Thursday, October 6, 2016

SB 1160 (Mendoza): anti-fraud legislation aimed at physicians permits MPN fraud


Governor Brown signed SB 1160 (Mendoza) supposedly to combat fraud in the form of abusive lien practices by physicians. The trouble is that injured workers in disputed claims often rely on physicians to risk non-payment by accepting liens, hopefully eventually to be paid. SB 1160 shoots an arrow into the heart of this largess because its language is such that it discourages physicians from getting involved in any liens at all. The net result is that many injured workers will no longer have access to medical care.


In exchange for this slap-in-the-face the bill supposedly eases up on Utilization Review for the first 30 days following injury. The idea, or so said the press releases, was to facilitate treatment. The trouble in this part of the bill is that it actually specifically prevents physicians even in this 30 day period from getting certain crucial but specific diagnostic studies because they're deemed too expensive. Access to profit trumps patient care in SB 1160. 

So much for easing up on Utilization Review. It appears that once again injured workers get the short end of the stick if in fact they get any part of it at all. 

7 comments:

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  3. Comment 1 of 2: What is your professional opinion of why our government agencies, our Governor, the DIR, and others including DA’s offices that allow the insurance carrier, employer and their law firms to continue to commit often times, heinous crimes and blatant disregard against IW’s. Why is there no mandated disclosure to injured workers that sets forth common tactics that are used against IW’s. Common tactics that include falsified medical reports and studies that favor the defense. Other tactics that include falsely painting the injured worker as mentally ill or delusional - obviously done to protect the insurance carrier from scrutiny.
    I see that most anyone inside a workers comp claim is the target of false scrutiny by the insurance carrier. The insurance carrier always gets the "good press" however, they commit some of the most heinous acts & crimes against injured workers.
    Additionally, can you explain or provide your professional opinion on why there is such a disparity in percentages regarding referrals of injured workers to psych evaluations in workers comp as opposed to regular MD settings. I believe that I've read that it is 1,000 to 1 - workers comp 1,000 referrals as opposed to a non-injured worker being referred for a psych exam in a regular MD setting. Clearly, injured workers are being “lured” into psych evaluations for strategic reasons. I believe to mar their credibility.
    There is no denying that filing a workers comp claim, in some cases, places the injured worker's future in jeopardy. For the last several years, I've learned that the defense in WC claims may choose to utilize what is referred to as "organized stalking" procedures against the injured worker. Organized stalking consists of a campaign of crimes beset against a person for the purpose of not only impairing the targets credibility but also destroying the person professional, personally, financially and emotionally. It is a strategy that consists of heinous and relentless crimes that include intrusions into the IW's private home, tainting of food & refreshments, theft of medical history & WC related documents, tapping of cell and home phones, hacking into e-mail and social networking sites, shadowing the IW's on the internet, vandalizing the IW's automobile and/or electronics in their home, overt aggressive stalking - not to be confused with sub-rosa surveillance, maiming of the IW's person during WC medical procedures, falsified medical reports and studies, false accusations against the IW of malingering or fraudulently filing a WC claim. It is also a strategy to belittle the IW or diminish the IW’s claims of being the target of crimes by including language that “the IW believes in conspiracy theories”. A well-known psych strategy meant to diminish the person who is the target of these the crimes. Surprisingly also used by California WCAB Judges and the CA Dept. of Industrial Relations.

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  4. Comment 2 of 2: Organized stalking aka organized corporate stalking is becoming more common today. It is often times backed up by government elect and agencies – thence being called “government sponsored stalking”. According to the law firm that represented me, they warn all of their clients of these crimes / strategies in advance – however, they were sorry that the warning slipped through the cracks on my claim. Another attorney who is affiliated with CAAA.org confirmed that the crimes that I endure in connection with the WC claim that I filed – does happen. When I asked the attorney to join me in preparing a formal disclosure that I hope will be mandated to be presented, explained to and signed by injured workers at the opening of all WC claims, his response was “We have enough trouble just getting medical treatment for our clients.” This was after I had explained to him what I had been going through – including having been systematically and intentionally maimed via the insurance carriers “network medical providers”. A heinous strategy, my body was maimed - I believe to “create the look of a condition” to offset any future medical needs that I may have had after suffering a back injury at work! Related to apportionment – a likely possibility. I was maimed repeatedly. More than one network medical provider implanted their version of the strategy. But I didn’t realize that the orthopedic surgeon was doing it intentionally until the 3rd lumbar epidural procedure wherein he brutally forced me under anesthesia and maimed by body from the base of my skull down to my tailbone as well as other parts of my body!
    My attempts to get help inside the WC system included contacting the law firm that represented me, the WCAB, the DIR, Governor Jerry Brown, the Orange County DA’s office, newspapers, cable and TV media and many more. I learned through IW’s groups that these crimes have been facilitated against IW’s for DECADES!!! Yet I was not warned!!! The DA’s office told me after I explained that I had suffered being maimed and battered during WC medical procedures and having intrusions into my home, etc. , “Unfortunately, your case is NOT unique.”
    I have since been trying to warn the public of the criminal strategies that are used against IW’s. I developed “Crimes Against Injured Workers” and O.C. California Crimes Against Injured Workers”. I have joined with other IW’s and IW’s groups to spread awareness, share our experiences.
    What say you Doctor Weinmann?

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  5. By the way, in response to your article above, I have spoken to Doctors who have indicated that they will not accept workers comp cases because it is common that they are not paid. In this regard, clearly, the
    Doctor is working to better the injury of the IW... otherwise, if the Doctor provided falsified medical studies and reports that favored the insurance carrier - they would be more likely to be paid for the "so-called medical services".

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  6. Re Cecilia Watt's comment of 8 Oct 16 at 2:16 PM: yes, many doctors will no longer accept workers comp patients "because it is common that they are not paid." The insurance companies and many employers like this quandary because it means that technically the injured worker has insurance without access to a treating doctor -- so costs stay down because there's only minimal providers to pay -- not unlike the current problem with the Affordable Care Act where one can buy into an insurance plan and still have little or no access to care. -- Robert L. Weinmann, MD, Editor, The Weinmann Report (www.politicsofhealthcare.com)

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