Wednesday, February 26, 2014

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.

1 comment:

  1. Holy Moly David DePaolo!! I read this article on these crooks and spine surgery with great interest, and shared it widely.

    Hey, how does an injured worker get in touch with that guy, Don know, the Commissioner who is discouraged about the Fraud going on in Work Comp?? Nobody seems to know how to reach him..... we have a tip for him..... look for the crooks where they are, not where they are not.

    What about Albert MacKenzie?? Where do injured workers go to report fraud?? Nobody seems to know for sure on that one!! One doctor recently said, "If she has complaints about human rights violations, tell her to take it to The Hague." (You should see his entire report.....for which he billlled handsomely, and couldn't even get dates of injury straight. D'oh!!!)

    Surprise, Surprise!! Just yesterday I learned of an Expedited UR request for additional information.... "Please specify spine surgery being requested" and thought, "Uh-ohhhhhhhh"

    This request, related to treatment of A TRAUMATIC BRAIN INJURY OF 1/9/12..... with authorized treatments so far limited to a few chiropractic sessions, a couple of psychotherapy sessions and 8 physical therapy sessions] The mailed notice got immediate attention.

    The Corvel response was, "oh, it was a mistake, please disregard"...... :/

    Yikes, that's good news, huh? Now, we'll see how they do with authorizing neurology, neuropsychology, and neuro- optometry that has been requested over two years.... they keep ruling out speech therapy and other ACOEM guidelines for treatments.

    What are these insurance adjusters and defense law firms thinking!!!? Yeah, and when they shift the burden of disability payments to the State, because they might think a taxpayer or two might become annoyed???? If they are not maiming and killing injured workers one way, they have other ways, don't they?

    They even fight 'self-procured medical care' even though they fail to provide any reasonable or necessary medical care in over two years..... yet about 30 doctors have billed for reports and recommendations for treatments that never seem to get authorized, and then magically, P & S gets called, 'game over'?? NOT!

    If your readers are in the vacationing public, let them know that ONE of the big "vacation ownership companies" KICKS THEIR INJURED WORKERS STRAIGHT TO THE CURB, AND FEEDS THEM TO THE INSURANCE ADJUSTERS AND BIG DEFENSE FIRMS.

    So next time your readers attend a 90-minute time-share presentation for the "free gift"......let them know that humans pay dearly for those gifts. Must be good for their bottom lines, huh?

    Thanks again for your blogs...... They serve also to help an injured worker keep up the will to fight to survive Workers Comp chicanery. #OccupyWyndham & Friends