Tuesday, June 7, 2016

Fraud and Hypocrites

Big fraud headlines draw lots of interest.

An alleged $90 million ring in Riverside County was busted with indictments against a host of workers' compensation vendors yesterday.

Former California state assemblyman Tom Calderon pleaded guilty yesterday to a bevy of charges, including damning accusations against his brother, former state senator Ronald Calderon, in the Drobot/Pacific Hospital scam.

Kareem Ahmed and his Landmark Medical business continue to be dogged by prosecutors in new criminal filings.
Batman wouldn't tolerate this...

Michael R. Drobot, son of former Pacific Hospital owner, Michael D. Drobot, pleaded guilty a few days ago to various fraud charges, and the cases against his father are nearing conclusions as others get sucked into the vortex.

All of this has, unfortunately, a number of commonalities.

Each case involves medical vendors.

Each case arises out of the Greater Los Angeles area.

And, each case involves operations that were allowed to balloon into astronomical numbers before anyone gave a rat's ass.

That last statement is what is most troubling.

Ahmed's recorded statement that "nobody gives a f#*k" about workers' compensation fraud is, frankly, very accurate.

Until the numbers get spectacular - then taking on organized crime becomes interesting to law enforcement.

Recent general media articles about California workers' compensation fraud imply that such criminal activity is easy because no single person is in charge, so it's easy for criminals to fly under the radar until greed trips them up.

These big headlines are nothing new. These activities have been going on since I was a punk lawyer - does anyone remember Dr. Mark Kaplan and his $50 million bust in 1993?

And what about the television news stories earlier than that where an intrepid reporter went into the organized crime circuit to expose nefarious doctors and lawyers scamming work comp?

The big headlines will continue, and we may whine and cry about it, but who cares? Until the greed escalates to the tripping point, criminals know that there is little risk in trying, so it will continue.

Yet, simple efforts that would be effective get stymied.

Not only is the Brown Administration not interested in reviewing where the money goes, it actively works against any audit.

The insurance industry is just as culpable, beating down attempts to get injured workers informed about their medical care just in case they might happen to notice that services are being billed that weren't delivered...

We're all a bunch of hypocrites. No one wants to say anything lest they get targeted. No one wants to do anything lest their next job be rescinded. No one cares enough to implement simple processes because it might cost some money - after all, fifty million here, ninety million there; it pales in comparison to the state's $30 billion industry...

We all think that the injured worker should be more engaged in their medical care, but we do nothing to make that happen. Instead, everything is kept in the dark, except for medical reports, which say nothing about the actual care provided, are all word processed forms that say the same thing, and provide no information about what is actually happening.

Tell the injured worker what care is being billed, and what is being paid. It's that simple.

The pat argument against providing injured workers an Explanation of Benefits is that no one will read them. Bull - that's just an excuse not to take action. Provide an incentive, like a couple of bucks to identify activity that could be fraud and trust me, someone on disability with nothing better to do will be reviewing those EoBs with a fine tooth comb.

In the meantime, these great fraud headlines bring lots of readers to WorkCompCentral.

But I'd rather folks be reading about success stories than fraud busts...

1 comment:

  1. The insurance industry and California politicians created the problem by driving the better doctors out with UR, IMR, byzantine authorization process, constant treatment denials, MPNs and underpayment or non-payment for medical services; the system incentivizes fraud over good and honest medical care