Ex-employees tell of Texas workers’ comp troubles
The Texas Tribune’s Elise Hu has found that the Texas Department of Insurance’s Division of Workers’ Compensation has more than its share of dirty laundry, much of which is finally starting to see the light of day. The division is in charge of sanctioning physicians who are defrauding the state’s worker’s comp system by overbilling and overtreating patients. A recent spate of firings and resignations, along with a review by the Texas Sunset Advisory Commission, have helped illuminate just how dysfunctional the whole thing has become.
The crux of the matter: Staff recommended sanctions against almost 70 physicians, Hu wrote, “Yet since 2005, division records show, the state has sanctioned just five doctors with removal from the workers’ comp system — and only in cases involving paperwork violations rather than harm to patients.”
The broken enforcement system, the former employees say, stems from [Commissioner Rod Bordelon]’s insistence on putting the due process rights of accused doctors ahead of the rights of their allegedly abused patients. That misplaced focus, the employees believe, results in part from political pressure on Bordelon.
Hu discovered that the cases that were unceremoniously shuttered by Bordelon involved millions and millions of dollars in workers’ comp claims, and that the system didn’t have sufficient safeguards against abuse.
Lockhart, Watts, Nemeth and Ford (the employees who either resigned or were terminated) say they left with great disappointment at the lack of enforcement. “You can make a lot of money if you’re a doctor practicing in the workers’ comp system, if you are so inclined,” Ford says. “If you’re dishonest, or if you learn how to game a system, there’s lots of money — I mean, millions of dollars to be made.” The agency document that details investigations into the nine doctors showed that, during the one-to-two year monitoring period, seven of them billed insurers more than $1 million, two billed more than $2 million, and one billed $3.2 million.
It’s a convoluted story heavy with details and angry quotes, but if you’re just looking for a summary of how the terminated employees feel, this seems to be a pretty good one:
“[The office’s] focus since late 2005 has been to protect wealthy doctors who have learned how to game the system and take advantage of injured claimants,” Ford says. “The motives for this protection are open to speculation. Money, political pressure, and career advancement are at the top of the list.”
Calif. reluctant to boost Medi-Cal’s anti-fraud staff
California Watch’s Christina Jewett reports on the California Assembly’s lukewarm response to the assertion of Medi-Cal’s fraud busters that, with another 38 staff, they could save the $16 billion program at least $51 million annually.
Jewett says Medi-Cal’s audit and fraud staff already numbers 712 employees (at full strength) and their calculations indicate that there may be $400 million in fraud in the system, as well as another $600 million in what Jewett describes as “Erroneous billing for services, supplies and care that is not necessary or poorly documented.” Jewett also lists a few examples of what auditors say are fraudulent cases.
FDA creates tipster Web page for alleged crimes
Do you know something about the sale of counterfeit prescription drugs or off-label promotion of medical devices? What if you came across fraud committed by a clinical trial investigator or a case of product tampering? Do you know how to get in touch with the Food and Drug Administration if you knew about an alleged crime?
Well, the FDA is trying to encourage tipsters to get in touch. The agency recently created a special page on its Web site to report suspected criminal activity, and the info gets forwarded directly to the FDA’s Office of Criminal Investigation.
Here are activities the FDA’s OCI would investigate: illegal diversion of pharmaceuticals and other regulated products; Prescription Drug Marketing Act violations; schemes involving fraudulent treatments, cures or devices; New Drug Application fraud; crimes affecting the safety or integrity of the nation’s blood supply or the adulteration and/or misbranding of food; Internet facilitated criminal violations involving FDA regulated products; illegal importation of FDA regulated products, and crimes involving the manufacture, sale or distribution of unapproved FDA regulated products.
We asked an FDA spokeswoman what exactly prompted this initiative and whether any tips have actually been reported. The FDA responded that nothing prompted the move and that it “can’t comment on any of the e-mails we have received or any other communication we receive via other means.”
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The AHCJ-NLM Fellowships will give four journalists the chance to spend a week on the campus of the National Institutes of Health learning about research and data from NIH and NLM, biomedical statistics, programs and resources and get hands-on training. Applications due Aug. 2.
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