Monthly Archives: October 2014

The Second Time Around

Today, October 29th, marks my second anniversary writing the Transforming Workers’ Comp blog, and as I wrote in my first blog post, What I Learned at the 5th World Medical Tourism & Global Healthcare Congress, and Why It Matters to the Workers’ Compensation Industry, I began the blog three days after returning from the MTA Congress in Hollywood, Florida.

The first anniversary was a milestone in that I actually was able to sustain my writing for an entire year, and gained enough support that my articles appeared in online medical tourism magazines and blogs. But this year’s anniversary is even more special, because next week I will be in Reynosa, Mexico, speaking at the 5th Mexico Medical Tourism and Wellness Business Summit.

At this year’s summit, I will be meeting people I have connected with through my writing and through LinkedIn who are in the medical tourism industry and who are business leaders here in the US and in other countries in the Western Hemisphere.

It is my hope that during the three days of the summit, I will find time to write a short piece about the day’s events, but if I am not able to do so (well, it is a mini-vacation, after all,J), then I will certainly do so once I return, as I did two years ago, and earlier this year after the Miami Beach event.

My topic, which I will be presenting on Friday morning, November 7th, is about the Barriers, Obstacles, Opportunities and Pitfalls of Implementing Medical Tourism into Workers’ Compensation. It is based on my original White Paper and various blog articles that I have written over the past two years.

Those of you who have criticized my idea in the past as ridiculous and a “non-starter” have failed to understand that globalization cannot and will not be stopped by any one industry, including the workers’ compensation medico-legal behemoth.

The fact that I was invited to speak proves that someone believes my idea has merit and is worth paying for both my airfare and hotel. Maybe in your narrow-minded view of the world it doesn’t, because doctors, lawyers, and service providers have placed the workers’ comp system in a padded cell.

It does as far as the medical tourism/medical travel community will learn about next week. As Schopenhauer wrote, “Every man takes the limits of his field of vision for the limits of the world.”

How many of you workers’ comp professionals have seen claimants treated by doctors, both in private practice and in hospitals who are foreign-born? Doesn’t that tell you something about where health care has been for several years, and where it is going? Of course it does. It even is happening in the UK, as one of my UK medical tourism connections has written about last week.

It is a sign that medical care is not limited to one part of the world, one hegemonic power in the world, and to one culture. As doctors and nurses come here to work, so too do our medical students go abroad to learn medicine when they get turned down by American medical schools.

Why not our workers? Because some judge says so, or some lawyer would object because he can’t collect a hefty fee? Or is it because our politicians are so jaded that they only know one thing: screw the workers anyway they can.

I take it as a badge of honor that business professionals will hear what I have been writing about, even though those in the workers’ comp industry bury their heads in the sand, shut their ears, eyes and minds to new ideas, no matter how “out of the box” they seem. You see, that is the real reason workers’ comp today is failing to address the problems injured workers face. The industry keeps insisting on doing the same things over and over again, expecting different results, and wasting time, money and resources on a broken system.

They insist that state laws, regulations and rules prohibit medical travel, but some states do allow it, as I mentioned in my paper and articles. Even a WC Deputy Judge said that medical tourism is here to stay, and while he referred to domestic travel, cross-border workers’ comp is already occurring in CA, and AZ amended their work comp laws to allow a claimant to collect benefits in AZ and Mexico, and a unanimous court ruled on behalf of that claimant.

Given these facts, medical travel to Mexico and other countries in the region for surgical procedures under worker’ comp cannot be too far off. What is really going on, is some high-level executives and consultants who get paid from keeping things the same, refuse to allow new ideas to enter the system, thus bringing on hardship, pain and misery for injured workers, while they and their clients get rich.

And the industry is now dealing with some bad actors who are screwing and maiming legitimately injured workers because the system is bought and paid for by the very entrenched interest groups that profit from maiming and harming workers who have already been injured. In law that is called “double jeopardy”, and no, Alex Trebek is not going to double your winnings.

So the next time I write, it will either be in Reynosa, or back home after my trip. Until then, muchas gracias por seguir conmigo estos últimos dos años, y espero que siga haciéndolo en los próximos años.

To paraphrase the most interesting man in the world, “Stay open-minded, my friends.”

Are you kidding?

Every day I check my statistics on WordPress to see how my posts are doing. Usually that consists of look at the number of views and visitors to the site, as well as where in the world they come from.

In the past, I have had views from people in certain countries that are suffering some kind of political distress. An example is the Palestinian territories, now called the State of Palestine, as far as WordPress is concerned.

But I just noticed today that I had two view from Iraq…IRAQ?!  Are you kidding????? With ISIS running amok, two people had the time, and the electrical power to surf the net and read my blog.

And Iraq is not the only strife-torn nation who has had individuals view my site. Pakistan, Nigeria (just hope it isn’t Boko Haram). Ukraine and Libya have had people view my blog.

But Iraq takes the cake…the country is falling apart, terrorists are seizing the countryside, the US and its allies are conducting airstrikes and these two are reading a blog about medical tourism and workers’ comp.

Unbelievable.

The Fiefdoms of Fools

Fiefdom: 2. Informal. anything, as an organization or real estate, owned or controlled by one dominant person or group.

Source: Dictionary.com

Last July, I wrote two pieces, The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System and The Stench of Fraud, Continued. These articles dealt with the issue of fraud in the workers’ compensation system. The first article was based upon David De Paolo’s article about physicians or hospitals in CA using phony or unapproved implants on patients.

The second article discussed the plight of a woman, also in CA, who I called “Ms. X”. Ms. X was injured in the course of her employment, and subsequent to her injury, was injured several times by the treating physician, the medical staff at facilities where she received treatment, her former plaintiff attorneys, the defense attorneys, the insurance company, and finally her employer, who fired her.

I let Ms. X speak in her own words so that the reader would understand the pain and suffering she was feeling was real, and not something that I made up to bolster my argument for transforming workers’ compensation. There are hundreds, if not thousands of Ms. X’s and Mr. X’s out there who are subjected to the dark side of the workers’ comp system in the US. And there are many others who file claims who never suffer abuse or fraud at the hands of the system.

But yet, there are still more vile and disgusting things happening to workers in this country, injured or not, legal or undocumented, native born or foreign, as David De Paolo discussed back in July in his article, How Dare They. David’s website, WorkCompCentral.com reported that over one hundred undocumented workers at a fruit packing plant in South Florida were arrested for workers’ compensation fraud, although only a few of them actually filed claims for workers’ compensation benefits. The company they worked for, Fruit Dynamics, hired the workers who were from Guatemala, Mexico, Honduras and El Salvador, knowing that they were undocumented.

The owners were never suspected in any complicity in the fraud, according to Maj. Geoffrey Branch of the Florida Division of Insurance Fraud. “At this time, we do not believe anybody affiliated with the ownership or management had any idea that any of these documents were fraudulent,” Branch said,“We believe that they thought they were on their face value valid, authentic documents.”  As David points out, the reason for the raid in the first place was because the original complaint was against the employer for intentionally hiring undocumented workers in a pattern of behavior and practice to underreport payroll and intimidate workers out of benefits for work injuries.

David also said that an attorney who had represented several of the workers over the years made the complaint to the Division because there was a pattern of practice that he noted.  The attorney said that the employer’s hiring and management practices were intentionally done to minimize workers’ compensation liabilities and abuse immigrant workers. The employer faced no retribution whatsoever from the law even though there is documented evidence that the company knew what it was doing and its insurance carrier went along with the plan in complicity, David added.

In today’s article, David revisits the case in Florida from July, and reports that the undocumented workers were given “diversion“, which would allow the charges to be dropped assuming compliance by the accused. However, the employer is under investigation, according to a report by WorkCompCentral.com. At the time of the arrests, the Chief Financial Officer of Florida said that the lead the investigators were following would “result in dozens of workers’ compensation arrests and many arrests for identity theft that have been potentially devastating for victims.”

Yet, as David pointed out in his article, that was not the case. The fact is that the few workers’ compensation cases that were in process by workers injured at the Fruit Dynamics plant in Naples, FL resulted in termination of the workers – the employer clearly was sending a message to its undocumented workers: don’t file a claim for injury. Clearly, David continues, the employer threatened, and executed, retaliatory action in order to keep its undocumented workforce complicit, and quiet.

Back in July, David stated that the arrests were “lightly veiled discrimination based on race. The masters aren’t prosecuted for their fraud and deceit, but the powerless workers are punished for their enslavement.”  On top of the fact that Fruit Dynamics engaged in immigration fraud, it is also under investigation for payroll fraud. David concluded that this is a case of racial discrimination bordering on enslavement.

Which brings us to the title of this article, The Fiefdoms of Fools. By that I mean that within the workers’ compensation system in the US, there are various fiefdoms that have been carved out and control the different spheres of influence each of them represent. As David discussed in his article about fraud in July, there are the fiefdoms of physicians and hospitals who commit fraud against the insurance companies and patients.

There are, as I discussed in my second article on the subject, fiefdoms of attorneys, both plaintiff and defense who abuse the system and the claimants, there are insurance companies who commit fraud against the employers, there are fiefdoms of medical facilities who commit fraud by falsifying medical records, there are fiefdoms of physicians who abuse and maim and injure the already injured for their own greed, and then there are the fiefdoms of employers, like Ms. X’s and Fruit Dynamics who terminate employees for filing a claim when they were legitimately injured, or in the case of Fruit Dynamics, unjustly terminated to cover up criminal activity of the company.

But we don’t have to look at what is going on in, or around the workers’ compensation system to see where there are other fiefdoms of employers who are abusing, intimidating, threatening, or retaliating against their employees. You only have to pick up a newspaper every now and then and read about a company like Wal-Mart eliminating health insurance for its employees, or the company that fired a worker who complained to his cable company Comcast, after Comcast contacted the employer.

It does not take much to learn that the American worker is being subjected to vile, disgusting, discriminating and obscene acts by their employer as a means to control and dominate them, in much the same way feudal serfs were controlled and dominated by their feudal masters hundreds of years ago. Each feudal lord had his own fiefdom that he ran as he saw fit. It is no different today with American employers and their employees. We have a former union president and his party to thank for that. The union movement has made many mistakes, but the Republican Party’s war on workers, in and out of unions is one reason why these fiefdoms exist.

Beyond the employee/employer dynamic, there are other kinds of fiefdoms that pertain to the subject of this blog. These fiefdoms are controlled by the various entities in workers’ compensation that have a stranglehold on the very way workers’ compensation claims are adjudicated, processed, treated and disposed of. The workers’ compensation third party administrator firms, claims management firms, pharmacy benefit management firms, bill review firms, and other service providers all have carved out their own little fiefdoms that they control and manipulate for their benefit and profit.

I began this article by defining the word “fiefdom”, but as the title implies, there can be more than one fiefdom, which is why it is plural in the title. As for the part about fools, what would you call people who insist on doing the same thing over and over again, expecting different results; what would you call employers, carriers, physicians, hospitals, medical facilities, lawyers, service providers and the rest who prey upon, abuse, harass, intimidate, retaliate, threaten and terminate employees for no other reason than filing a claim for benefits they rightly deserve after being injured on the job; and what would you call people who knowingly commit fraud for profit? I’d call them fools.

The Urge to Merge: Why Health Care Costs Are Still Rising

Back in March of last year, I wrote a piece about the consolidation of US hospitals leading to higher costs and the reduction of quality.

In that article, I provided the reader with a chart of the changes in hospital consolidation in the US by region, and referred to an article on Payerfusion.com that stated that hospital spending is the key driver of healthcare costs in the US and has been growing at nearly 5% year over year.

In today’s Wall Street Journal, Suzanne Delbanco, executive director of Catalyst for Payment Reform, wrote an Opinion article further expounding on the issue of hospital consolidation and its impact on health care costs.

According to Dr. Delbanco, nationwide, payments to hospitals on behalf of the privately insured are an estimated 3% higher as a result of consolidation, according to a report by her organization.

She states that in some cases, hospitals have increased their prices by nearly 50% after a merger, and mentioned that when two San Francisco area hospitals merged, their prices increased 28%-44%, according to an analysis by an FTC economist.

For employers, who pay about 60% of the total cost of an employee’s health care, this meant that they were burdened with higher costs, as well as consumers, who also saw their portion of the bill go up.

As long as there is an urge to merge, as long as hospitals and hospital systems consolidate, health care costs for privately insured individuals, insurance companies, employers, and consumers will continue to rise.

For the purpose of this blog, employers who must deal with group health insurance costs, as well as workers’ comp costs, need to decide if they are going to continue to be played as fools and allow hospitals to get away with ever increasing costs. That brings to mind the line in the original Star Wars movie, where Obi-Wan says to Han Solo: “Who’s the more foolish? The fool, or the fool who follows him?”

It does not have to be that way. There are alternatives to high cost medical care, and you would be foolish not to look into them.