Category Archives: California

Trump Esta Loco: What it May Mean for Cross-Border Healthcare

In picking a fight with Mexico over the building of a wall on the US/Mexico border, the current illegitimate occupant of the Oval Office is not only threatening the relationship with our nearest neighbor to the South, but with our number two trading partner, as the following stats point out for 2016:

2016 : U.S. trade in goods with Mexico
Total 2016 Exports: 211,848.7
Imports: 270,647.2
Net: -58,798.6

Source: https://www.census.gov/foreign-trade/balance/c2010.html

By threatening to slap a 20% import tax on goods from Mexico, including his ties, this so-called businessman, will hurt the very farmers who voted for him, as well as the workers who buy their household goods from Walmart and other low-cost outlets, as many parts or food items are made or grown in Mexico. When I spoke at a medical tourism conference in Reynosa in 2014, we drove along the border area where the maquiladoras are located and saw that one of them makes frozen food that is sold across the border. Want to pay 20% more for that frozen TV dinner?

Then there is all that cerveza and tequila and mescal, not to mention avocados and guacamole that will cost more. Stay very thirsty my friends, because it will cost you more to drink with the most interesting man in the world, and all thanks to the least interesting man in the world.

What then does this mean for cross-border medical care?

If Herr Trump gets his way, not only will Mexican goods get more expensive, but if we get into a trade war, look for costs of medical care south of the border to go up as well, or even slow to a crawl or not at all. There is a hospital being built in Tijuana with the assistance of Scripps Health, and as I’ve written about in the past, the Insurance Company of the West already writes workers’ comp policies to include cross-border healthcare for their insured’s whose employees live in Mexico, but work in California.

Since the passage of NAFTA, trade between the US and Mexico has increased, and the towns along the border have benefitted from it. Back then, the talk of building a NAFTA superhighway was met with strong and fierce resistance (I was living in Texas at the time), but I realized that we already had one. It’s called Interstate 35, and runs from the Canadian border to the Mexican border, as does Interstate 5 on the West Coast.

In two earlier posts, I discussed a case in Arizona where the injured worker received two benefits, one from Mexico and one from Arizona (https://richardkrasner.wordpress.com/2014/01/20/nafta-work-comp-and-cross-border-medical-care-a-legal-view/) and (https://richardkrasner.wordpress.com/2015/02/04/nafta-work-comp-and-cross-border-medical-care-a-legal-view-update/).

So before you book that trip to Cancun for your tummy tuck or face lift, check to see if there is a 20% tax imposed on your flight, hotel, food, etc., from either the US or Mexican governments. If so, thank the orange-haired son of an orangutan.

donaldtrump-orangutan

Sad News

Learned this afternoon of the sudden death of my fellow blogger, David De Paolo. See the link below. Never met him, but readers here know that I have always reported what he wrote fairly and honestly, and even though my comments to him have not appeared in my posts, I respected him as a fellow blogger.

He will be sorely missed, as he was a regular fixture in many of my posts.

http://www.workerscompensation.com/compnewsnetwork/news/24272-david-depaolo-founder-of-workcompcentral-dies-at-56.html

 

Cross-Border Health Care in California Expands

In my earlier posts on cross-border health care, “Cross-border Workers’ Compensation a Reality in California“, “NAFTA, Work Comp and Cross-Border Medical Care: A Legal View“, “NAFTA, Work Comp and Cross-Border Medical Care: A Legal View: Update“, and “Cross-border Health Care and the ACA“, I discussed the way some Mexican workers living in Mexico, but working in the US or traveling between the US and Mexico, have been able to get health care on both sides of the border.

An article in Fierce Healthcare.com last month,  says that Scripps Health will help run a hospital in Tijuana, along with Sistemas Medicos Nacionales S.A. de C.V. (SIMNSA).

SIMNSA is the medical insurer in Mexico that the Insurance Company of the West (ICW) contracted with some time ago to treat Mexican workers of ICW’s US insureds in the San Diego/Imperial Valley area of CA.

According to the article by Ilene MacDonald, the insurer will design, build and operate the facility, and will seek accreditation from the international arm of the Joint Commission, the Joint Commission International (JCI), and will be an affiliate of the Scripps Health Network.

Those who think that cross-border health care, whether general or work comp-related is not going to happen better think again, because it is, and while this is just now involving the areas along the US-Mexico border, with or without that stupid wall some jerk wants to build and have Mexico pay for, medical travel on this continent is moving forward.

The only thing that is not happening yet is travel further down into Mexico and into the other countries in Central and South America. But that will happen, no matter what you or any putz running for president says.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

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WCRI – Day One, Part One

Day One of the WCRI’s annual conference began with WCRI’s Chairman, Vincent Armentano, of The Travelers Companies, introducing new President and CEO John Ruser. He presented the first s…

Source: WCRI – Day One, Part One

Cross-border Health Care and the ACA

From the ‘before you go to the WCRI conference’ department is an article about a subject not on the agenda in Boston this week, and since I convinced the WCRI that crossing the Hudson river is not medical travel, nonetheless, people are leaving the country and one US state for medical care, and not just for work-related issues.

Jim Arriola, COO of MediExcel Health in California, and Caitlin Gadel, an attorney at Seaton, Peters & Revnew, wrote an article this month in California Broker magazine (pg. 20-22), outlining how cross-border health plans in California are complying with many of the provisions of the Affordable Care Act (ACA).

You may recall that I wrote about cross-border health care, especially for workers’ comp, in my article, “Cross-border Workers’ Compensation a Reality in California“, as well as these two articles, “NAFTA, Work Comp and Cross-Border Medical Care: A Legal View” and “NAFTA, Work Comp and Cross-Border Medical Care: A Legal View: Update“.

According to the article, almost twenty years ago, the California Department of Managed Health Care (DMHC), began regulating a consumer driven phenomena for receiving employer-sponsored health coverage south of the border.

As stated in the article, on a daily basis, up to 40,000 workers cross the border from Mexico to work in California. These workers and their families live in Mexico, and prefer to get their medical care in Mexico.

Changes to the Knox-Keen HMO Act allowed US and Mexican health plans to establish cross-border coverage. Much of this is occurring in the San Diego and Imperial county area, as discussed in “Cross-border Workers’ Compensation a Reality in California” with the Mexican HMO, SIMNSA, as well as others such as Blue Shield of CA, Health Net, Cigna, Aetna, and MediExcel Health Plan.

Depending upon the benefits of the plan, some cross-border coverage plans have premiums that are 40% to 50% lower than those in California.

There are an estimated 60,000 enrollees in various health coverage plans in California, and some experts predict the total number will increase to over 100,000 as more employers offer coverage as a result of the ACA rules and regulations, according to Gadel and Arriola.

Gadel and Arriola report that many ACA provisions (as well as the thousands of pages of regulations), apply to cross-border coverage, especially if the coverage is not a qualified expatriate plan.

Gadel and Arriola advanced the idea that some brokers may be concerned whether a cross-border plan satisfies the ACA definition of a minimu-essential coverage (MEC) when the provider network is in Mexico.

They also said that legal experts have noted that under federal regulations, employer-sponsored plans approved by state regulators are MEC plans.

In order to receive approval from the DMHC, such plans must submit evidence of their compliance with ACA regulations.

Brokers, it is suggested by the authors should not offer cross-border plans exclusively because of the differences between cross-border plans and expatriate plans.

However, the authors note, because of the complexity of the ACA’s conflicting interpretations, some cross-border plans may have been erroneously classified themselves as group expatriate coverage.

The reality, they say, is that the vast majority of cross-border plans and their enrollees do not meet the federal criteria for expatriate classification.

My last post, “Borderless Healthcare: A Model for the Future of Medical Care in Workers’ Comp” was based upon a presentation given last Thursday about medical tourism to Mexico. So if there are health care plans in California providing cross-border health care into Mexico, and there is also cross-border workers’ comp occurring between California and Mexico, and in both of these cases, the mode of transporatation is generally automotive, and the presentation by Manatt, Phelps & Phillips requires airfare to Mexico, why is it that workers’ comp cannot do the same?

I don’t want to hear excuses, I want to hear why this industry refuses to join the 21st century, why it points to laws and statutes nearly a hundred years old that restrict injured workers to their own states or to the US for medical care requiring expensive orthopedic surgery, when there are less expensive and better alternatives a short flight away?

A fellow blogger wrote today about this industry’s failure to fully embrace technology, and the answer to his questions, and to mine were right there…if this industry were to change, the status quo would be undone and many companies would be forced to go out of business and their profits with them.

Our workers’ comp “system” mirrors the general health care system in many ways, as per this quote from Uncle Walter:

“America’s health care system is neither healthy, caring, nor a system.”

Walter Cronkite

It is a profit-making endevour that preys upon the sick and injured and lines the pockets of lawyers and vendors. That is why no one in this industry is listening to us…greed.

 

 

Medical Management Internship Paper, Summer 2011

No doubt, many of my readers have wondered what I learned in my MHA degree program, and why my writing has been of interest to so many of you.

Upon checking my stats for the blog, I noticed that someone had viewed a paper I wrote in the summer of 2011 for my Summer Internship course, as part of my MHA degree program requirements. The school I attended required all students without a health care background to take a one-credit course as an Intern in a health care organization.

The organization I choose was one my school already contracted with, Broadspire. At the end of the course, we were expected to write a paper about our internship for a grade in the course.

The following link will direct the reader to a copy of my paper that I hope the reader will find interesting, and will highlight my skills as a researcher and writer. Speaking engagements as well as research opportunities are most welcome, as are full-time positions and consulting opportunities.

https://www.dropbox.com/s/5573hm8xo074po0/Medical%20Management%20Internship%20Paper.docx?dl=0

As the summer session was very short, only three projects were undertaken, and the last one was truncated due to time constraints and the report presented to Broadspire concentrated on only two states, Florida and California.

Let me know your thoughts.

The Miasma of Fraud

One last post before you celebrate Thanksgiving.

Business Insurance’s Stephanie Goldberg reported today, that five people have been charged  with workers’ comp insurance fraud in California, and that the insurance commissioner called it, “one of the largest workers’ compensation insurance fraud cases we have ever seen.”

In July, 2014, I wrote two articles about fraud in California, “The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System” and “The Stench of Fraud, Continued.”

Charged in the case was the former CFO of Pacific Hospital, James L. Canedo, two orthopedic surgeons, a chiropractor, and Paul Richard Randall, a health care marketer.

They were charged with illegally referring more than 4,000 patients for spinal surgeries, and generated more that $580 million in fraudulent bills during an eight-year period, according to the US Department of Justice, in a statement released yesterday.

Many of the claims were paid by the California work comp system, the rest by the federal government.

Canedo and Randall have pled guilty, and the other three have agreed to plead guilty, and under the terms of their plea agreements, each defendant could face prison terms and be required to pay restitution to their victims.

The US Attorney’s office for the Central District of California said in a statement that Canedo faces 10 years in prison and at least $20 million in restitution.

The scheme consisted of kickbacks of $15,000 for each lumbar fusion surgery, and $10,000 for each cervical fusion surgery, according to the US Attorney’s statement.

The ongoing investigation, dubbed “Operation Spinal Cap”, discovered that some of the patients lived hundreds of miles away from Pacific Hospital, and closer to other qualified facilities, the patients were not informed that medical professionals were offered kickbacks for referrals, and that insurers had paid the hospital more than $226 million for the surgeries.

Once again, we see that workers’ comp, especially in California, but also in other states, is like a fetid pool of rotting vegetation and other foul matter, so that what was once called a stench, is now a miasma that hangs over the surface of the system.

It does not have to be like that. It can be better. You can find an alternative to expensive surgeries and illegal payoffs, if only you would consider new ideas and new possibilities.

Or you can continue to breathe in the foul air. The choice is yours.