Florida Workers' Comp Report: Insurers Unfairly Target Physicians

The Florida Medical Association, silent rather than actively supportive of dispensing physicians in the workers' comp fight last year, may be poised to take a more proactive role in the issue during the 2013 legislative session.

A new report from the state Division of Workers' Compensation (DWC) points to continued interference by insurance carriers into the doctor-patient relationship.

"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 M. Scott, general counsel of the Florida Medical Association.

Other pertinent results from the DWC report, according to the FMA:

* 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.

* There is virtually no difference in the cost of a repackaged prescription whether it is dispensed by a pharmacy or a dispensing physician.

* Other cost drivers are responsible for high workers’ compensation costs. If these other cost drivers were addressed, rates could be reduced by 7.5 percent to 8.3 percent. 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.

“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.


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Comments (2)

Peter Rousmaniere
10:46AM JAN 10TH 2013
I am trying to locate Nancy Smith regarding her article relating to dispensing of medications by physicians in workers comp. Physician dispensing of medications is prohibited by most health plans, including Medicare, and workers comp is an outlier. Thus, physician complaints about restrictions on dispensing are a little odd. I would like to talk with her about her research. I write the workers comp column for Risk & Insurance Magazine.
11:17AM JAN 9TH 2013
What utter nonsense. Physicians are dispensing drugs to patients primarily to generate profits - at the expense of taxpayers and employers. Moreover, as these docs don't know what other drugs their patients are taking, they are placing patients at real and substantial risk.
And, this is in violation of the AMA Code of Ethics.

Ms Smith, this is NOT reporting. FMA has mischaracterized the DWC report, and your reporting of this is a disservice at best.

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