Category Archives: Doctors

2015 Top Ten Workers’ Compensation Fraud Cases

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

  Number Value
Non-Employee Fraud Cases 9 $ 848,000,000
Employee Fraud Cases 1 $ 1,500,000
Total $ 849,500,000

The top six of our top ten fraud cases of 2015 are from California, a perennial offender. The other four cases are from New York, Washington, Utah, and Massachusetts. As we continue to discover each year, non-employee fraud cases dominated the list. This year’s dollar amounts were particularly large, with nearly $850 million in total frauds. The largest fraud was a $580 million kickback scheme out of southern California. Authorities have begun to enforce the law against companies who have misclassified their workers and we expect to see a continued increase in these enforcement actions, both against our traditional offenders and against some of the sharing economy companies who are now the subject of multiple lawsuits. 1. (California) Surgeons and Owner of Hospital Charged In $580M Kickback Scheme (11/26/15)

(Credit: MoneyTimes) The kickbacks involving millions of dollars are increasing the insurance costs for patients.Such practice corrupts the relationship between doctor and patient, thus polluting medical profession.

(Credit: MoneyTimes) Kickbacks involving millions of dollars are increasing insurance costs for patients.

Five people have been criminally charged for their involvement in a medical kickback scheme that defrauded the California workers’ compensation system and insurance companies of $580 million over eight years. Two of the five charged were surgeons and one was a former owner of Pacific Hospital. The scheme benefited doctors and chiropractors who referred their patients to two Southern California hospitals for thousands of operations.   2. (California) FedEx Settles Misclassification Case For $228 Million (6/16/15)2. fedex FedEx has agreed to pay $228 million to resolve claims by 2,300 FedEx Ground pickup and delivery drivers in California. FedEx was labeling drivers as independent contractors in order to avoid the costs of trucks, branded uniforms, scanners, fuel, maintenance of the trucks, insurance and much more. Drivers were also not paid for missed meals, rest periods, or overtime compensation.   3. (California) Spanish Translators Caught in $24 Million Workers’ Compensation Fraud Case (12/17/15)Screen Shot 2016-01-16 at 12.21.25 AM The owners of G&G Translation services and over 200 of their employees fraudulently billed $24.6 million in workers’ compensation cases for services never rendered.  For example, one bill was for $422,000 for translation services by a translator who was actually in prison at the time. G&G obtained a list of patients who needed translation services at medical facilities and used those names to submit bills to large self-insured employers. 4. (California) Sewing Subcontractors Charged With Running $11 Million Dollar Workers’ Comp Insurance Fraud Scheme (4/16/15) Caroline ChoiJae KimTwo CEOs of a sewing company were arrested on April 15, 2015 for conspiring with their CPA, Jae Kim, to underreport $78.5 million in payroll to multiple insurers. They were arrested on 18 felony counts of workers’ compensation insurance fraud totaling more than $11 million in losses.   5. (California) Truck Drivers Awarded More Than $2 Million Due To Misclassification By Employer (2/3/15)
Pacer Cartage drivers protesting in November (Photo from the Teamsters Union)

Pacer Cartage drivers protesting in November (Photo from the Teamsters Union)

Pacer Cartage, Inc. (one of the largest port trucking companies in the U.S.) owes $2,026,483 to seven truckers due to “unlawful payroll deductions and expenses as part of a wage theft scheme” by the company. The employees were incorrectly classified as “contract laborers” who were forced to lease their trucks by their employer, and the employer avoided paying workers’ compensation premiums. Their leases were deducted from their paychecks, and the employees were not allowed to use the trucks for any other business purpose or drive them home.     6. (California) NFL Player and Gallagher Bassett Adjuster Plead Guilty to Wire Fraud & Filing False Workers’ Comp Claims for $1.5 Million (10/1/15)
Marcus Buckley (55) played for the New York Giants from 1993 to 2000.

Marcus Buckley (55) played for the New York Giants from 1993 to 2000.

Claims Adjuster Kimberly Jones filed fraudulent workers’ compensation claims on behalf of former NFL player Marcus Buckley between 2001 and 2011. In 2006 Buckley filed a workers’ compensation claim that was settled for $300,000 in 2010. After the case was settled, Buckley and Jones filed numerous requests for reimbursement under Buckley’s closed cases providing fictitious invoices, statements and credit bills. Buckley received more than $1.5 million.   7. (New York) Plumbing and Heating Contractors Settle for $1.4 Million(4/21/15) USDOL_Seal_circa_2015.svgFour Long Island City plumbing and heating contractors misclassified and underpaid a total of 300 employees. At least 25 employees were misclassified as independent contractors, several hundred were not paid overtime, and the companies’ recordkeeping did not meet the Fair Labor Standards Act requirements. The companies settled out of court when the Wage and Hour Division’s New York City District Office investigated and litigation began for a total of $710,000 in back wages to cover September 2010-April 2014 and damages for 300 employees equaling $1.42 million dollars.   8. (Washington) Drywall Contractor in Walla Walla Must Pay More Than $1 Million in Workers’ Compensation Premiums and Penalties (4/17/15) drywallShawn A. Campbell and his wife were held personally liable for over $1 million in unpaid premiums, interest and late penalties for their company. Campbell listed his employees as co-owners in order to avoid paying workers’ compensation premiums.   9. (Utah) Construction Company to Pay $700,000 for Misclassification Scheme (5/1/15) CSG Workforce Partners (a.k.a. Universal Contracting, LLC and later as Arizona Tract/Arizona CLA) required their workers to classify themselves as “members/owners” which limited their legal rights and gave them no minimum wage guarantee, no time-and-a-half overtime pay, no workers’ compensation insurance and no unemployment insurance. When the employers found out that the state of Utah was investigating, they packed-up and left for Arizona. However, they were tracked down and charged $600,000 in back wages to employees as well as $100,000 for their willful violations of employment laws. 10. (Massachusetts) Roofing Business Owners Indicted for Workers’ Comp Fraud Totaling $615,000 (3/25/15) Two business owners allegedly failed to accurately report their payroll and underreported earnings in order to be granted lower insurance premiums in three roofing companies between 2008 and 2014. They avoided paying a total of more than $615,000 in insurance premiums alone.   For more information, contact: Leonard T. Jernigan, Jr. Adjunct Professor of Workers’ Compensation Law N.C. Central University School of Law The Jernigan Law Firm 2626 Glenwood Avenue, Suite 330 Raleigh, North Carolina 27608 (919) 833-0299 ltj@jernlaw.com www.jernlaw.com Twitter: @jernlaw Blog: www.ncworkcompjournal.com

independent_medical_examination

A 10 Step Guide To Your Independent Medical Examination

Follow these steps to ensure you get the most out of your independent medical examination.

You will reach the stage in your worker’s compensation claim where you will be examined by a doctor of your choice. This exam may generate the most important evidence in your claim. I strongly recommend that you do the following:

  1. Needless to say, always tell the truth. Never exaggerate or overstate your symptoms. On the other hand, do not understate your symptoms, either. This is your one chance to tell it all.
  2. Be sure to write down the time and place of your independent medical examination (IME, for short). It is important that you make it to this appointment on time.
  3. Before going to the IME, spend an hour or two writing down the history of your injury, your current complaints based on the injury, what things aggravate your injury, and what care and treatment you have been given for your injury. You will have only a limited amount of time to describe these things to the IME doctor. It is important that you have a well-organized statement to give to the doctor. Therefore, you should take your written statement to the IME and use it to make sure that you tell the doctor a complete statement of these things. Then, save the written statement and return it to me. If the things in your statement do not end up in the IME doctor’s record, this may be useful in the future.
  4. Remember, although this is a doctor of our choosing who will be fair and impartial. The doctor is not in our pocket. He (or she) will be using the AMA Guides to the Evaluation of Permanent Impairment which has certain “tests” to determine if a patient is faking or exaggerating their symptoms.
  5. The best way to go into the IME is to be alert, relaxed and polite. The IME is a fairly routine process. You are not being singled out. Don’t be defensive.
  6. A major part of the IME will consist of you answering<!–more–> written or oral questions or giving a statement to the doctor. Answer all questions politely and truthfully. Don’t try to fake anything or unreasonably exaggerate any problem. Any experienced doctor will quickly discover this and it could ruin your case. Take your time in answering questions to make sure that you answer each question clearly and truthfully. Answer only the questions that are asked and don’t ramble on.
  7. You will probably be asked to describe your pain. Paint is often difficult to describe. You might find it easiest to explain activities that worsen your pain. You should have a list of everyday activities that increase your pain.
  8. When talking to the physician try to be as accurate as possible. Explain when and how you were hurt. Tell him your current symptoms in as neutral a way as possible.
  9. Do not complain bitterly about your previous treatment. Don’t say things about the company doctor being in cahoots with the employer. The IME doctor’s evaluation won’t be made better by complaints.
  10. After the IME, I am interested in knowing just what went on in the examination. Therefore, after the examination, take at least one half-hour to write down as much as you can remember of what the doctor said, what you answered, what the doctor did, and what, if anything, was dictated into a recorder. Note as accurately as possible the time that you arrived at the office, the time that you were placed in the examining room, when the doctor entered the room, and when the doctor left the room. It may be important to have an exact record of the time the doctor spent with you in the examination room.

If you follow these directions, you will provide the IME doctor with an accurate description of your work-injury condition. This will lead to a clear and reliable IME report that can held your claim. Of course, check with your attorney for more suggestions.

NIOSH_Latex_Facts

NIOSH Alerts Home Healthcare Workers About Latex Allergies

NIOSH Latex FactsToday we have a guest post from my colleague Jon Gelman of New Jersey.

NIOSH (The National Institute for Occupational Health and Safety) has published a booklet to educate Home Healthcare Workers about preventing latex allergies. Latex products are made from natural rubber, and sensitivity can develop after repeated exposure. Limiting exposure to latex can help prevent allergic reactions for both home healthcare workers and their clients.

Once Natural Rubber Latex (NRL) sensitivity occurs, allergic individuals continue to experience symptoms, which have included life-threatening reactions, not only on exposure to NRL in the workplace but also upon receiving or accompanying a family member receiving healthcare services at inpatient as well as office-based settings.

In September of 1997, the Food and Drug Administration (FDA) issued a final rule requiring cautionary statements in the labeling of all medical devices that contain natural rubber likely to come in contact with humans. The rule provides that such products must contain the following cautionary statement in bold print: “Caution: This product contains natural rubber latex which may cause allergic reactions.” Additionally, the FDA issued a final ruling that the labeling of medical devices that contain natural rubber, likely to come in contact with humans, shall not contain the term “hypoallergenic”.

Over the last few years, there has been a significant increase in the number of workers’ compensation claims filed against employers on behalf of individuals who have suffered latex allergic reactions. Scientists and government officials estimate that about 950,000 U.S. health care workers have developed an allergic sensitivity to latex.
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For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Returning-to-work

Returning to Work Shouldn’t Be This Hard

Today’s post comes to us from our colleague Roger Moore of Nebraska.

Communicate with your doctor and follow a few guidelines to stay safe when you return to work.

In virtually all workers’ compensation cases an injured worker has to return to work in some capacity. Often these are very stressful situations and it is not uncommon for issues to arrise including conflict with an employer over what a safe return to work actually is. Your goal should be to continue to earn a paycheck while at the same time not risking further injury. Many times this is easier said than done.

Whether it’s a supervisor who ignores your restrictions or a human resources department that actively skirts them, issues frequently come up. We see employers do everything from requiring an injured worker to lift or stand more than they should, to pressuring an employee to return to work the day after a surgical procedure.

You can expect that a nurse case manager or HR specialist from your employer is communicating with your doctor’s office about your return to work. Sometimes they may misrepresent the work that they expect you to do upon your return. It is your job to fill in the gaps.

The most important thing an injured worker can do is communicate with his or her treating physician.

  1. Educate your doctor about the job you were doing when you were initially hurt.
  2. When you are assigned to work, educate your doctor about the light duty job you are doing.
  3. If you are assigned to a job that is difficult for you to perform due to your injury, talk to your doctor about what aspects of that job are difficult. The doctor will likely be willing to restrict you from doing that specific activity.
  4. If your employer is Continue reading
dystoniafoundation

Dystonia Is Often Misunderstood

Dystonia FoundationToday we have a guest post from our colleague Len Jernigan of North Carolina.

Several years ago I had a client in North Carolina who was an insurance man. While taking some papers out of the back of his car at work he slipped, hit his head and developed a neurological conditon called “Dystonia.” I did some research and discovered that it is a disorder that affects the nervous system, causing muscles to contract involuntarily.

it is a disorder that affects the nervous system, causing muscles to contract involuntarily

Significantly, I also found out it can be caused by trauma, although often dystonia develops without any trauma and may be genetic. The case was denied by the workers’ compensation carrier (and Continue reading

medical-bills-credit-score

Workers’ Compensation Q&A: What Should I Do If I Receive A Bill From My Workers’ Compensation Doctor?

Put your money back in your wallet. Your employer’s insurance carrier is responsible for medical treatment of work-related accidents.

Today we have a guest post from our colleague Amanda Katz of New York.

Question: I received a bill from my doctor for treatment relating to my workers’ compensation claim. Am I responsible for payment?

Answer: You do not have to pay your doctor for treatment resulting from your work-related accident.

There is often confusion about paying doctor bills related to work-related accidents, but the reality is relatively simple. Take for example Joanna. While at work, a heavy box fell on Joanna’s foot. As a result, she was unable to walk and had to immediately go to the emergency room. Following treatment for her broken foot, Joanna received an expensive bill from the hospital. What should Joanna do?

Joanna should not pay the bill!

Under workers’ compensation law, Continue reading

medical-exam

What Every Employee Should Know: Preparing For The Defense Independent Medical Examination (IME)

Prepping for your IME is important. Follow these guidelines to get ready.

After your work injury your employer has a right to make you go to what is called an “Independent Medical Examination” or “IME.” The IME is, basically, an examination by a doctor chosen by your employer who will take your statement of what happened and perform a physical examination. How you conduct yourself during the IME can help or hurt your case. I strongly recommend that all injured workers follow the recommendations below in preparing for an IME.

Before going to the IME, spend an hour or two writing down the history of your injury, including:

  • your current complaints based on the injury,
  • what things cause your injury to be aggravated,
  • and what care and treatment you have been given for your injury.

You will have only a limited amount of time to describe these things to the IME doctor. Therefore, you should take your written statement to the IME and hand a copy of it to the doctor. It is important that you have a well-organized statement. Then make sure what you say to the IME doctor is in keeping with your written statement. Save the written statement and give a copy of it to your attorney. He or she will be able to use the statement if the things you say in it do not end up in the IME doctor’s record.

You will probably be asked to describe your pain. Since pain is subjective, it is often difficult to describe. You might find it easiest to describe activities that worsen your pain. You should have a list of everyday activities that increase your pain. Be as truthful, accurate, and complete as possible.

Even if your care before the IME is poor, I recommend against complaining bitterly about that care. Instead focus on just describing the facts. If true, tell the IME doctor how the care so far has not worked and yet the company doctor continues giving you that same useless care; or how the company doctor spends more time communicating with the company representative than with you. Recall and apply that old admonition from “Dragnet”—“just the facts, sir, just the facts.”

After the IME, your attorney will be interested in knowing exactly what went on in the examination. Thus, after the IME, take at least one-half hour to write down as much as you can remember of the following:

  • what the doctor said,
  • what you answered,
  • what the doctor did,
  • and what if anything was dictated into a recorder,
  • the time that you arrived at the office (be as accurate as possible),
  • the time that you were placed in the examining room,
  • when the doctor entered the room,
  • and when the doctor left the room.

It may be important to have an exact record of the time the doctor spent with you in the examination room.

You need to spend some time to prepare for the IME. By following the guidelines set forth above, you will provide a truthful, accurate, and complete statement of your condition. Hopefully, the IME doctor will then provide your and your employer’s attorneys with similar findings, diagnosis, and recommendations for treatment. Of course, you should spend some time talking to your attorney before any IME. Good luck!

diabetes

Official Disabilities Guidelines Now Covers Diabetes

While diabetes is not a work injury or illness, it can have a serious impact on the rate at which an injured worker recovers. For instance, people with diabetes may have a much harder time healing from a foot or leg injury.

The latest edition of the annual Official Disabilities Guidelines (ODG) has been released, including the latest ODG volume on treating patients. ODG Treatment is the nationally recognized standard for medicine in determining the scope and duration of medical treatment in workers’ compensation. For the first time this year, ODG Treatment includes a chapter on diabetes.

According to the American Diabetes Association, there are nearly 26 million people in the United States who have been diagnosed with diabetes, and an estimated 7 million more people suffering who have not yet been diagnosed. Clearly, the implications of diabetes on workers’ compensation are significant.