The Ministry of Justice (MoJ) has told MedCo to crack down on the large tier 1 medical reporting organisations (MROs) that have created multiple tier 2 agencies to increase their chances of receiving instructions.
Speed Medical, Doctors Chambers and, now, Premex have all registered 10 tier 2 agencies, and Litigation Futures understands that another of the tier 1 MROs – that is, a high-volume national provider – is preparing to follow suit.
MedCo users who choose to select an MRO are provided with a list of seven, of which only one is a tier 1 provider. An unexpectedly large number of companies have registered at tier 1 – in the absence of any official figures, it is said to be anywhere between 15 and 19 – meaning that the market share for tier 1 firms which previously dominated the supply of reports has fallen dramatically. This has led to the move to create tier 2 agencies to help fill the gap.
But in a statement published on the MedCo website yesterday, the MoJ said that “such actions have the potential to put at risk the chances of existing MROs to compete for selection, and also runs contrary to the policy objective of providing users with a range of seven ‘different’ – ie, unconnected – MROs to choose from”.
The MoJ also highlighted the growth of the ‘Qualitas’ model. It said this “allows ostensibly unconnected MROs to share instructions” and “has the potential to enable organisations to subvert the rules on financial independence as well as raising issues over choice and data handling”.
Referring to both issues, the statement continued: “The system was neither designed nor intended to permit this type of behaviour, but the Ministry of Justice is clear that MedCo, through the application of qualifying criteria, its user agreements and ethics policy, has the requisite tools to address it.
“In addition, the issue of MROs overstating their capabilities in order to be in tier 1 will shortly begin to be addressed by MedCo through a programme of detailed audits.”
The statement was strongly criticised by Qualitas Medical Assurance co-founder Dr David Pearce, who told Litigation Futures that neither the MoJ nor MedCo had responded to repeated offers to meet and address any concerns they may have about his company. He said it was “outrageous” that such comments had been made publicly without giving him the chance to respond.
Dr Pearce described Qualitas as an IT company “first and foremost” that effectively provided MROs with the technology to run their businesses via the cloud. It has also created an accreditation scheme to help smaller MROs compete.
He said Qualitas was “an ethical organisation” that had no shares or other stake in any of the MROs using the system (except for one which is owned by Qualitas’s founders), and banned the payment of any commissions. “Doctors are being paid properly [£80 per case] and the process is supported by efficient administration. It is what the MoJ wanted,” he said.
He added that all the MROs involved are legally and financially independent, have complete data segregation and ISO compliant security, and make their own independent decisions on which expert to instruct on a case by case basis.
Bippon Vinayak, the chairman and CEO of Doctors Chambers, said: “I am pleased to note that all models are being evaluated. However, these models are either opportunistic or a reaction to the overcrowded tier 1 and disproportionately higher chance of presentation in tier 2. Once these issues are addressed through audit and a more appropriate presentation of the tier 1 and tier 2 companies, the issues should hopefully self correct.”
Speed Medical had no comment ahead of an oral hearing of its application to bring a judicial review over the MedCo scheme, which is due to take place on Tuesday.
We have asked Premex for comment.
MedCo has also published a summary of legal advice received from Andrew Parker, the well-known head of strategic litigation at DAC Beachcroft, which indicated that MedCo does have the powers it needs to deal with behaviours identified by the Ministry of Justice.
In a further bid to improve transparency, MedCo has published a summary of its board meeting last week as well.