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.
Growth of Managed Care
Managed care enrollment in the United States is growing at an unprecedented rate. The number of Americans enrolled in preferred provider organizations (PPOs) increased by more than 32 percent in 1993. The number enrolled in health maintenance organizations (HMOs) increased by over 9 percent.
HMOs
1992 -- 38.8 million enrollees
1993 -- 42.3 million enrollees
PPOs
1992 -- 58 million eligible enrollees
1993 -- 76.6 million eligible enrollees
SOURCE: 1. InterStudy
2. American Association of PPOs