Number of MROs shrinks by a third as MedCo clamps down

Heskins: Warning letters usually produce the desired result

The number of medical reporting organisations (MROs) on the MedCo system has shrunk by a third in only eight months, it emerged last week.

Martin Heskins, chair of MedCo, told the PI Futures conference in Liverpool that by the end of August 2018 there were 78 MROs in the system, compared with 120 at 31 December 2017.

He said the drop could be explained by an increase in audits and reduction in ‘shell’ companies – companies set up by MROs purely to boost their presence on the MedCo system.

Mr Heskins said 10 of the 78 MROs were tier 1, compared to seven at the end of last year, and the number of accredited medical experts had fallen slightly from 739 to 705.

He said 407 warning letters had been sent out to MROs, experts and authorised users (mainly claimant lawyers) last year, a huge increase on the 46 sent out in 2016.

“Warning letters normally produce a result we’re happy with,” Mr Heskins said. “In a number of cases it can result in a suspension.”

Suspensions increased from 197 in 2016 to 277 last year, although the number of those reinstated in the system more than doubled from 42 to 98.

Mr Heskins said the number of audits of MROs had risen from 24 to 44. He said some MROs failed prepare sufficiently for audits, there was a lack of knowledge of the qualifying criteria and “occasional obstructive and/or abusive behaviour to auditors”, along with “refusal of entry to premises”.

He said MedCo was about to change its agreements so that refusal of entry would immediately result in suspension.

Mr Heskins added that problems with medical experts included the number of practising addresses, with one expert claiming to have 199, and the number of examinations carried out on the same day.

“The record for this is 160, with one or two experts claiming to carry out 130. One of these managed to do all of this on a single day between Barking, Birmingham and Liverpool. That expert has just been suspended from the system.”

Mr Heskins stressed that MedCo was “not a regulator” – the relationship between MedCo and all of its users was contractual one.

Mike Cutler, managing director of Premex Services, a leading MRO, said the launch of MedCo triggered a “free for all” by allowing MROs to self-certify as suitable for lawyers to instruct.

This resulted in a “frankly unfair cap” on the instructions Premex could achieve, and a “windfall for new market entrants”.

Mr Cutler said instructions “fell off a cliff” after the arrival of MedCo in 2015, and that “everyone” created more and more shell MROs as their volumes reduced.

While he credited MedCo for severing the links between law firms and MROs, and for accrediting expert witnesses, Mr Cutler said that, after three and a half years, there had not been a full audit of MROs and some were still self-certified.

He said the “rush to implement” MedCo – which was the fault of the government rather than the organisation itself – had led to “three and a half years of disaster” from which the organisation was only just recovering.

He added that there was no need for randomisation, a key principle of MedCo, and argued that lawyers should be free to instruct the MROs they wanted to.

Jon Scarsbrook, a partner at Irwin Mitchell, said MedCo had improved the quality of behaviour in the industry but not the quality of medical reports.

He said accreditation had “not done enough” to improve experts and Irwin Mitchell “spent a lot of time fixing issues with them”.

Mr Scarsbrook said he did not think MedCo was ready to expand beyond soft-tissue claims and questioned how the planned new small claims portal would enable litigants in person to correct discrepancies in medical reports.

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