Monday, August 5, 2013

Whistle Blower Suit Isn't About What's Right

Salacious.

That's the best word to describe this morning's news about a whistle-blower complaint unsealed July 24 in Sacramento Superior Court by Judge Raymond Cadei in which it is alleged that was a massive conspiracy involving more than 90 defendants in Southern California and hundreds of millions of dollars of greatly inflated prices on counterfeit spinal hardware installed needlessly on unsuspecting workers' compensation claimants.

Some of the names in the complaint are familiar, like Drobot, Randall, Pacific Hospital of Long Beach, Tri-City Regional Medical Center.

Some of the names are new to the media.

The allegations range from counterfeit implant hardware, to use of cappers and runners, and hugely inflated billings for unnecessary and dangerous procedures and cross/counter-espionage.

Some of the defendants that talked with WorkCompCentral reporter Greg Jones, of course, deny that they did anything illegal or wrong, and counter that the whistle-blowing plaintiffs have ulterior motivations ranging from eviction for failure to pay rent, retaliation for not acquiescing to a quarter million dollar shakedown, and a reverse law suit in response to revengeful non-payment of medical bills.

And all of this would be too dramatic for reality if it weren't real itself.

According to the complaint, the defendants cashed in on the pass-through for medical equipment used in fusions “through the unlawful employment of ‘runners, cappers and steerers,’ overbilling, illegal kickbacks to doctors and counterfeiting of medical implant hardware.”

The medical hardware pass through provisions were eliminated in SG 863.

“This scheme has led to patients receiving dangerous medical implants that have a substantial likelihood of failure,” the complaint says. “Many patients received spinal fusion surgeries that utilized counterfeit screws and rods, placing patients’ lives at risk and subjecting them to further surgeries to replace the counterfeit hardware.”

At least one defendant says that the suit against him is stayed by a bankruptcy proceeding.

Another says it was someone else who was doing money laundering and that there was nothing wrong with the business practice under his watch.

And yes it all is about money. Allegedly hundreds of millions of dollars in ill-gotten gains.

And none of it is about the spinal surgery patients - the workers' compensation claimants that were likely duped into having dangerous, unnecessary surgery that has altered their lives completely - introducing much higher levels of impairment and disability, much higher levels of pain an discomfort, ruining any chance of a return to work, than would have existed without surgical interference.


Those are the people that are the real story. The defendants and plaintiffs have their own reasons for fighting. In reading the complaint and the news story about this case it is clear that the well being and interests of the injured workers, who were the subjects of this conspiracy, were not a factor.

The plaintiffs seek to cleanse the dirt off their hands by "blowing the whistle" but if the defendants interviewed for the story are to be believed, there is plenty of mud left to sling around making this case more of a distraction than a correction of social wrong.

Because of medical privacy laws we may never know the story of the hundreds or even perhaps thousands of unsuspecting victims of these, likely criminal, acts (the state Attorney General's office has declined to participate in the case which is when the suit was unsealed).

At the end of the day, all things considered, the money involved isn't that much.

But the lives involved amount to a great deal of social burden that you and I will pay for, for the rest of their lives.

5 comments:

  1. all allegations are just that until proven, and I have heard Carrier doctors say no surgery is ever necessary, which is totally not true...why would a carrier doctor say that? (1) he is paid to say that, (2) the carrier would not have to pay for the surgery if we all adopted that philosophy, but it is not truthful

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    1. Correct .... my Spinal cord was compressed 6.5mm for over 2 1/2 years the carrier refused to treat in any way. SCI needs immediate care, surgery to stabilize the spine. ER doc said would be a quadriplegic in weeks made call and carrier approved surgery only 34mm plate 6 screws that have been confirmed without hardware in hand... to be Counterfeit...then carrier sent me home with NO MEDS for after care from that kind of surgery? Oh that's right WC don't have to pay to for pain and torture.... oh suffering....I have had my share believe me....

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  2. Thank you, David DePaolo, for this great blog post!
    - Paul J. Molinaro, M.D., J.D.

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  3. I am one of the patience I have had to have 3 lumbar puntures in the last 12 weeks diagnosis is psnudotumor celebri opening pressure 38 1st one. might need brain surgery for shunt ....had to go to riverside county hospital...the insurance refused any treatment for neuro...had c5 thru c7 acdf on 10/01/10 at Long beach pacific hospital....need info

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  4. Anyone who believes he or she has fallen victim to these alleged exploits should immediately consult with an experienced attorney ASAP... California has short statutes of limitations... many attorneys who handle these kinds of lawsuits offer free consultations and would take the case (if there is one) on a contingency basis, meaning only get paid if compensation is recovered).
    - Paul J. Molinaro, M.D., J.D.

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