Duggan-Leonard No Fault reform bill allows insurance companies to harass doctors who treat injured car crash victims through denial of payments, claims of improper overutilization, refunds — even threats of criminal charges
Monday, in my blog post “Will Michigan doctors stop treating car accident victims?,” I talked about how the badly flawed Duggan-Leonard-Theis No Fault reform plan will scare off many Michigan doctors and medical providers from treating injured car accident victims.
Specifically, House Bill 5013 does the following:
- Provides auto insurance companies with an expansive list of new “excuses” for denying and delaying payment of overdue medical bills.
- Excessively limits what doctors can charge.
- Makes it harder for doctors to bill auto insurance companies; and,
- Exploits doctors’ legal inability to sue auto insurers for unpaid and overdue medical bills.
As if that weren’t bad enough, HB 5013 — backed by Detroit Mayor Mike Duggan (former CEO of the Detroit Medical Center), House Speaker Tom Leonard (R-DeWitt) and House Insurance Committee Chair Lana Theis (R-Brighton) — also exposes doctors to indefensible new levels of harassment at the hands of claims adjusters.
How does HB 5013 subject doctors who treat car crash victims to harassment by claims adjusters and auto insurers?
HB 5013 empowers No Fault car insurance companies to harass doctors and medical providers who care for and treat car accident victims by forcing them to brave the following new legal hurdles:
- A doctor can be ordered to “refund” money to the auto insurance company if it’s shown (after the insurer has already paid the doctor’s bill) that certain circumstances exist. “If the unauthorized amount is not refunded within 30 days,” then the doctor can be forced to pay interest “on the amount refundable” as well as “court costs and attorney fees incurred in seeking payment of the money owed.” (HB 5013, Pages 53-54)
- A doctor can be “prohibit[ed]” “from charging and receiving a payment [through No Fault] for any treatment, training, product, service, or accommodation” provided to a car crash victim if the Department of Insurance and Financial Services (DIFS) “determines” the doctor “has engaged in a pattern or practice” of misconduct. (HB 5013, Page 54)
- A doctor can be ordered to pay “a refund of amounts received” from a No Fault car insurance company if the Department of Insurance and Financial Services (DIFS) “determines” the doctor “has engaged in a pattern or practice” of misconduct. (HB 5013, Page 54)
- A doctor who is shown to have “knowingly submit[ted] false or misleading records or other information to an insurer … is guilty of a misdemeanor punishable by imprisonment for not more than 1 year or a fine of not more than $1,000.00, or both.” (HB 5013, Page 55)
- A doctor who accepts No Fault car insurance payments for “treatment, products, services, or accommodations” rendered to a car crash victim “is considered to have agreed” to submit to the insurer-conducted “Utilization Review” process, which allows No Fault car insurance companies to determine that a doctor’s “utilization of treatment, products, services, or accommodations” is “above the usual range of utilization for the treatment, products, services, or accommodations based on medically accepted standards,” i.e., that a doctor “improperly overutilized or otherwise rendered or ordered inappropriate treatment, products, services, or accommodations, or that the cost of the treatment, products, services, or accommodations was inappropriate.” Based on that “utilization review” determination, the auto insurer may either “requir[e]” a doctor “to explain the necessity or indication for treatment, products, services or accommodations provided” or deny payment of the doctor’s medical bills, or both. (HB 5013, Pages 54-56)
- A doctor can be “require[d]” by a No Fault car insurance company “to explain” in writing “the necessity or indication” for “treatment, products, services, or accommodations … that are not usually associated with, are longer in duration than, are more frequent than, or extend over a greater number of days than the treatment, products, services, or accommodations usually require[d] for the diagnosis or condition for which the [doctor’s car-accident patient] is being treated.” (HB 5013, Pages 55-56)
