An article in the Los Angeles Times yesterday bemoaned the death of a bill in California that would have required workers comp insurers to send claimants notices of medical services billed to verify they were actually performed. So-called explanation of benefits (EOBs) are routinely used in health insurance to help catch bogus billing by medical providers. So why not extend the practice to workers compensation?
Well, insurers in the state hated the idea and successfully sought to kill the bill. They feared the cost of the added paperwork and postage would be greater than any savings from fraud.
On the other side of the argument are a handful of employers and local prosecutors — led by our friend, Al MacKenzie of the Los Angeles DA’s office — who say the insurers’ argument is nonsense. “(As a medical provider), if I know you’re an injured worker, and you don’t get a copy of the bill, then I basically have a license to steal,” MacKenzie was quoted in the article.
Insurers say that if sending EOBs is such a good idea, they don’t need legislation to initiate this anti-fraud procedure.
But here’s the rub: no one really knows if this is a good idea. To our knowledge, the EOB experience has never been researched to determine whether the savings is worth the cost.
In theory it sounds like a no-brainer. But I suspect many EOBs are viewed by recipients as junk mail, are ignored or not well-understood. Even if they find discrepancies on the notices, what’s the incentive for a comp claimant to report them?
I could be wrong. But we just don’t know. Here’s an idea: let’s test EOBs on a sample of comp claimants and determine whether the fraud savings justify the cost. A scientific study could determine not only whether comp claimants report discrepancies, but could also gauge whether sending EOBs has a deterrent effect as well, as some proponents believe.
If there’s any prosecutor, insurer, employer or researcher in the Golden State that wishes to pursue this idea, please contact me. The Coalition would be a willing partner in helping to conduct this research project.
And here’s another idea: To reduce costs, why not send EOBs electronically. Insurers gather detailed personal information when a worker is injured. Why not include an e-mail address and automatically send them an EOB whenever a claim is received from a provider? The only cost would be a programming change to the insurer’s claims system.
And with the money saved, why not offer an incentive to claimants to report discrepancies. Perhaps a small portion of the savings? Could this work? What do you think?