The California Medical Association recently filed an amicus curiae brief in a case in which a California physician was removed from a health plan’s panel of participating providers without a hearing. In the underlying case, Rozengurt, M.D. v. Blue Shield, Mark Rozengurt, M.D., charges that he was automatically removed from Blue Shield’s panel of participating physicians after being placed on three years’ probation by the Medical Board of California. Blue Shield notified Dr. Rozengurt that that he would be eligible to reapply three years after he completed his probation and refused to provide him with any kind of hearing on the termination. The CMA brief focused on Section 805 of the California Business & Professions (B&P) code which requires that any action taken by a peer-review body that adversely affects a physician’s right to practice medicine based on a "medical disciplinary cause or reason" must be reported to the medical board. And before taking such an action, the peer-review body must afford the physician hearing rights. For the entire article, please go to www.calphys.org.
November 30, 2002--- AMED NEWS Opinion Article Addresses Survey Use
in Prompt Pay Claims
Noting that a collective $33 million in fines and restitutions paid by insurers nationwide hasn't stopped insurers from using every loophole they can find to delay or avoid payment, a recent Opinion article demonstrates the use of data collected in an AMA prompt pay survey to support claims under state prompt pay laws. The survey data is used to combat HMO tactics such as hiding behind the "clean claim" provision of the laws by saying that a claim is not filled out correctly or making partial payments on a claim. Prompt-payment laws in 47 states give insurers specific deadlines to reimburse physicians for submitted claims outside of defined limits. For the entire article, please go to www.ama-assn.org. For additional information concerning HMO litigation, please go to www.hmocrisis.com