Crookedproviders, lien setup bleed comp system
If you need more proof the workers-comp system in California is a mess, look no furtherthan the report this week that indicted and convicted medical providers filedmore than $600 million in liens against workers-comp claims.
The lien system in the state continues to be fertile groundfor fraud. Designed as a safety net to ensure injured workers get treated, it’snow a slush fund for crooked medical providers and lawyers.
Fraud and abuse are rife in Southern California, wheremedical rings are targeting just-retired workers, says one insurance exec whowrote us this week. Runners hang out at Social Security offices and othervenues frequented by retirees. They entice the retirees to file claims byoffering free medical care and a windfall to supplement retirement income. Theretirees are brought to lawyers’ offices, signed up and then shuttled off to medical offices for“treatment.”
The number of worker “injuries” occurring on the last day ofthe job is rising, this exec says.
Legislation to help weed some of these abusive providers outof the system is cruising through the California legislature. The bill wouldban providers who’ve been kicked out of Medicare and Medicaid for over-billing.The bill sponsor says there’s evidence that crooked docs banned from governmenthealth plans have turned to workers comp to ply their trade.
The sponsor also says his legislation will target lawyers whosign up comp clients, but never actually interview them, then file claims forthem in distant cities and ultimately settle the cases for their fees — oftenwithout the workers’ knowledge.
The legislation is a good idea, but much more needs to bedone. Workers compensation in California is a huge, complex multi-facetedprogram. There are no easy answers on how insurers, employers, policymakers andothers can hit that sweet spot of minimizing fraud while making sure injuredworkers get the treatment they deserve. But finding a better way than the liensystem might be a good start.