby boom. But there are hints it may be slowing cost increases but raising uncomfortable questions."
Health-Cost Trims Hold Inflation Down. David Wessel, Wall Street Journal, June 30, 1997.