Business
Fraud, Massage Therapy Driving Up No-Fault Coverage
Around the State
The “no-fault” coverage, a hallmark of the state since 1971, has grown 70 percent in the past two years and the rates could skyrocket another 40 percent within a year.
The increase is primarily due to a rising number of fraudulent claims mostly in the state’s metro areas and a business exemption enacted several years ago that allows some massage health clinics to avoid state filing requirements regarding vehicle injury treatment.
In some cases the treatment may be giving an individual an ice pack.
With a study on the issue expected to be delivered to the state Cabinet in a few days, the insurance industry has complained that without the rate increases many companies couldn’t afford to remain in Florida.
“How can you afford it?” asked Gov. Rick Scott, who equated the projected overall cost to add a half million dollars to the $910 million sticker price that state motorists currently collectively pay for the coverage.
Florida Chief Financial Officer Jeff Atwater is supporting efforts to reform the no-fault system in the 2012 legislative session.
”Regrettably, to keep these companies here we have to make our business models work and if we have a system that provides this much fraud, where every dollar collected is a dollar lost, the commissioner has no choice but to keep increasing the premiums so they can stay in Florida,” Atwater said.
Staged accidents have grown 58 percent from 2008 to 2009 and an additional 39 percent the following year, according to figures from the CFO’s office.
Florida requires no-fault coverage of at least $10,000 in personal injury protection in the event the driver or any passenger is injured in a crash. The coverage is good for 80 percent of medical expenses and 60 percent of lost wages.
Officials say there shouldn’t be an increase in the average cost for no-fault insurance because the number of registered motorists in Florida has held steady at just under 16 million while the number of crashes is down from two per 100 drivers in 1996 to one and a half per 100 in 2010.
However, a big reason no-fault medical protection has grown, according to Robin Westcott, the state's insurance consumer advocate, is that a little less than a decade ago the state created exemptions for certain health clinics, particularly massage centers, to provide medical care for those recovering from accident injuries.
With the exemption, the massage clinics file directly to the insurance companies rather than to the state or any health provider.
Insurance companies, in turn, question medical treatments not prescribed by doctors.
Meanwhile, Westcott said in a state where 21 percent of residents have no health care coverage, police agencies have reported that 25 percent of drivers during random checks lack adequate motor vehicle insurance.
With only 10 states still requiring no-fault, Westcott said the state should consider a tort system with bodily injury coverage that is not mandated.
“We will soon have people paying $4,000, $5,000 for a $10,000 benefit,” Westcott said. “That is not fair.”
Comments (2)
Fraud, Massage Therapy Driving Up No-Fault Coverage posted by: Jim Turner | Posted: November 2, 2011 3:55 AM
FL LICENSED MASSAGE THERAPISTS; ARE NOT THE MAJOR CAUSE of FRAUD IN FL PIP!!!
As the Insurance Committee Chair for the Florida State Massage Therapy Association (FSMTA), let me assure you that we are working on weeding out this sort of thing within our own profession from our State Board to our State Association and on to FL Massage Therapy Schools.
As FL Licensed Massage Therapists, we are totally in agreement that fraud is running rampant and we too are extremely disgusted that our profession, which we have worked so hard to uplift over the past 25 years, is being tarnished by what is happening with PIP Fraud. We too are policyholders and are being affected by higher premiums. We aim to help fight this as much or more than anyone!
In reference to Jim Turner’s article, and in all fairness to our profession, to our therapists and to our members, this fraud is NOT in any way perpetrated by the majority of FL LMT's but the old saying holds true, one spoiled apple ruins the entire bushel. When greed gets in the way, all innocent people in it's path suffer.
We know for a fact (as I have also presented to NICB and FBI agents and some from the FL Dept of Insurance,) and many others recognize the fact, that in most cases, massage therapists are unsuspectingly being "used" by unscrupulous others who are over coding, over-billing, over utilizing massage therapists to perpetrate this fraud. I have personally seen claims where it would be totally impossible for 1 or even 3 therapists to have done the work in one day that was billed to an insurance company, claims signed by the by a hired Licensed Massage Therapist. Documentation does not even come close to fitting the claim and yet insurers have paid these outrageous claims then try to do the review of claims after the fact.
I have suggested that one way insurers could help is to only directly reimburse those who are trained and licensed to perform the therapy and not those who own clinics or hire the therapists’. This would eliminate much of the tracking it takes to find those responsible for fraudulent activity.
Due to their own rule changes, Chiropractors in FL are not allowed to be "hired" by massage therapists, this sounds like an idea that should be taken up by other medical providers as well. My own personal question would be, why would a medical provider with much higher degrees want to be hired by an LMT unless it is to circumvent the kickback laws in making money off the services of another?
Let me make it clear, since massage therapists are EXEMPT from the "clinic licensure laws" there is NO REASON for them to even be trying to obtain a "Clinic license", or to hire other medical professionals who in turn work together to bill insurance. A massage therapist should only provide medically necessary treatment to a patient while billing insurance when PRESCRIBED via a written prescription from a treating physician. This is how it was done for over 20 years and the insurance industry nor’ our massage profession ever saw this sort of fraudulent activity!!
Another issue I see as part of the problem. A massage therapist does the difficult hands on work while others who are not specifically trained in this type of work do not want to, do not know how to, and do not have the time to do the therapy but are the ones being paid by insurers, thus using the "system" to rake in the big bucks, raising our premiums, while paying pennies on the dollar to the massage therapist who actually does the intensive hands on work.
Be assured we have a task force in place and are working on creating Standards of Insurance Billing and Coding for Massage Therapists. This, we hope will be required for them to use if they are to be paid by insurers. This would not only give therapists legal guidelines by which to bill by, but would also provide insurers and fraud investigators an avenue to know when a massage therapist is straying from the Standards of Insurance Billing and Coding established by our profession.
I invite any comments and suggestions.
Sincerely,
Vivian M. Mahoney, LMT
Insurance Committee Chair/Consultant to FSMTA
865-436-3573
865-850-3195
vivianmadison