Is PIP Fraud Is Exaggerated?
For months now, Floridians have been showered with grandiose assessments by the insurance industry and its pals in Tallahassee about how fraud in the personal injury protection system is pushing mandatory premiums skyward.
This despite the industry’s patent refusal to cough up hard data that prove the runaway fraud scenario is fact, not a smokescreen to disguise padded profits. Even some of the state’s most knowledgeable officials, CFO Jeff Atwater and Insurance Consumer Advocate Robin Westcott among them, have rapped insurers for failing to submit the numbers as requested.
And yet, the industry not only continues to get away with its intransigence, its exaggerated fraud picture reigns in Tallahassee as a top issue of legislative concern. Surprised? You shouldn’t be. A credible, independent study completed in December by a Florida State University professor found that state leaders are too cozy with the insurance industry and are relying on flawed data in pushing for PIP reform.
It is this toxic climate that has allowed Rep. Jim Boyd, R-Bradenton, to advance through the Florida House committee process a potentially crippling measure that, if passed, would ruin the business climate for legitimate medical providers, lead to the loss of thousands of jobs in the health care field, and cripple accident victims’ access to quality health care.
HB 119’s most ballyhooed provision is its proposal to require accident victims to report to a hospital emergency room within 72 hours to quality for the PIP coverage they paid for, even if they suffered only minor injuries. Such as senseless mandate takes legitimate business away from trusted medical professionals with whom many patients have built a longstanding relationship; providers whose practices are set up to handle this important patient load. And
since symptoms of many accident injuries can take weeks to show up, Floridians would have to seek treatment under high-deductible medical plans, making them pay twice for the same coverage.
Worse, putting the onus on ER doctors to confirm injuries resulted from an accident would easily overwhelm an already-crowded emergency system, and subject ailing patients to long, unnecessary emergency room waits. It’s a disaster in the making.
But that’s just the beginning of HB 119’s parade of horribles. By capping attorney fees, for consumers and medical providers but not deep-pocketed insurers, and requiring onerous site inspections and deposition-like examinations of medical providers, the measure is an attempt to eliminate Florida consumers’ most effective advocates. There’s a reason Boyd’s bill has been dubbed “the insurance industry’s wish list”: It does nothing to target fraud and everything to protect the industry’s bottom line.
Thankfully, on the other side of the Florida Capitol, Sen. Joe Negron, R-Stuart, has filed a more sensible measure that truly seeks to combat fraud. Not only does SB 1860 establish an organization to support, prosecute, investigate and prevent fraud, it holds both unscrupulous insurers and doctors accountable. Insurers that fail to pay valid PIP claims would be subject to new action for unfair and deceptive practice, and doctors convicted of fraud would lose their license for five years and be barred from submitting a PIP claim for 10 years. That’s fair.
Negron’s bill isn’t perfect, but if fraud is truly the target for reform, his effort would get the job done long before Boyd’s pro-industry “fix.” Which measure carries the day may very well determine whether accident victims have access to quality medical care, and whether medical providers will be able to continue to do business in a toxic environment. Florida can’t stomach any more industry-friendly wish lists. Insurers have had their way in Tallahassee long enough.
President and chief operating officer
Diagnostic Professionals Inc.