Tuesday, December 1, 2015

Conspiratorial Profiteering

Does the amount of kickbacks for patient referrals in a specific geographic area correlate to higher medical utilization and severity costs in that region?

Recall that in past studies over just the last couple of years, the California Workers' Compensation Institute pointed out that the Los Angeles metropolitan area was responsible for an inordinately high amount of medical costs in the state.

Also, recall that certain medical vendors, some who have been in the workers' compensation business for quite some time, have admitted to participating in a referral kickback scheme in connection with Michael Drobot, Pacific Hospital of Long Beach, and others related to what has been called the biggest fraud scheme in California.

It turns out that, yes, there is a correlation between kickbacks and higher medical utilization and severity.

WorkCompCentral conducted an analysis of liens in the California Electronic Adjudication Management System and determined that Philip Sobol, MD, who recently admitted to participating in Drobot's scheme, alone was responsible for 13,766 liens filed under his company name since 2005, with a total claimed value of $85.6 million.

Another $1 million was filed under his name personally.

Over the same 10-year period, at least 1,505 liens were filed under the name of Griffin Medical Group, owned by chiropractor Alan C. Ivar, with a claimed value of $6.7 million. Ivan also admitted to participating in Drobot's game.

Both Sobol and Ivan have agreed to plead guilty to conspiracy charges.

The combined $93 million represents a big chunk of the $580 million that prosecutors say was fraudulently bilked from the work comp system over the years by the Drobot cartel.

Interestingly, the plea agreement between prosecutors and Sobol included a statement that the stipulated facts are not intended to indicate that he provided any patients with "substandard medical care or that any treatment he provided or prescribed was not medically necessary."

Who are they trying to fool? Sounds to me like lawyerese nonsense intended to downplay the incredible greed of someone addicted to $70,000 to $130,000 per month in "fees" from Drobot-controlled entities.

My guess is that Sobol is trying to protect some of his ill-gotten gains from sure to follow patient lawsuits for malpractice.

A little bird told me the other day that Sobol was also the number one source of Independent Medical Review antagonism, writing on average 9 letters per day contesting the utilization review denials of his treatment requests.

Nope - no substandard or unnecessary care.... Sure.

The National Council on Compensation Insurance just recently released a study across its covered states on medical treatment utilization noting wide disparity in geographic zones for specific injury codes under a "common fee" analysis to account for fee schedule (or none) discrepancies.

NCCI found that certain states had much higher utilization than other states.

The study authors don't offer any explanation, but speculate that treatment guidelines have something to do with this phenomenon.

Certainly, based on California's experience, conspiratorial profiteering by unscrupulous medical vendors should also be entertained as a reason.


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  2. I am one of the biggest victims of Pacific Hospital of Long Beach I was used for Human Factors and Ergonomics CSI Computable Systematic Interoperability with Department of Defense working with Abbott Labs and have UK implants that were brought to this Country USA in 2004 that were put in my body the end of 2003 and they collect workman's compensation on me when it was an Automobile Accident I was involved with Celebrity Express on November 5th 2001 the doctor who I saw Hossein Saboonie Alapour AKA Nick Alapour from Las Vegas phony paid for marriage Hitman to Charmine Irene Steinberg relative of Darrell Steven Steinberg once head of the Democratic Senate now Mayor of Sacramento he has protected the Butcher Doctor from accountability for what he's done to me. That doctor alapour said I needed surgery from the auto accident when I met him 2002 and then in 2003 he did two surgeries the second one put a lot of implants in me and left me for dead also then Hospital sent me home to die. I had to go to the doctors assistant Dr Mark Wolgin to readmit me back to Pacific Hospital of Long Beach to do a third surgery to save my life. Then the following year 2004 they were all paid workman's compensation by Berkshire Hathaway and when I was in an automobile accident I was in and I lost my case in Burbank in 2005 while Dr. Alapour was buying a condo in Beverly Hills. UK implants and other implants hidden in my body something in my neck can only be seen standing up MRI and Graphene Flakes all over my skin it came in 2004 from UK and PEEK Organic Plastic Discs L4 L5 S1 in my back again from UK came here in 2004. Dr. Alapour abandoned me with Grade 5 violation of my spinal canal plus two spinal fluid leaks in my upper spine. Also the second surgery medical records show 12 days in the hospital, doctors record show 10 days in the hospital they had me sign the release two days before they sent me home to die I had no idea I was in so much pain. PEEK Plastic to be put in mature adults and I was 38 years old and didn't tell me that was only meant the last 8 to 10 years and already has been in me almost 17 years.