A Grand Opporunity

There's good news coming out of the Drobot/Pacific Hospital/Calderon drama - the possibility that the doctors who were on the dole will also face prosecution.

Michael D. Drobot's plea agreement requires him to cooperate fully with federal, state and local prosecutors by testifying at trials and grand jury proceedings and providing documents, records and other evidence requested by the U.S. Attorney's Office.

Albert H. MacKenzie, a former deputy district attorney in charge of the Los Angeles County District Attorney's fraud interdiction program, told WorkCompCentral that having Drobot as a cooperating witness gives prosecutors the greatest opportunity he's ever seen to clean up medical fraud in the workers' compensation system.

“My hope is that it is utilized to the fullest extent, that it just doesn't end up with the Calderons being prosecuted, but we also reach out and look at who were all these people who were vultures preying on the bodies of injured people,” he said. “It's incredible and I hope it isn't lost.”

While the federal government may focus on the Calderons, MacKenzie said there will still be “plenty of meat on the bone” for the state's top attorney and county prosecutors to identify and prosecute the doctors who took payoffs from Drobot.

MacKenzie cited Labor Code section 3215 which provides:

"Except as otherwise permitted by law, any person acting individually or through his or her employees or agents, who offers, delivers, receives, or accepts any rebate, refund, commission, preference, patronage, dividend, discount or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring clients or patients to perform or obtain services or benefits pursuant to this division, is guilty of a crime."

Violation of this section can result in jail for up to a year and a fine of $10,000 on a first offense. A second or subsequent conviction is punishable by incarceration in state prison.

MacKenzie is right - once the linchpin is secured it's time to go after the people who have fed off the destruction of innocent workers' lives.

Last month I was critical of the California Fraud Commission and the money they hand out - money that is collected from employers as an assessment on policy premiums.

At the California Fraud Assessment Commission meeting last month Jiles Smith told attendees that they're going to have to think outside the box.

“Every time a prosecutor comes in asking for more and more and more funds, knowing that there’s no more funds available, it’s going to push us into that situation every year where we are trying to do our best, reading thousands of pages to determine whether or not the District Attorney’s Office does, in fact, grasp what it is they’re supposed to be doing with these funds to impact the workers’ compensation fraud problem in the state and those cost drivers that continue to make workers’ compensation (in) California one of, if not the most expensive in the country,” he said.

I said last month that district attorney offices that want more fraud money not only have to open more investigations and close more prosecutions, but need to market those efforts more effectively.

I stand by that statement.

Here is a situation where the the State Attorney General and the various district attorneys within the county of Los Angeles have been given an extraordinary gift - this is akin to the capture of Joaquin “El Chapo” Guzman.

If the attorney general offices that seek fraud commission funding want to prove themselves that they are worthy of the money they will take advantage of this unique opportunity.

And as more individuals are identified I hope that the victims of these criminals seek civil compensation for ruined lives.

Certainly the State Compensation Insurance Fund in its RICO action against Drobot's son, Michael R. Drobot, alleged to have established a similar scheme, will benefit from this testimony.

The younger Drobot's attorneys have filed a motion in that suit asking the U.S. District Court for Central California to issue a six-month stay on the proceedings because a federal criminal investigation of their client is underway.

But all of the surgical victims have damages too and while the restrictions in California for medical malpractice make it nearly impossible for these unfortunate folks to get any meaningful recovery, riding the coattails of the State Fund's suit with independent actions against the complicit doctors for fraud and conspiracy should be actionable.

This case represents the single biggest opportunity to clean up workers' compensation in California and the single biggest opportunity for these attorney generals to redeem themselves in the public eye.

I despise sensationalism, but this is one situation where I hope to see more headlines about miscreants taking a fall for the despicable ruination of lives and the compromise of the workers' compensation system.