The subject of fraud in workers’ compensation usually refers to claimants who fraudulently file claims to get benefits that don’t belong to them.
But there is another kind of fraud in workers’ compensation…the kind of fraud perpetrated by physicians, hospitals, and other medical facilities, either against the injured workers or against the system itself.
Why this kind of fraud exists is for the same reason that fraud conducted by larcenous and bogus claimant’s exists. Greed.
In a post today on his blog, CA attorney, David De Paolo mentions several cases where physicians or hospitals were charged with using phony or unapproved implants on patients.
Kickbacks, defrauding of insurance companies, and compounding problems are just the tip of the iceberg. One individual, who I will call Ms. X, has been a victim of not only of fraud, but of abuse by the medical providers she was forced to go to under CA work comp laws.
To summarize her experience, let me just say that she endured three epidurals that not only hurt her, they may have damaged her muscles and nerves, and even a defense attorney, in a letter to convince her to settle for a few thousand dollars, said that she was being harmed. Anesthesia was administered against her will, and the legal system took advantage of her as well.
Medical records and forms were changed, doctors treated her with contempt, and her life has been turned upside down and would have been homeless if not for her sister.
Those of you who have read my blog these nearly two years, know that I have been passionate about giving injured workers the best medical care available, and at the lowest cost possible. I know that the American health care system is broken and dysfunctional, but now it seems that it is actually harmful to those whose medical condition is the result of a workplace injury.
Those who criticize my idea to implement medical tourism into workers’ comp should look themselves in a mirror and ask themselves this question: do we really provide injured workers with the best medical care possible, given our broken and dysfunctional health care and workers’ comp systems, and because we have been strait-jacketed into this situation by antiquated state statutes and laws that actually perpetuate this fraud and abuse?
To the medical tourism industry, I am asking the following question that you need to answer, and answer affirmatively so that the health care industry will take you seriously. Will you follow the lead of these fraudsters and hucksters and use phony or unapproved implants on your medical tourism patients, or will you guarantee that you will use FDA approved and legitimate implants and will dispense drugs that have not been compounded in suspect labs? And will you agree to weed out those providers, mostly in the cosmetic and plastic surgery arena, and see that they are turned into the appropriate authorities in their home countries, because they are giving medical tourism a bad name.
And will both the medical tourism and workers’ comp industry promise that patients such as Ms. X will not be maimed and battered by a corrupt and fraud-prone workers’ comp and health care system?
Maybe it is time to get rid of the bad doctors, medical facilities, lawyers, and workers’ comp personnel who care more about their jobs and the profits of the companies that provide services to the workers’ comp industry, than the health and welfare of every single injured worker. And maybe it is time to seriously look at some out of the box solutions to the problems our broken, corrupt, and dysfunctional system is causing injured workers. Medical tourism could be one of those solutions.