According to an article by the OC Register*, at least 22 defendants are facing federal charges in Southern California for their involvement in health care fraud. These defendants are part of a nationwide crackdown of nearly 301 medical providers being accused of falsely billing upwards of 900 million dollars.
How does this fraud affect the patient?
In many of these cases, medical providers were giving doctors kickbacks in order to prescribe prescriptions, surgeries and expensive treatments that the patient never received. In one instance, Medicare paid a clinic more than 3.7 million for occupational therapy, in which the patient only received inexpensive massage and acupuncture. In another case, a Fountain Valley psychiatrist billed workers comp for 4.2 millions dollars worth of medical services using false patient reports.
These providers often target funded government health care programs like Medicare and TRICARE (military insurance plan), which is paid for by the American taxpayers. (Source 1*) Unfortunately, corrupt and fraudulent medical providers and doctors is something the injured worker has to deal with. These medical providers do not have the patient’s best interest at heart, and will recommend treatment based on their own self-interest.
Last week, our own Keith More had to reprimand a doctor who immorally examined our client from his van, because his office wasn’t wheelchair accessible. The doctor did this just so he could receive his fees. Regrettably, he’s not the only corrupt physician that is putting a strain on the work comp system. All around the state, Utilization Review (UR) Doctors, who are supposed to give their medical recommendation as a neutral third party, are denying and recommending treatments based on the influence of insurance companies.