Cuomo Attacks (Part of) No-Fault Fraud — An open letter to the Governor

Dear Gov. Cuomo:

First, let me tip my hat to you in going after No-Fault fraud, as you announced yesterday.  Your decision to shut down medical mills and strip the licenses of deceptive doctors that churn phony No-Fault claims is admirable. I know this follows on the dozens of arrests made last week by Preet Bharara, the United States attorney in Manhattan for this type of conduct, coming from largely Russian-born individuals living in Brighton Beach.

But — and you knew there was a “but” coming, didn’t you? — I think you have only addressed half the problem. And with No-Fault fraud now on your plate, I think I speak for many when I ask that you authorize a more comprehensive investigation.

For the problem of No-Fault fraud stems not only from doctors doing phony billing, but comes also from sham medical exams by insurance companies to deny benefits.

You see, in order to get No-Fault benefits, an injured person must be examined by a so-called “independent” doctor that is hired by the insurance company responsible for paying, and treatment authorized. But there are way too many accident victims who are denied those benefits after quickie 5-minute exams. In order to appreciate why that would happen, one only needs to understand a fundamental conflict of interest: The more denials a doctor issues, the more sought-after s/he is by the insurance companies for future exams. If you are the insurance company and knew Dr. Smith denied coverage 30% of the time and Dr. Jones denied it 90% of the time, wouldn’t you want to keep sending claimants to the one that saves you money?

New Yorkers surrendered certain rights with the birth of the No-Fault laws. We can no longer bring actions unless we have suffered a “serious injury.” In exchange, we are supposed to get guaranteed medical/economic benefits up to $50,000 in exchange for the premiums that we pay.

But what happens with this kind of insurance fraud? The insurance company benefits because many lawsuits can’t be brought and then a second time by stopping the benefits the claimants were supposed to receive.

Investigation of this fraud should be relatively simple, as you know from being our former Attorney General. If a doctor is seeing 10 patients in an hour for No-Fault exams, and churning out cookie-cutter denials, you can bet your last dollar that doctor isn’t doing it with the best interests of the patients in mind.

So I applaud your efforts to go after No-Fault fraud from those doctors running medical mills and over-billing. And if there are some attorneys in cahoots with the medical providers, go get them too.

But please don’t leave the legitimate auto accident victims, with legitimate injuries, out in the cold because of fraud being perpetrated from the insurance company end of things.

Respectfully submitted,

Eric Turkewitz

 

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6 Responses Leave a comment

  • TouroGrad 2012.3.9 at 13:35 | Quote

    A lot of the heavy no fault motion parts (Civil Kings for example) have massive settlement rates. It would, to an outside observer be part of this massive grind on the part of the insurance companies where they can pay an attorney to litigate claims as long as they’re all settling at a low enough percentage of the original claim, regardless of the legitimacy of the claim.

    It would also appear to an outside observer who has no knowledge of the actual workings of the system that the insurance providers are just doing blanket denials as part of a money saving scheme, where they’re functionally reducing the no-fault rates paid to doctors.

  • Ron Miller 2012.3.9 at 15:12 | Quote

    I think, politically, the problem is that any time of tort reform seems to go in only one direction. There is rarely balancing “oops, we tried this and it does not work” legislation to fix efforts that clearly are imprudent or unfair to plaintiffs. Because – aside from trial lawyer lobbyists – there is not much of a push back to existing laws. It is hard to get a grassroots effort to fix bad tort reform laws because people don’t expect to be injured.

    Your cap on medical malpractice attorneys fees in New York really screws over a lot of plaintiffs who will never get a lawyer for meritorious claims. But the political will to get legislatures to look at that issues like this is virtually nonexistent in most states.

  • Phil Dinhofer 2012.3.9 at 16:55 | Quote

    Fantastic letter Eric.

    I am pasting it onto my letter head and sending it on over to Gov. Cuomo.

    I suggest everybody else do the same.

  • Eric Turkewitz 2012.3.9 at 22:05 | Quote

    I am pasting it onto my letter head and sending it on over to Gov. Cuomo.

    I suggest everybody else do the same.

    Even better, why not have clients who have been denied benefits after sham exams, write to Cuomo and explain how little time was actually spent with them investigating their injuries?

  • andrews 2012.3.10 at 16:13 | Quote

    Here in Florida, our legislature has just enacted “reform” promoted by the governor which will require you to go to the hospital whether you need to or not.

    By strange coincidence, the governor came from the hospital industry. While he served no time in prison, his company did have to give back part of the money they stole.

    Oddly enough, the insurance industry, which gets to deny claims for unnecessary hospital visits, also backed the bill.

    Some people wonder if Tallahassee is too close to Chattahoochee. Others wonder if the legislature is too close to the ATM.

Comments are closed.


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