Friday, June 20, 2014

Trusting Mistrust

The sub-theme of my talk to the California Society of Industrial Medicine & Surgery on Saturday is, "You can't trust a system built on mistrust."

A couple of stories in this morning's WorkCompCentral News provide substantial evidence (you knew I had to work that in!) of that concept.

A grand jury indictment was unsealed yesterday alleging a huge financial kickback scheme involving compound drugs, doctors and pharmacists, some of whom are "regular" names in California workers' compensation and within the Greater Los Angeles area (recall that recent studies reflect dramatically higher costs in that geographic zone compared to the rest of the state).

Kareem Ahmed, the president and chief executive officer of Landmark Medical Management, is charged in the indictment with paying doctors more than $25 million in kickbacks to prescribe and dispense to California injured workers three compound creams he had formulated to use the most profitable ingredients.

The indictment alleges that Ahmed, acting in concert with pharmacist Mike Shah, Landmark Marketing Manager Evette Charbonnet and former Landmark Vice President Bruce Curnick, to identify and recruit physicians who treated injured workers to prescribe and dispense these three medications.

The way the kickbacks were concealed was for Landmark to purchase accounts receivables from physicians; the purchase of receivables was allegedly contingent upon the physician prescribing the “remaining month supply” to the patient from a pharmacy that had a contract with Ahmed.

Ahmed through his attorney has denied any wrongdoing.

Posting bond and also named in the indictment are:
  • Dr. Daniel Capen, who faces nine counts and posted a $1 million bond on Wednesday. He received $2.5 million from Ahmed between 2010 and 2013, according to the indictment.
  • Dr. Eduardo Anguizola, who faces nine counts and posted an $800,000 bond Thursday. He allegedly received $2 million from Ahmed.
  • Michael Barri, a chiropractor and owner of Tri-Star Industrial Medical Group Inc., who allegedly received $1 million from Ahmed. He faced nine counts and posted a $400,000 bond Wednesday.
  • Dr. Randy Rosen, who allegedly received $600,000 from Ahmed, faces nine counts. He posted a $300,000 bond Wednesday.
  • Curt Hauge, who is accused of receiving $8 million from Ahmed for referring business to Landmark subsidiaries, faces five counts. He posted a $100,000 bond Thursday.
  • Bruce Curnick, a former vice president of Landmark who is accused of a single count of conspiracy. He posted a $100,000 bond on Wednesday.
Other defendants charged with accepting payments from Ahmed in connection to the alleged scheme include Dr. Rahil Khan who is alleged to have received $1 million; chiropractor Robert J. Villapania, owner of Regional Associates Medical Group, who allegedly received $1 million; and Dr. Arsalan Pourteymour and chiropractor David Evans, who are accused of accepting more than $650,000 through Performance Medical Group.

Dr. Craig M. Chanin, is accused of accepting payments in exchange for referring patients but the indictment does not say how much he is alleged to have been paid.

The details, comments by Ahmed's attorney, and allegations of involuntary manslaughter against a half dozen of the defendants are in this morning's story by WorkCompCentral reporters Greg Jones and Sherri Okamoto. You can trust me that they did a fantastic job of uncovering and reporting this story.

Along the same trust theme, the Workers' Compensation Research Institute released the first of four multi-state studies that point to a factor that we all knew impacted return to work success but has never been measured: trust....

WCRI’s Predictors of Worker Outcomes is Phase 1 of a four-phase, 20-state study looking at the factors that influence injured worker outcomes. The first phase of the studies examined data from Indiana, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, Virginia and Wisconsin, and broke out each into its own state-specific study, which also featured the data collected across all states.

Though the reports caution against making conclusions because of the small sample size, they are nevertheless groundbreaking in that they are the first that I know of to delve into the impact of the employment relationship psychology post injury on injured worker recovery success.

For example, workers who were strongly in fear of being fired after their injury were found to return to work a median of four weeks later than those who weren’t concerned about being terminated.

Of the 3,200 sampled workers, interviewed in 2013, and who were injured in 2010 with more than seven days of lost time, 21% who were not working at the time of the interview predominantly due to their injury “strongly” agreed that they were concerned about being fired. 

For that subset of workers, the median time from their injury to their initial return-to-work lasting at least 30 days was 13 weeks.

The 10% who were not concerned about being fired took a median of nine weeks to return to work lasting at least 30 days.

WCRI's study also found that workplace trust factored into recovered earnings.

Sixteen percent of workers who were strongly concerned about being fired reported large earnings losses at the time of the interview predominantly because of their injury, compared to just 3% who weren’t concerned about being fired. Those worried about being fired also had lower average health-and-functioning recovery scores, and were more likely to report problems with access to health care.

There are numerous other factors of course that contribute to the return to work survey results, such as co-morbidities, and WCRI is lining up other states for more study and reporting.

Former president of the Workers’ Injury Law & Advocacy Group, Andy Reinhardt, a claimant attorney in Richmond, Virginia, told WorkCompCentral yesterday, when queried about the study findings, "It’s not a normal employment relationship.”


The WCRI studies can be purchased here. Trust me, this is good stuff...


  1. Wow, David!

    I should have reserved my comment from yesterday. You've got mistrust in mind, as well.

    Thanks, again.


  2. Let's hope those indictments are the tip of the iceberg. I may have some of that expense 'creme' in the garage, with the other poisons provided by a different Dr. Ahmed. I checked the list to see if any of the 'suspects' in my case are listed... nope, not yet.

    Fingers crossed and complaints still flying.....

    David, it doesn't seem like you really 'get' the extent of the fraud involved in WorkComp.... medical, legal, insurance.... it's ugly, very ugly. It is costing lives, unnecessarily.

    Do Greg Jones and Sherri Okamoto ever do investigative reporting involving the neuro or psych crowd of doctors? Some of those boyz realllly stretch the line......with very creative fabrications and skewing of truth, with some plausible deniability. I have 5 file cabinets of info documenting 894 days of fraud, negligence and other efforts to "defend against providing medical care" by the Defense firm and the Insurance Company. FIVE FILE CABINETS. No secrets in work comp; if you know anyone interested, let me know.

    I would write more but I'm in the middle of disputing some more CORVEL shennanigans.... Talk about another crowd! They seem to have RNs write their reports, in questionable English, then doctors without expertise in, for example, brain injury, just sign off on the garbage reports. Ought to be some law enforcement!

    Please keep us posted on those white collar indictments. We keep telling our friends and neighbors to follow your blog.... WE ARE THE MEDIA NOW.... and trust that your blog stats are increasing. Take care. Lucy & Friends #ADJ8181903

  3. PART 1 OF 2 I think that it is the med tort law state by state, that is in our HMO systems that is no good. And then that just boils over into comp. We can not fight back in a fair in timely manor any more. Because of the med tort laws that were laid out state by state, over the last 15 or so years. It was done to stop the frivolus lawsuits, but what it did was hinder our roads to civil roads. The giants been able to do what ever they what for the last 15 years, and the MED mal law suits have dropped I think some say by 90 percent. Possible if we had our little civil stingers back. State by state, the same way they were taken. Us little folks could fight back against the abuse. With out it taking years and year in many cases. Just to get justice. In a system that we were not supposed to have to prov our injuries in exchange for not being able to sue as all know. But that coupled with the med tort law deal just gives these Dr.s and Ins. Co.s cart blanc to FLEECE the AMERICAN workers as they are. Our Grand Bargain has been stolen Period. And then when I Report the abuse in my care and my wife to all the major players in the game, they all turn a blind eye to the abuse going on in comp. IT is SHAMEFUL and we THE injured workers demand JUSTICE NOW. Could you please pass that on to the big folks you know Sir. Thanks, and thanks for sticking to the facts, your getting it. And so are many others now. Just the elected officials. LIKE IT Broken, just like it is. Crazy, and that is what it makes folks,and is that really a good public policy in this day and age? Peace to all at the table one day were the leaders, even the Unions ones turn their eye to abuse that is JUST LIKE at the VA hospitals. But form some reason the American worker is just not valued and now one seems to care that their Grand Bargain was stolen until it is to late. This harms some of our fams generationaly. Not to mention all the ill sides effect that stem out of the injustice going on in our care and employment needs, such domestic violence, divorce, kid taken away, BK, foreclosers, suicides, some by cop, ect. then our kids see these adults going off on their health care providers, even right after they have seen lawyer who have told them it would cost them more to fight it a lot time than it would be worth, for the smaller cases. Thus making the iw's patients feels a real lack of justice. That coupled with the fact that folks are having to be their own advocates with out lawyers in many cases, because none want to take the lower end cases....

  4. PART 2 OF 2 Sorry, got long winded, and as my comp folks like to tell me all the time. IT'S COMPLEX... he he he and even in our private care harm is being done and the med boards, as were are showing here in WA, are not being impartial, nor following any real rule of law it seems, but rather allowing folks to run on gut instincts and not the objective facts. Then the never ending legal limbo begins. We need our civil stingers back in state med tort laws state by state, just the way they were taken from us in the first place. Please see a movie on NET FLEx called HOT COFFE, it explains it some. Things have been good in comp, not even 40 years ago when my father went though this same gaunlet. NO good, and it reeks of inequality and injustice and that is not good for in civil society. Peace to all at the table one day. But my take, gives us our civil stingers, back and us patients will keep the big Giant profiteers at bay. Wow that was a mouth full. I hope I made sense this time. Thanks again sir, I love your digging up the TRUTH for that is what we need. WE need to pull back the veil. For just because we have done something one way for a long time? Just like slavery, it does not make it right. And pretty much if we are allowing the big corps to use up labor and cheat them out of their Grand Bargain on the back end of the deal, sending them to the streets or the Feds if so lucky. Thus allowing some BIG guys to,who do not pay any federal taxes to use up labor and toss it out once broken. Hurting the workers and small biz while the GIANTS head out the back door with their leaders from both parties, and the unions, while the workers loos their TRUST in Government, and their GRAND BARGAIN all at the same time. Stealing the fruit from labor, in a very elaborate shell game or fleecing has mad pop used to like to call it. Peace Bro

    1. I still need to get set up or I should meet my new Dr., but, after all I have been through. I don't trust any of them, any more. I know their are a lot of good ones. But taking the chance after being burned, over and over by a few, makes me hesitant.
      It's to a point that I would rather die of somethings I don't even know I got going on at home, rather then endure the abuse and chastising of another elites gate keeping snob in my care. Sorry, but that is the truth.
      A system that pts the Dr.s, Pt, relationship against one another.. and then hinders the Pt's aves for civilly relief once harmed? Is just not a workable system to me.
      A System with out trust and Good Faith Duty, is no system at all.

  5. Not sure I agree. The U.S. Constitution is essentially based on mistrust. The idea that people abuse power and need to be held in check. Doesn't the Landmark situation prove that?

  6. I am currently working on a case where one of the doctors (I'll omit the name) on that list has dispensed compound creams supposedly two days in a row, to the same applicant, in the same quantities, both four week supplies. In addition, he had two different pharmacies deliver the very same compound creams on the same two days that the creams were were supposedly dispensed in that doctor's office. I say supposedly, because when I deposed the applicant, he brought his creams to the deposition. They were prescribed way before the date of injury and expired before they were delivered. Small business owners can thank that doctor and his cohorts for driving up the cost of work comp insurance in California with their alleged kick back scheme and other conduct for which they will be held to answer soon enough. This is all music to my ears. I hope justice is served.

  7. Thanks David, Benjamin Steve, James and Darren! :D I just shared this blog again on FB and Twitter with these comments and QUESTIONS ABOUT THE COMPOUND...

    Hey, GREAT PIECE. Do you or any of your readers know if that 'compound' could also be known as "FLUR/CAP/MEN/CAMP or and 'CYC/KETO/LIDO'??? I received, in 2012, a series of packages of this krap, and since my major complaint has been and still is TRAUMATIC BRAIN INJURY, I wondered if that Doc wanted me to apply it to my frontal, temporal and occipital lobes or what! Another related doctor apparently prescribed an expensive 'at home ultra sound' thing, and again, I wasn't sure which lobe to put it in. One of the #WorkCompMill doctors also demanded that I take home a bag of meds, "in case" I needed them (even though I advised I don't take drugs). All of it is in the garage with other poisons. If they sent me some of that 'compound' you're writing about, could you have the District Attorney's office contact me so we can add a few names to the investigations and indictment list. I got more unbelievable stories.... well documented! ASK ABOUT #WorkCompFraudNow. #ADJ8181903 :D

    "The sub-theme of my talk to the California Society of Industrial Medicine & Surgery on Saturday is, "You can't trust a system built on mistrust.""

    "A couple of stories in this morning's WorkCompCentral News provide substantial evidence (you knew I had to work that in!) of that concept."

    "A grand jury indictment was unsealed yesterday alleging a huge financial kickback scheme involving compound drugs, doctors and pharmacists, some of whom are "regular" names in California workers' compensation and within the Greater Los Angeles area (recall that recent studies reflect dramatically higher costs in that geographic zone compared to the rest of the state)."

    See full article here:
    See also David's piece on The Mission and The Business:



  8. Hi Guys. Well. I don't know if it's 'politically correct' to share my today's blog here, but it's related to this blog, and this blog is also shared in a couple of the links of today's post.

    I think that perhaps the Defense Attorney struck a nerve when he suggested that I would rather have him as a pen pal than get necessary medically necessary treatment for injuries of 1/9/12, which my employer failed to provided and continues to refuse to provide.

    Hmph, those NorthCal attorneys are something, aren't they. Well, if you can take a look great.... I shared it with buddies on linked in and facebook too......around the world. His office is not far from #Livermore and I wanted to suggest he ask up there about #Fukushima, but he probably knows it all anyway.

    Let's hope these collective blogs do some good..... xoxooxxo

    #WorkComp? #Americans Maiming and Killing Injured Americans for Profit

    Thanks. More soon! xoxooxox