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Apr
6

Highlighting the lowlifes – Real investigative journalism looks into workers comp

Finally.

Investigative journalists are catching on to the widespread, rampant abuse of work comp by unscrupulous “doctors” and scam artists who’ve figured out it’s easy to make bank by cheating employers and taxpayers out of their workers’ comp dollars; and a whole lot less risky than taking on Medicare or Medicaid.

Christina Jewett’s series in Reveal highlights the lowlifes in California who’ve made millions filing fraudulent claims for non-existent medical conditions attributed to both real and imaginary patients. Comparing work comp fraud to Medicare, Jewett cites the relative ease and low risk inherent in cheating workers comp compared to the higher risk, harsh penalties, and Federal investigative muscle confronting would-be Medicare fraudsters.

The list of scams won’t surprise anyone who’s been in workers’ comp; fake diagnoses used to justify procedures that never happened; non-existent medical providers billing for services never delivered to claimants; claimants subjected to surgeries for conditions they never had.

Nauseating indeed, if for no other reason than we’ve seen it all before so many times.

Another “area of opportunity” for profiteers looking to shake the work comp money tree is the air ambulance industry. A recent Nightline story shines a very bright light into the very cloudy world of “life flights;” families bankrupted, insurers bilked, and employers stuck with bills for “life-saving” flights for patients whose lives were not in imminent danger.  Last summer, James Laughlin reported there were over five hundred fee disputes between comp payers and air ambulance companies in just one state – Texas.

I applaud Nightline, Jewett and the Center for Investigative Reporting for their diligence.  It’s remarkable how real journalists can help focus public attention on what’s really wrong with workers’ comp.

Michael Grabell and Howard Berkes could learn a lot from Nightline and Ms Jewett.


11 thoughts on “Highlighting the lowlifes – Real investigative journalism looks into workers comp”

  1. Now, now, Joe. Michael and Howard were shining a light on problems, even if they did not have all the facts straight.

    Remember, it is better to light a candle than to curse the darkness. So Michael and Howard’s candle may have been flawed, but the darkness it dispelled was far worse. don;t you think?

    1. Richard – No, I do NOT think Grabell and Berkes were “shining a light on problems”. They were – and are – pursuing an agenda. Not reporting, but advocating. That’s fine – if you are honest about it. They are not. Every social insurance program has problems – but the problems caused by lousy docs and opioid manufacturers and dispensing docs and crappy surgeons and fraudulent legislators are far worse.

      Grabell and Berkes have forever damaged their reputations.

  2. Is there anything that would prevent WC companies from issuing EOBs to the injured workers?

    1. JG – No. CompPharma doesn’t collect or have access to any data regarding prescribers – or dispensers, patients, or drugs prescribed or dispensed.

  3. Grabell and Berkes shined a light and opened up peoples eyes to the abuse of injured workers, they did a great services to injured workers. Christina Jewett’s series in Reveal highlights the lowlife – is also a great report that shows the harm done in workers comp. Why cant you say all these reporters have done a great job at exposing a BROKEN, profiteering industry, that has lost its way in the name of the all mighty dollar, over the health and well being of the injured workers, its there to serve, not to profit off the abuse and harm of folks injured on or by their jobs. THE GRAND BARGAIN has be taken away by ALEC led legislators and biased Dr.s who harm instead of heal, all in the name of profits over human life.

    1. Darren – first, thanks for the comments.

      Second, I suggest you read much more of what I’ve written here and elsewhere about opioids, the industry’s unwitting complicity in the opioid crisis, solutions to that crisis, the effective use of a formulary, return to work, opt-out, and the myriad other topics. That should clarify what I stand for.

      Third, I suggest you make a point of reading my posts about Grabell and Berkes. I’ve spoken extensively with both and have found them to be biased, completely uninterested in facts, and focused only on data that supports their ideological position. Once you’ve read everything I’ve written, I’d be interested in your view.

      Finally, your diatribe against the industry is flatly false. You have no idea what you are talking about re industry “profits”; where, pray tell, are these “profits”? Look at premiums; down dramatically in every state over the last two decades. And why isn’t your anger directed at the docs dispensing those opioids instead of the insurers whose hands are tied by regulation and fear of litigatoin?

      1. Just look here in WA state, our WC hedge fund was at 10 points, and now since the 2012 ALEC laid out legislation, is now at 18 points. That has almost doubled in just 4 years time. Then look at wc comp industry’s profit margins nationally over that same time period have gone up 600%. Profits are through the roof for wc insurance company’s, while the injured workers are suffering from the take aways, these ALEC based laws have led to. The numbers do not lie. As far as your war on drugs? I could care less. No one from the industry cares if the injured workers commit suicide or OD’s on drugs. That is just another game by big pharma, to push the new designer drugs because the patents have run out on the old drugs that worked for may of us for years. We have had opiates for centuries, what’s changed? ALEC and its bad legislation is whats changed. ALEC legislation and state med tort laws that took the patients rights away to fight back and sue our Dr.s through the STate med boards, that protect Dr.s and hinder the individuals FRIVOLOUS rights. This fence of addiction discrimination, does more harm than good. America is just now finally getting over it’s war on drugs, that it lost and only created more damage then good, starting another war will only lead to the same ends. Im tired of industry paid HACKs, spinning lies and misleading folks about what’s really going on in workers comp and state med tort laws. Our grand bargain has been taken, plan and simple, along with our individual rights to fight back civilly and fairly. This pitting labor against each other state by state, all competing for better comp rates, only helps the big insurers, while employers and employees, suffer from the take aways and higher comp rates. ITs Time for the FEDs to step in, where these bought out State laws have been implemented by ALEC. THE WAR ON LABOR needs to come to an end, and those’s who help to perpetrate it, need to be called out on the carpet. Suits protecting Suits, while labor and our grand bargain gets thrown under the bus. Industry does not fear litigation from the injured workers, not in the least, industry has got us all locked out civilly, economically, and legislatively. The deck has been stacked against the injured and our rights, and we need the FEDS to come to our rescue, where our State legislators have been bought out and mislead by industry, namely ALEC made legislation. The injured are starved out and waited out, delayed, denied, and defended against, when what our grand bargain called for was to be repaired, retrained, and or retired. The 3 D’s versus the 3 R’s, all in the name of corporate profits over human life. NPR had the facts correct, its the industry hacks, that are spinning the lies here. I’ll look back at some of your writing, but I only expect to see more of the same.

        1. Darren
          While I agree that Alec-promoted legislation is problematic, your data on profits is wrong. I am quite familiar with L&I and wholeheartedly disagree with your characterization of that organization.

          As for your prejudging me, that does you no credit. I look forward to your retractions.

  4. WELL, the insurers have been paying for opiates TO THE COS for years. First it was anti-inflammatories, now it will them again which are known to erode internal organs. But no matter what, the insurers will pay for all of this corrosive medicine. just as they pay for the many faulty surgeries. Where many end up worse than better. but then the insurers will not pay for any injury but a lousy pithy sum ( via a legally abused lengthy litigation process) and then send them off to the SSA/Medicare approved by all including & especially the insurance company. What a racket this is. How much money has the insurance industry made in the last 30 years & how many employees does it serve up? In CA. injure workers have gone done from 1 mil to under 500,000, this figure comes from an insurance association representative so again how much money has the insurance industry made since the debacle of workers compensation started in the 70’s, especially since the first reform of “89” and how much has it paid out to very many totally injured workers for their disabilities???. in 2005, 17.1% went to injured workers for all of their injuries. How much goes to attorneys? How much of it goes to QME’S, AME’S IME’S , utilization reviewers & insurance employees, that deny medical care, voc rehab, disability ratings?. Well, it’s way over 80%, a whole lot more than any totally disabled injured worker ever got!
    There is less than 50% of injured workers per year BUT the insurance industry keeps increasing premiums? Something definitely does not add up and again, like I stated above, what a racket! Nothing like the insurance industry profiting off of making sure there are enough of injured workers…

    1. Insurers have been paying for them BECAUSE THEY HAVE TO. Doctors are prescribing them – that is the proximal cause of the problem.

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Joe Paduda is the principal of Health Strategy Associates

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