Posted On: September 24, 2007, 5:54 am CDT

Posted By: TPG

JG: Well, you may have sat through many depositions and be familiar with a "Colossus" program (which I am not); however, I am familiar with adjusters and various insurance company policies and procedures. I guarantee that none I have ever come in contact with have the position that all PIP claims are fraudulent as you stated earlier. That is not to say that insurers are going to sit idly by and be raked over the coals by providers that overcharge for the services rendered. Each of the insurers I deal with pay at the 95th percentile for the same services that other physicians in the area charge. In other words, 95% of all physicians in that area charge less than what the insurer is willing pay. While I am sure you may find that "bean counting" it also protects the insured from having their benefits exhausted by an unscrupulous provider that wants to charge $75.00 to put ice on someone's back for 15 minutes. In all, if the physician fee schedule is put into place, which they are discussing right now, it would be much better, but there would still likely be a lot of fraud.

As to your comment regarding investigations of fraud, we actively engage in the same as do insurers who are required by law to investigate fraud.