By DEAN TRAVINSKI - WFAA - June 14, 2010
The nation's largest doctors' group says one in five medical claims is processed inaccurately by commercial health insurers, often leaving physicians shortchanged.
The American Medical Association released its third annual report card on insurers Monday. Medicare performed well in how quickly and accurately it paid doctors.
Commercial insurers such as Aetna Inc. and Anthem Blue Cross matched their payments to what they agreed to pay doctors about 80 percent of the time.
The group's report card is an effort to reduce the cost of claims processing for doctors.
The AMA is meeting in Chicago in its first annual meeting since the passage of President Barack WFAA
Showing posts with label Insurance claims. Show all posts
Showing posts with label Insurance claims. Show all posts
Tuesday, June 15, 2010
Sunday, January 13, 2008
Judge rules insurance company falsified document
By BRETT SHIPP - WFAA-TV - Jan. 10, 2008DALLAS - A Dallas judge ruled that the state's largest workers compensation insurance carrier committed fraud against an injured worker.
Texas Mutual Insurance Company has already been accused of callously denying claims against injured workers, but allegations of falsifying records could be a first.
Questions about Texas Mutual's business practices were first raised in a News 8 Investigation four years ago.
Injured workers complained that the insurance carrier was randomly denying their claims and robbing them of much needed medicine and benefits.
In an attempt to deny the claims of injured worker Juan Narvaez of Dallas, Texas Mutual is suing him in civil court.
Only now, Texas Mutual is on the defensive.
District Judge Martin Hoffman issued a ruling declaring "Texas Mutual Insurance Company committed fraud on this court" by "falsifying a critical medical record."
The record was a doctor's report in which someone added letters that tend to support the insurance company's position in the case.
"This fraudulent conduct was committed knowingly by agents and representatives of Texas Mutual Insurance Company," Judge Hoffman said.
"I'm upset by it, certainly," said Peter Rogers, who represents the injured worked.
Rogers said his client, who hurt his back on the job four years ago, is tired of fighting Texas Mutual for his care.
The judge ordered Texas Mutual to pay $30,000 and publish the court's ruling on their home page on the Internet.
State Workers Compensation officials said they are already reviewing the facts of the case. Texas Mutual officials have yet to respond.
Texas Mutual Insurance Company has already been accused of callously denying claims against injured workers, but allegations of falsifying records could be a first.
Questions about Texas Mutual's business practices were first raised in a News 8 Investigation four years ago.
Injured workers complained that the insurance carrier was randomly denying their claims and robbing them of much needed medicine and benefits.
In an attempt to deny the claims of injured worker Juan Narvaez of Dallas, Texas Mutual is suing him in civil court.
Only now, Texas Mutual is on the defensive.
District Judge Martin Hoffman issued a ruling declaring "Texas Mutual Insurance Company committed fraud on this court" by "falsifying a critical medical record."
The record was a doctor's report in which someone added letters that tend to support the insurance company's position in the case.
"This fraudulent conduct was committed knowingly by agents and representatives of Texas Mutual Insurance Company," Judge Hoffman said.
"I'm upset by it, certainly," said Peter Rogers, who represents the injured worked.
Rogers said his client, who hurt his back on the job four years ago, is tired of fighting Texas Mutual for his care.
The judge ordered Texas Mutual to pay $30,000 and publish the court's ruling on their home page on the Internet.
State Workers Compensation officials said they are already reviewing the facts of the case. Texas Mutual officials have yet to respond.
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