New state workers’ comp report shows insurance carriers unfairly target physicians

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An alarming concern related to the continued interference by insurance carriers into the doctor-patient relationship is one of the troubling findings of a new report from Florida’s Division of Workers’ Compensation (DWC).

“For the last several years, insurance carriers have engaged in what appears to be an anti-competitive scheme of intimidation against dispensing physicians — physicians who are simply trying to treat their patients effectively and efficiently,” said Jeffery Scott, general counsel of the Florida Medical Association (FMA).

The report also shows:

  • The National Council on Compensation Insurance (NCCI) and insurance carriers continue to make bogus claims, based on the NCCI’s inaccurate math, that physician dispensing is a major cost driver in increasing workers’ compensation rates, blaming physicians for the $380 million in rate increases the NCCI has secured for its carriers over the past three years.
  • Moreover, the DWC report clearly shows that there is virtually no difference in the cost of a repackaged prescription whether it is dispensed by a pharmacy or a dispensing physician. The truth is that the NCCI and carriers have used physician dispensing as a scapegoat for hundreds of millions of dollars in rate increases when other medical costs have been the real cost drivers in workers’ compensation. The numbers are fabricated in an attempt to eliminate doctor dispensing.
  • The report indicates that other cost drivers are responsible for high workers’ compensation costs. According to the report, if these other cost drivers were addressed, rates could be reduced by 7.5 percent to 8.3 percent. However, the NCCI and insurance carriers have only pursued legislation against physicians and blamed physicians for the increased workers’ compensation rates. Had the NCCI and carriers pursued legislation for these other cost drivers, the NCCI’s rate increases over the past three years would have been largely negated or eliminated, and rate decreases potentially could have occurred.
  • Carriers frequently, and improperly, underpay physicians who have valid claims for reimbursement. Based on the report, in 92 percent of cases that reach a determination, the carrier was found to have underpaid and the health care provider won. Carriers like to force physicians into the expensive and time-consuming process of pursuing dispute resolution in an attempt to wear them down. Physicians may often give up on seeking reimbursement before pursuing dispute resolution. However, when dispute resolution is sought, it is clear that carriers lose.

“If we want to increase patients’ access to health care in Florida, we need policies that help our physicians provide that care in a free-market system – not make it harder with price-fixing schemes that hurt physicians and their patients,” said Scott.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including SaintPetersBlog.com, FloridaPolitics.com, ContextFlorida.com, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.