Posted 01 December 2017 by Donna Scully
Donna Scully, director of law firm Carpenters, looks at the steps taken to make the medical referral body more effective
Restricted by its founding principles and structure, by any independent assessment, MedCo had a turbulent couple of years after it was created in 2014. Driven by an unnecessarily rushed political agenda, a good concept was too hurriedly pushed to implementation without considering the possible consequences and resulting behavioural changes by the marketplace. It quickly became apparent that users of the system were attempting, in the words of MedCo itself, to “circumvent the principles of the random selection process”. Too substantial to be dismissed as teething problems, a subsequent review identified the need for extra resources and a fundamental restructuring of the criteria under which it operated.
Action against fraud is taking place on a number of fronts, although the consensus is that it could be more assertive and directed more rigorously. Now, on the third anniversary of its incorporation, MedCo is at the heart of this fight against fraud, improving the quality and standards of medical investigation and reporting. In a coincidence of timing, the Insurance Times Fraud Charter group heard an update from MedCo, only a day before it published its annual report for 2016. Having suspended 134 Medical Reporting Organisations (MROs) posing as shell companies and the judicious use of a “no refund” policy, the not-for-profit organisation operated at a substantial surplus in 2016 and is now able to reduce registration fees going forward. In other good news, roughly 80% of registered medical experts have now passed the online accreditation course.
Any system is not perfect. MedCo remains reliant upon the quality of data inputted by MROs and is still forced to spend a disproportionate amount of resource on policing solicitors and MROs. Its formation does though provide some salutary lessons for the future. As we have long known from the development of the AskCUE PI system, MedCo has re-confirmed that effective data management systems can be at the forefront in combating fraud and tackling other unwelcome behaviours in the claims system.
Returning to the MedCo annual report, although couched in diplomatic language, the organisation squarely lays the early problems at the doorstep of the government, saying “Due to the government’s timetable for implementation of its policy on whiplash reform, MROs self-certified their compliance with the original qualifying criteria.” The lessons must be learnt. The new round of reforms must not be rushed, with the full consequences understood, as far as possible, from the outset. The new regime must ensure that the Portal and MedCo work as one, with data shared between the two systems. The changes to the two systems will require planning, investment and careful thought, with input from all parties, to get it right. We must try and predict the unintended consequences and how behaviours will change and adapt before implementation. Both systems could be at the vanguard in tackling fraud and be highly effective. For all the progress made, it is a great pity that the Government’s wider proposed reforms on small claims will substantially reduce its effectiveness by letting through the system precisely those claims it has sought to limit.
This article was first published in Insurance Times on 1st December 2017. You can view the full article here: https://www.insurancetimes.co.uk/expert-view-medco-turns-the-corner/1425727.article