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BEVERLY HILLS, Calif. -- The co-owner of a chain of California medical clinics that is accused of billing fraud lashed back against the State Compensation Insurance Fund on Tuesday, saying the giant carrier has smeared his reputation in a cynical attempt to escape payment for medical bills. Dr. Alexander Zaks said State Fund, also known as SCIF, falsely accused him of not being in control of the six clinics he founded with another doctor and two chiropractors to treat injured workers...

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Comments (7):
“It seems that Zaks might have a point here and I'd be interested to hear more about his allegations that the attorney Roth has some sort of vendetta against him. My main question would be why would a SCIF attorney have a vendetta against a medical clinic that professes to have come into existence to give "proper" medical care to low income agricultural workers in the central valley? This article makes it sound like we all should be thankful that Dr. Zaks was generous enough to finally bring proper medical care to an entire region of California that apparently was served by a bunch of backwoods doctors that were anti low-income injured workers until Zaks' clinics moved into the region. The point about SCIF losing that Palm lawsuit is probably fairly accurate. Right or wrong SCIF does seem to be targeting some of the "big" players that have become filthy rich off the w/c system (I'm assuming there is some sort of financial interest involved though that isn't mentioned in this article). SCIF was clearly given the message that the MPN is not the place to target and fight their battle against those perceived as being unfriendly toward businesses and the economic health of the w/c system and clearly the effectiveness of the MPN's took a huge hit, as when I look at the doctors in the bigger MPN's out there, there is no shortage of docs that applicant's attorneys regularly use and have used in the past. Right or wrong it seems that SCIF is looking toward a new strategy and all of us have a stake in the outcome. Good for Zaks in fighting back and commenting on this case. Since you brought it up Mr. Zaks, please do tell us why Mr. Roth has a vendetta against you as this seems to be the only argument that isn't shrouded in logical fallacies unless of course we are to believe that this is as simply as SCIF trying to get out of paying some bills (exempli gratia: "We're talking about monopolization by SCIF of the work comp industry and they are pushing their weight around to steamroll providers out of business," Zaks said). Vendetta: n. 1. A feud between two families or clans that arises out of a slaying and is perpetuated by retaliatory acts of revenge; a blood feud. 2. A bitter, destructive feud.”
By: Zurich SF 3, 02/15/2006 04:52:34 pm

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“Ive been on the medical end of workers compensation for years, and Ive closely followed most of the shenanigans pulled by insurance companies (SCIF included) as they attack any medical provider with the temerity to treat injured workers against the wishes of the carriers. It was, therefore, with great sorrow I read the original article published by Workcompcentral noting SCIFs newest assault on medical providers. I was amused and gladdened by Dr. Zaks apparent stance of 'having done nothing wrong, I am here to stay.' But I too question the idea of a vendetta. Sure, I know (having reviewed the court filings of the case) that there was apparently an attempt on the part of SCIF, via the auspices of Bruce Roth to deny injured workers their benefits and avoid paying the Millcreek Surgical Center (or whatever the proper name was) for services rendered based on a fairly minor technical issue of having used a name slightly different than that filed under the fictitious business permit. So I am sure that after spending a few years attempting to disqualify fees Mr. Roth must have been incensed to learn that, unfortunately, once the billing error was corrected, SCIF was liable for the fees. (I am sure he missed out on quite a hefty bonus check for not being able to successfully deny payment for services rendered. Maybe the vendetta springs from a poorer Christmas in the Roth household than he had anticipated). It certainly appears that Mr. Roth is going for round two because he lost round one. More interesting to me is the case of Scheffield Medical Group, Inc v. Bruce M. Roth 63 Cal. App. 4th 1465. It seems that Mr. Roth has indeed made a career of malicious prosecution of medical providers for the sole purpose of delivering cost savings to carriers and bonus checks to himself while being protected by the loose shield of being a state employee, as the judge in this case noted that Mr. Roth is not liable for economic injuries caused by his instituting or prosecuting any judicial or administrative proceeding within the scope of his employment, even if he acts maliciously and without probable cause. It seems that based on the filings in the Millcreek incident and the Scheffield case, that Mr. Roth doesnt mind either personally committing acts of perjury or causing others to. I mean, its obvious that years ago he knew that Dr. Zaks had a legally sound corporate structure, hes even lost on the issue in court, but here he is again, issuing the same old argument. Now, admittedly, Im not an attorney, but when he alleges an illegal or improper corporate structure, but his own previous actions have demonstrated that this is not the case, is that not perjury? I guess a court will have to decide. In the meantime, its fairly obvious that SCIF has decided to destroy anyone large enough to defend themselves. Theyve recently decided that all medical providers who want to see their patients will have to join the Blue Cross/Blue Shield network. Now given that SCIF is 60% of the workers compensation market in California (much higher up in the Central Valley) that pretty much means anyone practicing workers compensation medicine either joins or goes out of business. But have you looked at the BCBS payment structure? Its 80% of Medicare! Thats right, about 50-60% of the OMFS. And with the paperwork in workers compensation and the costs of doing business, coupled with tactics like this on behalf of SCIF (after improperly applying ACOEM to avoid payment for years, and a refusal to care about penalties and interest) it appears to me that Dr. Zaks might have a point, it appears that Mr. Roth has convinced his backers in SCIF to target any clinic with the means to pay attention. Doctors beware, they are coming after you and you arent paying attention. Maybe its not a class action suit waiting to happen, maybe its not a good case for CAAA to try the RICO argument again. What do I know? Im not a lawyer. ”
By: Todd St. Vaughn, 02/15/2006 10:05:10 pm

“I do not know the specifics of this lawsuit. I can however testify to the fact that the carriers, including SCIF, are trying to starve out the applicant providers, particularly anyone who has the guts to treat on a lien. The carriers hold the providers monies long after the MSC. Virtually all my cases now go to lien trials which means no payment until about 9 months after the MSC. Everyone else gets paid timely except the applicant treating physician. The stategy is siege warfare and it's working; providers are going out of business. Right on Palm Medical. Congrats on teaching SCIF a lesson. You know the MPN's are hand picked and qualified docs have been denied inclusion if they have an applicant profile.I personally think the MPN's will die before year end. SCIF will not be able to legally pay less than the official medical fee schedule as an inducement to send injured workers to a physician (via the MPN). Does anybody else out there realize that that would be a kickback from the physician to SCIF for the referral of the patient. Such a scheme violates 139.3 and 4906(g). ”
By: Alexander Caligiuri, 02/16/2006 07:33:21 am
“Folks on the Applicant side seem to assume we all operate with the same personal financial motive they have. In case you haven't read the paper lately state workers haven't gotten a real raise in years and there are no "bonuses" either. The only ones with a financial motive are the ones who have been forced to make a fortune helping the injured worker maintain their poor state of health. I wonder how they measure their success. By returning the patient health or by level of permanent disability. ”
By: Reynold J. Roth, 02/16/2006 05:32:09 pm
“Interesting, but John, it's damn hard to return an injured worker to work when all your treatment is denied and the insurance carriers violate all the UR timeframes as a SOP. ”
By: Todd St. Vaughn, 02/16/2006 07:33:14 pm
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“All treatment denied is the byword by SCIF and most of the others also. UR is a joke, because often they use the same ACOEM Guidelines to deny treatment as doctors use to guide their treatment of the patient, so what is one to do? That is even if the claim is not denied to begin with and investigation of a claim is a joke and mainly consists of an ER interview. Whose side do you suppose the ER is going to come out on? The insurance companies need to be investigated.”
By: Marisela G. Skidmore, 04/05/2006 10:39:55 pm

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“Treatment authorizations are being denied by utilization review by the most devious means possible; phone calls to Dr.'s offfices for peer to peer conferences are made so as to be virtually impossible to return and given timeframes that no one can meet, making it all but certain that the therapy will be denied. This appears to be an official policy of the insurers since it is widespread amongst all carriers. It's time to stop the fraud perpetrated by insurers against injured workers.”
By: Mark Bernhard, 09/26/2006 01:36:22 am

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