In movies and on TV, law is often portrayed as black and white. Guilty or not guilty. Plaintiff or defense. In reality, it’s not that definitive.
Take “Usual, Customary and Reasonable (UCR)” reimbursement rates, for example. That’s the amount third-party payers (such as auto insurance companies) generally use to determine how much they reimburse a health care provider under a PIP or no fault policy. In these types of cases, the issue is whether the health care provider has charged a “reasonable” amount for services. Obviously, there’s great discrepancy from case to case, requiring a comprehensive, strategic defense.
With another attorney, I recently presented “Trials and Tribulations of the UCR Case” to about 150 insurance professionals and attorneys at the Medical Claims Defense Network Conference in Orlando. The audience was defense-focused, but we received compliments for presenting both sides of the case, from pre-trial motions to jury selection and litigation approaches. I find arguing the prosecution’s case generally helps me plan a more solid defense strategy.
The value of developing a long-term strategy was certainly on my mind the following day when I arrived in Gainesville, Fla. for a day-long presentation to Nationwide Insurance on detecting, investigating and prosecuting insurance fraud. The Insurance Information Institute estimates staged auto accident rings could cost Floridians as much as $1 billion this year. A remarkable number that directly impacts our state’s relatively high insurance rates. I shared how insurance professionals can expose and investigate schemes, along with best ways to stop the bleeding once it’s uncovered.
My colleague, Zasha Rodriguez, recently presented “Fighting Insurance: Our Wants and Desires” at the International Association of Special Investigative Units (IASIU) in Tampa, and I’m looking forward to a presentation this week at the Special Investigators Association in Atlantic City, NJ. I hope to see you there.
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