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Wednesday, November 11, 2015

Eight Indicted in $25 Million DME Kickback Scheme

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  0 shares
A federal grand jury indictment unsealed Tuesday charges eight people with defrauding California wor…

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Anonymous Nov 3, 2016 a 2:58 pm PDT

Clean em up and throw them out. These sneaky people give all DME providers a bad name. And make Payers Leary of all vendors so it hurts all of the folks providing legitimate services. It's a shame but glad they are being brought to justice. All the Dr and provider names should be released and publicized if this is unsealed.

John Stalberg Nov 3, 2016 a 2:58 pm PDT

Partially a product of insurance co behavior--they have no problem paying alleged crooks, but refuse to pay good faith treaters, med-legal reporters (Yes even AMEs and panel QMEs), and interpreters and court reporters. Indolence pervades the payer side.

Mary Huckabaa Nov 3, 2016 a 2:58 pm PDT

You are absolutely right. This gives all DME a bad name. It makes the insurance carriers treat all providers as bad actors. It's a shame. A real shame.

Anonymous Nov 21, 2016 a 6:49 pm PST

Doing some liposuction on the "blob of Fraud" in Southern CA?

KURT HOFFMAN Nov 3, 2016 a 2:58 pm PDT

Don't believe everything you read. A lot of this sounds like bunch of crap. Don't forget there is a witch hunt and many legal activities can be viewed as illegal from a different perspective.

Kevin Yang Nov 3, 2016 a 2:58 pm PDT

Is that you "Dr./Mr. A?"

Frank Ramirez Nov 3, 2016 a 2:58 pm PDT

Are you one of the ones named in the indictment? Sounds like it!

David Stein Nov 3, 2016 a 2:58 pm PDT

“Today's indictments show how the defendants in this case allowed greed and corruption to influence their patient care decisions and treated their patients as a commodity to be bought and sold,”

That sounds like insurance companies and the UR process.

Hopefully the second round will pull in some of the people conducting schemes out of insurance companies. Look for the connections to this case and you will find them. Start at Zenith and State Fund.

Mary Huckabaa Nov 3, 2016 a 2:58 pm PDT

How do you go from doctors taking kick backs to refer patients to certain DME providers to 'sounds like insurance companies and the UR process'? The patients are the #1 victims of all of these shenanigans. In this case, the insurance companies are the #2 victims. Employers who pay premiums are #3 victims. The honest providers are #4 victims. And the entire WC system is victim #5. jstalbergattnet : once approved by UR, the carrier must pay. They can smell the fraud, even verbalize it. But, carriers are not law enforcement. The best they can do is report it and hope the DA's follow through. Who steps up for the injured worker who is being prescribed all this unnecessary crap so that the non-reputable physicians can do this? It's just a shame. A real shame, that what is supposed to be a system to treat injured workers has become a game of finger pointing who is doing right and who is not. We should all be working together to make this system work for the injured worker. UR is meant to stop the illegal referrals by making sure the treatment recommended is appropriate. Once treatment is approved, the provider referrals and kickbacks 'may' be controlled by MPN and Ancillary Network providers.

David Stein Nov 3, 2016 a 2:58 pm PDT

UR decisions are mostly financial decisions. UR bypass for "partner doctors", certain procedures and prescriptions excluded from UR, etc. So sure, the quote sounds very similar to the way UR is approached by payers. If UR and IMR weren't such profitable tools then would Zenith have rewarded Rupali Das recently for her role in the legislation?

It is not a few bad docs vs. workers comp. It's a few bad people throughout workers comp giving comp a bad name. Start with the fraud within the insurance company first since they control the money.

Gary Tobia Nov 3, 2016 a 2:58 pm PDT

I would agree with anonymous on this issue, 100 %!!! Carriers commit more fraud under color of law more than you can imagine in their UR depts. that also affect IMR handing down a valid decision. Glad I have OBAMA care through VA - Get a lot better medical treatment even with all the VA issues

Kevin Yang Nov 3, 2016 a 2:58 pm PDT

I can't believe that most of the comments here (probably from misguided injured workers, lien claimants, and/or attorneys who can no longer refer to these terrible providers) find some twisted/paranoid way to blame egregious provider fraud on the "big, bad insurance companies."

Thomas Hall Nov 3, 2016 a 2:58 pm PDT

Let both sides get the story correct. As we all know there is big money is in the Insurance Business. Referrals and denials of treatment are prosperous for the Insurance Carriers and for the Law Offices that represent them. I personally understand how a injured worker feels about going to a company doctor. You are given the fith degree at the doctor evaluation. Then the doctor says it is a sprain and you will get over it. Just take it easy for a while and go back to work and I'll see you in 2 weeks. You go back to work and then you get laid off by the employer or they look for something to fire you. You never got an MRI until after you got your own Attorney involved because your in so much pain. The Attorney refers you a Doctor that is not affiliated with the Insurance carrier for a MRI. And guess what the MRI reflects you have (2) 6mm-7mm buldged disk in your low back L-4, L-5. BUt the company doctor did not take the MRI nor did he refer you to get an MRI. The Insurance carrier has already denied the claim and the Defense attorney says file your lien and see you at court. It is sad but that is what happens in the real world. You complain or let someone know about the injury and YOUR FIRED and to top it off the insurance carrier raises the the employer premium. One thing that no one is really thinking about is what would the Insurance Carrier do without a Medical Provider. No matter what anyone does there is fraud on both sides. There was never as many problems with the system in the 80's as there is today. GREED is on both sides. I would watch out as the future might send everyone to CIVIL LITIGATION and there will be no more workers compensation cases.

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