MUA services inconsistent with MUA guidelines – prima facie showing lack of medical necessity established

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Synergy Med. v Praetorian Ins. Co., 2013 NY Slip Op 51047(U)(App. Term 1st Dept. 2013)

“Notably, defendant’s peer reviewer explained in some detail that the manipulation under anesthesia (“MUA”) procedures performed at plaintiff’s facility were not medically necessary according to the standards of protocol followed by the National Academy of MUA physicians.”

“The unsworn operative reports of plaintiff’s principal submitted with plaintiff’s attorney’s affirmation were without probative value (see Grasso v Angerami, 79 NY2d 813 [1991]). In any event, even if considered, the conclusory, fill-in-the-blanks findings set forth therein were insufficient to withstand summary judgment”

Definitely a plan of attack on MUA cases.

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One Response

  1. It is simply a bad case of lawyering by Plaintiff. Simply attaching a copy of the operative reports is meaningless. A simple affidavit would have solved the problem. The best plan of attack on MUA cases is for carriers to hire competent doctors who understand MUAs and have performed more than one when they were first certified. This decision is meaningless.

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