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Changes to the MedCo qualifying criteria to halt the gaming

In March, the MoJ announced that changes would be made to way that MedCo operates, following the MoJ’s Framework Review at the end of last year. Those proposals were intended to tackle the issues then facing MedCo and the gaming of the system by some MROs and they included changing the number of Tier 1 and Tier 2 MROs that appeared in any given search.

Yesterday, the MoJ announced the detail of those changes to the MedCo qualifying criteria. MedCo Director and DWF Motor and Fraud Head, Nigel Teasdale takes a look at the new qualifying criteria and the important new MRO definition which will apply to those MROs already registered with MedCo and those looking to register.

Background

MedCo was established to oversee the provision of good quality medical evidence in soft tissue injury RTA cases and was set up with the support of those in the claimant, medical and the defendant community. Since implementation, MedCo has had to deal with a number of organisations intent on subverting some of the MoJ’s policy objectives.

One of the issues facing MedCo was the registering of ‘shell-companies’, used to gather instructions that were then forwarded on to a parent company, or other related organisation. The more shell companies that were registered, the greater the overall chances of any MRO appearing in the result of a MedCo search.

In order to tackle that problem in particular, the MoJ announced in March of this year that a number of changes would be made to the MedCo qualifying criteria back including a proposed definition of an MRO for the purpose of MedCo.

The MedCo definition of an MRO

Following the MoJ’s announcement in March, a short stakeholder survey took place to identify the potential problems with the MoJ’s proposed definition. Following that survey the MoJ has announced both the new definition for MedCo MROs and the new qualifying criteria for registration, which includes as before, a separate set of additional qualifying criteria for those MROs claiming to have high claims capacity and national coverage.

The new criteria apply immediately for all new MROs registering with MedCo and also for those applying for reclassification as a high volume, national MRO. For existing shell companies the new criteria apply from 8 November and for all other MROs, the criteria will begin to apply three months hence.

To meet the MedCo definition, an MRO must demonstrate that they are:

  • independent
  • properly staffed and resourced; and then
  • directly and solely responsible for all work associated with receiving instructions via the MedCo portal and instructing a medical expert to provide an initial medical report.

To meet the definition, MROs must then also:

  • establish and maintain the direct management and control of a panel of MedCo accredited experts;
  • employ staff in-house with responsibility for managing the instructions received from authorised users and for directly undertaking all administrative work associated with the commissioning of reports from MedCo accredited experts on their own panel;
  • manage the appointments process for claimants;
  • oversee and quality assure the report production process and have systems in place to effectively manage any complaints from instructing parties; and
  • comply fully with the MedCo Data Contributor Agreement, including its Ethics Policy, and operate in a way which is not contradictory to the Government’s stated policy objectives.

The definition looks to tackle shell companies by ensuring that all MROs that appear in any MedCo search result are actually capable of processing the request for a medical report in their own right and functioning like an MRO, rather than just simply a means of capturing the initial instruction, only then to pass that instruction on to the parent MRO to process. The definition acknowledges that some MROs may fall under common third party ownership but MROs must be fully functioning entities in their own right, with a principal function of providing medical reporting services.

The criteria for high volume MROs has changed slightly in that they now specify that an MRO which has not previously processed 40,000 independent medico-legal reports, may still be considered to have the requisite capacity, if they can provide evidence to demonstrate that they have the ability to reach that capacity within the following 12 months and possess an appropriate business strategy and sufficiently scalable operational functions for it to deliver increased capacity without it being at the expense of quality.

What happens next

The new definition and criteria provide welcome clarity and should enable MedCo to exercise its powers to substantially reduce the gaming by MROs which has become too common a feature. We are likely to shortly see action being taken to end some of the abuses of the MedCo system, which have been aimed at circumventing the randomisation of the search results.

The proposed changes to the search results announced back in March will provide more choice to claimants, who are now able to select from two Tier 1 MROs, or ten Tier 2 MROs, as opposed to one Tier 1 and 6 Tier 2 MROs as has been the position to date.

At the same time, concerns remain including around whether the restrictions on financial links go far enough. Let us hope that the MRO market is able to respond positively to the current changes so that the government is not obliged to tighten the current restrictions still further.

The constant attempts to game the system in order to increase market share have no doubt distracted MedCo away from its efforts at ensuring that there is quality in the provision of medical reports. That, together with ensuring completed data is uploaded, has to be where MedCo will now focus its resources so the industry can see tangible improvements to the quality of medico-legal reporting, making a medico-legal report worth waiting for.

MedCo has developed and will be publishing guidance which will assist MROs in interpreting the new criteria. All new definition and revised qualifying criteria can be viewed on the MedCo framework review page

Contact

For further information please contact Nigel Teasdale, Head of Motor, Fraud and Costs, on +44 (0)1772 554264.

You can read about the changes made in March in our update The game is up

By Nigel Teasdale

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This information is intended as a general discussion surrounding the topics covered and is for guidance purposes only. It does not constitute legal advice and should not be regarded as a substitute for taking legal advice. DWF is not responsible for any activity undertaken based on this information.

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