Copyright 2012 Arturi Consulting, LLC All rights reserved.
PIP Law Update
By Robert Arturi
Arturi Consulting LLC
February 26th 2012
The Florida Legislature is currently working on two pieces of legislation that will have a significant impact on how the medical community handles Personal Injury Protection (PIP) patients. Both of these bills, according to their respective supporters, aim to reduce fraud from the system. While both bills preserve the $10,000 amount available to injured motorists, each proposed bill takes aim at how that money can be spent. Senate Bill 1860 (SB 1860), sponsored by Sen. Joe Negron (R-Stuart) will prevent massage therapists and acupuncturists from treating PIP patients. Those providers not affected by the new terms would have to become licensed PIP providers and register with the State in order to bill under the new system. Additionally, and a more far reaching effect, medical providers will be reimbursed at current Medicare rates. SB1860 also imposes sharper sanctions for providers found guilty of fraud.
The second piece of legislation taking aim at PIP providers is House Bill 119 (HB119) and is sponsored by Rep. John Boyd (R-Bradenton). HB119 is far bolder than SB1860 and seeks to completely change the entire system, rather than modify some of the parts. HB119 would replace the existing PIP system with a proposed “Emergency Care Coverage” insurance program. The principle remains the same, as do the coverage amount of $10,000 and the general idea of providing assistance to injured motorists by providing medical, funeral and lost wage benefits. While SB1860 would merely eliminate massage and acupuncture therapies from coverage, HB119 will change the entire process from the beginning, as it includes a 72 hour window for those seeking treatment. Additionally, HB119 specifies that such treatment could only be obtained at an emergency room rather than a medical clinic. HB119 also eliminates chiropractors, along with acupuncturists and massage therapists as in SB1860, from providing care under the PIP program. HB119 reimbursement rates are not as rigid as those in SB1860 but this is offset by the fact that there are fewer eligible providers able to provide treatment.
Both bills share support from insurance groups but the House bill, in its current state, is their likely choice as it modifies attorney fees and allows insurers to obtain statements under oath from patients. Both bills are supported by Gov. Rick Scott, however he has also indicated a preference for the House bill. The House bill has not been without opposition. Sen. Negron, supporter of SB1860, suggests that the provision allowing insurance companies to obtain statements from patients is too far reaching. Negron may have an arguable bias toward his proposed PIP bill but with such significant impacts coming from both pieces of legislation, opposition is surely mounting.
Under the provisions of the current PIP system, some providers have flourished. Pain clinics and referral services have spent millions to attract attention from potential injured motorists. Over the years, complex referral networks have emerged and this is likely what has gotten the attention of legislators. For every example of fraud, there is another example of a reputable clinic providing excellent patient care. It seems the legislature had this in mind because, although they framed their legislation to “reduce fraud,” they did not explicitly say from where the fraud was originating. The argument can be made that the legislature is pointing the finger at massage therapists and acupuncturists, along with chiropractors in the House bill, but that is as close as it comes to an indictment of any particular provider. There are also others who will suffer a decrease in income if these proposed changes occur. Some outpatient facilities, such as diagnostics and physical therapy, will fall behind their inpatient counterparts, especially if the House version passes. With all treatment originating at the hospital and referrals starting in emergency rooms as opposed to the current auto injury clinics, the availability and direction of referrals will likely change.
Almost every piece of legislation has consequences, someone gains and someone loses, and both SB1860 and HB119 are no exception. There will likely be opposition to these changes from organizations representing acupuncturists, massage therapists and chiropractors as well. The problem with opposition to this legislation is that it will lack unity. Those standing to gain from these changes include motorists, whose auto insurance premiums should fall (in theory), insurance companies, hospitals and hospital group physicians. Motorists and insurance companies both have strong lobbies and rarely do they support the same legislation. By contrast, the select medical providers targeted by both bills will likely take a stand but it will be an uphill battle. At a time when Floridians are looking to save money on insurance in any way possible, it will be difficult to convince voters that these changes are a bad idea.
Ultimately, it looks like some type of change is coming. With consumer groups, insurance groups and a large number of state lawmakers in favor of some type of reform, the winds of change have already started to blow.