Submitting a health care provider’s invoices to a peer-review organization is sufficient for an insurance carrier to challenge a treatment as unnecessary and deny reimbursement under the state’s Motor Vehicle Financial Responsibility Law, the Supreme Court of Pennsylvania has held.
In a unanimous Dec. 21 decision, the justices reversed a Superior Court decision that had awarded $39,000 in attorney fees to health care provider Doctor’s Choice Physical Medicine & Rehabilitation Center, based on what the intermediate appeals court had deemed an invalid peer review. In its opinion, the Supreme Court pointed out “the shortcomings of the peer-review regime,” an issue attorneys said won’t change unless the legislature devotes renewed attention to the process.
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