Tag Archives: abuse

Fraud is Fraud…No Matter Who Does It

Saw this on Twitter, courtesy of Larry Klaahsen.

It is high time to stop all forms of fraud, waste, abuse, and to stop kidding ourselves that we are the only nation that can provide quality health care to all our citizens, workers or not.

It is high time that employers demand that their state’s work comp laws are opened up to the practice of medicine by other providers whose main motivations are not monetary, but humanitarian, and are strictly and thoroughly vetted.

But until that happens, this smiling faker and many others, including lawyers, physicians, judges and other stakeholders will continue to take advantage of the system, and the right-wing, libertarian billionaires will destroy workers’ comp and take us back to the 19th century.


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

Share this article, or leave a comment below.

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Healthcare CEO’s Reject Single-Payer

There are many reasons why the US is the only industrialized nation that does not have a single payer health care system.

One deep seated reason has to do with the foundational value system of the US, from the time of the early settlers whose religious convictions lined up with the rising middle class of 17th century England’s economic values (i.e., the Protestant Ethic).

But another reason — at least for the foreseeable future — as my fellow blogger, Joe Paduda wrote a while back when talking about Bernie Sanders’ plan, is that the health insurance industry will not blow up their businesses and start all over from scratch.

To prove Joe’s point, Modern Healthcare.com published an article last week that explored the opinions of healthcare CEO’s on the ACA and the subject of single-payer health care.

Here are the key takeaways from the article:

  • the nation’s top healthcare leaders overwhelmingly back the ACA
  • support its goal of pushing providers away from fee-for-service medicine and toward delivering value-based care
  • while the Republican Party and its presumptive nominee continue to stand by their “repeal and replace” slogan, the sector’s CEOs overwhelmingly reject that idea, in large part because they are unimpressed with the GOP’s attempts to articulate what it would replace it with.
  • only a small group supports moving to a single-payer system, which has been a central theme of Democratic presidential candidate Bernie Sanders
  • The overwhelming message from the survey, was that the next president and Congress should stay the course set by President Barack Obama and the ACA.
  • But healthcare leaders are also looking for the nation’s political leadership to reject complacency and look for ways to improve what they see as a far-from-perfect piece of legislation.

Here are the survey results, as published today by Don McCanne of PNHP:

The CEO Power Panel includes 110 top leaders of hospitals, insurance companies, physician groups, trade associations and other not-for-profit advocacy groups. The second-quarter survey on policy options that the next president and Congress might address attracted 86 respondents, a 78% response rate.

Future of ACA

Do you support Congress and the next president in:

Repealing and replacing the Affordable Care Act?

2.3% – Yes

67.4% – No

29.1% – It depends on the details

1.2% – No opinion

Expanding the ACA’s subsidized private insurance plan system to achieve universal coverage?

34.9% – Yes

15.1% – No

48.8% – It depends on the details

1.2% – No opinion

Scrapping private insurance in favor of expanding an enhanced Medicare to cover the entire population (single payer)?

9.3% – Yes

61.6% – No

29.1% – It depends on the details

Other insurance issues

Allowing private insurers to sell individual and family policies across state lines under national rules that preempt state rules?

52.3% – Yes

20.9% – No

24.4% – It depends on the details

2.3% – No opinion

Expanding the use of health savings accounts to pay premiums and meet costs under high-deductible plans?

74.4% – Yes

11.6% – No

12.8% – It depends on the details

1.2% – No opinion

Creating subsidized high-risk pools to cover people with preexisting conditions?

43.0% – Yes

16.3% – No

36.1% – It depends on the details

4.7% – No opinion

Medicare

Raising Medicare eligibility to age 67?

54.7% – Yes

23.3% – No

22.1% – It depends on the details

Expanding means testing within Medicare, such as higher co-pays or reduced benefits for high-income seniors?

50.0% – Yes

18.6% – No

30.2% – It depends on the details

1.2% – No opinion

Moving to a universal Medicare Advantage system with a means-tested defined contribution (premium support) for seniors?

28.2% – Yes

20.0% – No

48.2% – It depends on the details

3.5% – No opinion

Gradually expanding Medicare to cover everyone over age 55 who doesn’t have private insurance?

21.4% – Yes

48.8% – No

28.6% – It depends on the details

1.2% – No opinion

Delivery system reform

Taking aggressive measures to curb rising prescription drug prices such as allowing imports and authorizing the CMS to negotiate prices?

70.6& – Yes

9.4% – No

20.0% – It depends on the details

Repealing delivery system reforms such as value-based payment, accountable care organizations and the use of quality measures included in the Affordable Care Act?

03.5% – Yes

83.5% – No

11.8% – It depends on the details

01.2% – No opinion

So, it is apparent that as long as the health care industry continues to profit from the status quo, and supports the ACA, the likelihood of single payer will be remote at best, despite what the Sanders’ campaign seeks.

Things will only change when the entire system collapses of its own weight from complexity, waste, fraud, abuse, and excessive cost so that no CEO’s opinion will matter. People will demand a single payer system because no one will be able to afford having insurance.

The ancient Greeks, among other people, discovered the science of dialectics, or the study of change. Dialectics says that the seeds of change come from within, and that change does not happen until certain conditions are met, and change becomes inevitable. We are not yet at that point, but it is slowly moving in that direction.


 

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

Share this article, or leave a comment below.

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.

 

 

 

Independent Medical Review Upheld as Constitutional

As I mentioned this morning to a good friend, I normally shy away from writing about California work comp issues, but the following article by Stephanie Goldberg, is indicative of how the legal system has been corrupted to the extent that benefits are denied to injured workers when it is proved they are necessary to deal with their injuries, especially those that leave the worker unable to be gainfully employed.

In other words, the courts have helped the employers screw the workers once again, and this is not coming from ProPublica/NPR.

Here is the article from Business Insurance:

http://www.businessinsurance.com/article/20151029/NEWS08/151029727/constitutionality-of-workers-comp-medical-review-process-upheld-by?tags=|68|309|70|74|92|329|304

We can and should do better, and not just for blue collar workers, but for white collar workers as well. which is what Ms. Stevens is. And I know two other white collar women in CA who have also gotten the shaft from the system. I wrote about them in three separate articles, “The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System“, “The Stench of Fraud, Continued“, and “What Price Profit?“.

From what I have heard about the IMR process, not all of the reviewers are equipped or knowledgeable to review cases, and they only look at medical records (which by one account had been changed), so the process is unfair, no matter what the court said.

Workers’ comp is being undermined from within and without. It is only a matter of time until it it is completely gutted and done away with. That is the fault of stupid and greedy people, but it is also our fault for choosing leaders who allow this to happen because instead of looking out for the people, they look out for the interests of the wealthy and powerful.

My Response to Rebecca Shafer and Michael Stack

Rebecca Shafer, J.D. and Michael Stack, CPA are the president and principal ofAmaxx Risk Solutions, Inc., respectively.

This morning, on their blog, Rebecca wrote an article about the six things employers should do to avoid being a part of a ProPublica report.

You may be aware that ProPublica and NPR have recently reported on the harm many injured workers have received not only at the hands of medical personnel and the workers compensation industry, but even from their own employers.

I decided to write a response to Rebecca and Michael. Here is the text of my email to them:

Rebecca and Michael,

There should be a seventh item to your list. Employers should respect the health, welfare, dignity and honest hard work of their employees so that the treatment these workers have been subjected to, as stated in the reports, do not occur.

But the problem is, the American employer historically believes he is lord and master of his domain, which includes the workers and the materials he uses to make the employer wealthy.

If you don’t believe me, here is a quote from someone who knew what real industrial hell does to workers and workers’ lives:

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

We are seeing a recrudescence of 19th century, laissez-faire industrial capitalism, with its grinding poverty, income inequality, and now thanks to ProPublica and OSHA, a return to the days when workers lost limbs all in the name of ever greater profit for the owner, but misery and despair for the worker who is injured.

There was a case a few years ago about a company in Alabama that had serious injuries to their employees and not even OSHA could shut them down, This company was featured in a series of articles in the New York Times and on PBS, and because the business owner believed that no one had the right to tell him how to run his business, he could do whatever he pleased.

This is libertarianism, or also known as classical liberalism, and was the modus operandi of American business throughout the 19th and early 20th centuries, until reforms such as workers’ comp, unemployment insurance, the eight-hour day and other legislation consigned these problems to the dustheap of history. But one political party, with the backing of big business and billionaires, are taking us back to the bad old days.

Until the American worker is treated with dignity and respect by their employers, there will continue to be more reports from not only ProPublica, but from Mother Jones, PBS, the New York Times, and many other journalistic outlets.

The culture of greed at any cost, the culture of adversarial labor/management relations, and the push for ever greater return on investment for those who sit on their behinds and reap the benefits of the sacrifices made by workers, whether it is an arm, leg, foot, hand, or fingers must end. That will only happen when workers are treated like human beings and not like the machinery that takes their limbs or their lives.

Addressing the problems reported by ProPublica will not be solved merely by telling the employer to do a better job of managing their claims, their TPA’s and carriers, and getting better communication with their employees, but rather the discarding of the mean-spirited, and vindictive attitudes many employers manifest against any employee who gets hurt or files a claim, files a grievance, or any other proactive stance that is seen as a threat to an employer and his precious bottom line.

Without workers, nothing gets done. Without workers, there is no business, no profit, no return on investment. We are still far from a completely automated industrial production system whereby no human will ever be hurt or maimed again, so rather than go back to the bad old days of the Industrial Revolution, as many Libertarians and Republicans, and the Koch Brothers would wish, why not be more respectful and open and honest with your employees and treat them as you would want to be treated if you were them…with dignity.

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I am willing to work with any broker, carrier, or employer who is sick and tired of being bled by the Wall Street vulture capitalists and the entire medico-legal system known as workers’ comp, to save money, and to provide the best care for their injured workers or their client’s employees, while at the same time, helping to break the monopoly of the American health care cartel.

Call me for more information, next steps, or connection strategies. Email me at: richard_krasner@hotmail.com. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Let Our (Working) People Go

I want to pick up on a point that was made by David De Paolo yesterday in my post, STOP THE MADNESS!!!, and in David’s post today.

The point David has been talking about for two days now is the idea to allow employees to opt-out of the workers’ comp system in the same way that the states of Texas and Oklahoma allow employers to opt-out.

David discussed the plight of Glenn Johnson and his wife who were arrested and charged with workers’ comp fraud, but were not guilty of anything other than asserting their rights to sue for damages caused by an explosion when Glenn was operating a forklift.

The nightmare the Johnsons endured is what David wrote about in his post yesterday. Today, David goes on to advocate, and quite rightly, for the right of employees to opt-out of the workers’ comp system so that they can get just compensation.

For some time I have advocated the opt-out program as a way into the workers’ comp market for medical tourism destinations and facilitators, and now believe, as David does, that employees should also get the same right to leave the system, a system that has harmed and nearly threw both Johnsons into prison.

The way Glenn’s employer’s insurance company and their third party administrator handled Glenn’s case is a sign that things are out of control and need to be addressed before more Glenn Johnson’s are hurt by it.

Allowing an injured worker to not only received medical care outside of the provider network, and even outside the country, as Oregon and Washington state does, and to seek redress through other means besides the profiteering workers’ comp system makes sense, and should be adopted nationwide.

Opting out of a madhouse created by money-grubbing doctors, lawyers, crooked politicians, and judges and arbitrators who side with the defendants instead of the legitimately injured workers, is the best way to see that real justice is done.

And when an injured worker needs surgery, to force him or even his employer, to have the surgery performed at a hospital that charges thousands of dollars unnecessarily for a common operation is beyond stupidity, it is criminal.

Better that the employee and the employer be allowed to choose to go to a hospital that can provide the same or better quality of care, and at lower cost, at a medical tourism destination in Latin America or the Caribbean, especially if the employee is from there, or if doing so would give the injured worker a better chance to recover faster and in a more tranquil environment than at home.

In other words, let our working people go.

I am willing to work with any broker, carrier, or employer who is sick and tired of being bled by the Wall Street vulture capitalists and the entire medico-legal system known as workers’ comp, to save money, and to provide the best care for their injured workers or their client’s employees, while at the same time, helping to break the monopoly of the American health care cartel.

Call me for more information, next steps, or connection strategies. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with and follow me on LinkedIn and my blog. Share this article, or leave a comment below.

STOP THE MADNESS!!!

As this is my official 150th post, I thought that the following post from David De Paolo needs to be seen by everyone who cares about the direction the US is headed, the way the global economy is headed, and what is happening to the working class in the US, especially injured workers such as Glenn Johnson, Cecilia Watt, Linda Ayres, and many others.

We have been lulled to sleep by a slick talking former Hollywood actor (a third rate one, and second rate president), his media and political consultants, a kinder, gentler grandfather figure with two dummy ex-governor sons, their media and political consultants, talk radio pundits who abuse and insult those they do not like, and a conservative movement funded by the late Richard Mellon Scaife, the Koch Brothers, Art Pope, Rupert Murdoch, and many others, to take this country back more than one hundred years when workers had no rights and bosses were like gods.

David’s excellent post should make us all pause to consider what we are doing to our fellow Americans and be angry, for unless you are a millionaire or billionaire, you too can experience the same or similar circumstances these people have gone through, and worse.

To paraphrase Marx (that’s Karl, not Groucho), “Worker’s of the World, Unite! You have nothing to lose but your lives!”

https://www.linkedin.com/pulse/option-necrosis-david-depaolo?trk=hb_ntf_MEGAPHONE_ARTICLE_POST

If you are as angry and disturbed over this blatant disregard for the dignity of working people, and are tired of the “system” being run for the benefit of the insurers and those who benefit financially, then contact me for more information on how we can offer injured workers better medical care that actually saves money, and does not allow profiteers to abuse people.