6 questions facing Minnesota medical fraud panel - KMSP-TV

6 questions facing Minnesota medical fraud panel

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ST. PAUL, Minn. (KMSP) -

A group of Minnesota lawmakers tasked with fraud prevention is taking a close look at six issues regarding health care billing and regulations in the state.

FRAUD PREVENTION WORKING GROUP AGENDA

MRI/CT regulations


MRI/CT scan facilities in Minnesota are subject to less oversight than x-ray facilities. The current debate is whether or not patients are getting unnecessary, expensive scans that could also be and physically damaging.

The question: Should standards and inspections through the Minnesota Department of Health be established for MRI/CT facilities similar to the way that the Radiation Control Unit oversees x-ray facilities?

Massage licensure


Massage therapists currently have no formal licensing requirement in Minnesota.

The question: If the insurance industry is to continue reimbursing massage therapy as a medical expense under no-fault, should the massage industry be subject to licensing requirements similar to that of physical therapy?

Batch billing

Insurers sometimes hold and later deny medical bills incurred prior to an independent medical examination through a process called "retroactive denial." This practice is considered unfair by some arbitrators. The result is batch billing, where some providers hold bills to delay the processing of claims.

The question: Should insurers be able to hold bills and deny bills incurred prior to the completion of their investigation if warranted?

Corporate practice of medicine regulation

Licensed chiropractors are increasingly owning and directing medical care at diagnostic facilities that perform MRIs, directing and overseeing neurologists, orthopedic surgeons and pain management doctors.

The question: Should the law stipulate that an individual must have equal or advanced licensing in the medicine practiced at, in order to operate and own a clinic?

Provider testimony

Minnesota law limits the ability of insurers to get testimony from doctors to answer questions about billing, treatment provided and records, without a lawsuit being filed against the doctor.

The question: Should insurers be allowed to bring motions in District Court  to argue the treating provider should be ordered to sit for a deposition pertaining to billing, treatment provided and/or records?

Misrepresentation of auto-garaging

Some patients who actually live in Minnesota use an out-of-state address to lower their insurance costs. This puts a financial a burden on the rest of Minnesota's honestly-registered, insured patients.

The question: Should Minnesota clearly spell out that these activities violate state law? If yes, how?

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