New York - Volume I, Number 1 - April, 1996


Physician State Court Jury Duty Exemption Repealed

Effective January 1, 1996, a new law has repealed the automatic exemption for professionals, such as physicians, from state court jury duty. Although the law does not rule out the possibility that a physician may be excused from duty, excusal requires proof that the applicant is mentally or physically incapable of performing as a juror; or, that jury service would cause undue hardship or extreme inconvenience to the applicant. A physician can request postponement of jury service only if: 1) it has not been granted before; 2) the request is made in advance according to outlined procedures; and 3) it is postponed to a specific date not more than six months from the date jury service would have started. If a request is denied, the applicant may make a personal request to the court set to hear the jury case, but the court has no obligation to grant any request. The law penalizes anyone disregarding a jury summons with a $250 fine. And it is a safe bet that payment of the fine will not relieve one of the duty to serve in the future.

Dept. Of Insurance Critiques Blue Cross Management

Not long after approving a rate increase quite a bit smaller than that requested by Empire Blue Cross and Blue Shield, the NY State Insurance Department concluded in a report that Empire still has problems managing claims handling, fraud control, underwriting and rating practices. Included in the September 1995 report was a recommendation to eliminate dummy codes, as well as charges that Empire did not stick to contractual requirements for particular claims (which consequently led to reimbursements at lower rates). The report also suggested that Empire bolster its fraud enforcement staff because more than half of the fraud cases opened in 1993-94 are not yet even assigned to prosecutors. In addition, Empire was faulted for denying payment for services rendered to a patient whose contract was canceled retroactively, and for delaying other valid physician payments despite absence of physician error. Some findings were turned over to the Department's general counsel for further review while others were issued to Empire for implementation within twenty days.

FTC To Review NY State Nurses Complaint Against IPA

The Federal Trade Commission will review a complaint by the NY State Nurses Association ("NYSNA") against the Rochester Community Individual Practice Association ("RCIPA"). The complaint alleges that RCIPA restricts patient access to care by refusing to reimburse for certain visits to nurse practitioners unless supervised by a physician. RCIPA, affiliated with Rochester Blue Cross/Blue Shield, dominates the managed care market in Rochester, while NYSNA is a union and professional association with approximately 35,000 members. Since nurse practitioners are certified by New York State to provide care in 13 specialty areas, NYSNA's complaint charges that mandatory physician supervision is a duplication of services that reduces a patient's ability to choose alternative providers. As a result, NYSNA argues, this is an illegally anticompetitive act by RCIPA that amounts to a restriction