At Reveal, Christina Jewett investigates the gaping holes in California’s workers’ compensation system that make it so vulnerable to fraud and leave workers in the dark about the bogus care being charged in their names. She begins the article comparing the workers’ comp system to Medicare:
When Medicare makes rules, it has a strong incentive to encourage doctors, pharmacists and others to follow them: money.
The purse strings are not held nearly as tightly in California’s workers’ compensation system, in which a division of power creates the first major hurdle.
Lawmakers make rules. The state’s Department of Industrial Relations administers workers’ compensation. Judges issue orders in workers’ compensation courts. Medical boards and commissions oversee doctors, pharmacists and chiropractors. And a market of more than 300 insurers and self-insured employers do the day-to-day job of deciding which medical bills to pay and which claims to fight.
“When everyone is responsible, no one is,” said Kate Zimmermann, a Kern County prosecutor who has combated workers’ compensation fraud for eight years. “He who has the gold can write the rules. … If you have one checkbook, you can say, ‘If you want the check, this is how.’”
And because workers never see a summary of services and charges related to their workers’ comp care, they don’t have the information they need to flag fraudulent care, the article states. For instance, Jewett interviewed a worker who had requested her medical records only to find that her provider had billed for transportation and language interpretation — services the worker hadn’t used.
Throughout the article, Jewett looks to Medicare to illustrate how that health care system has prevented fraud. An example: the Medicare program bans providers who’ve been convicted of defrauding a health care program. California’s workers’ comp system, on the other hand, does not. She writes:
But those banned providers have no problem starting a second career in California’s workers’ compensation system.
Medicare banned Dr. Thomas Heric in 2006 after he pleaded guilty to charges related to writing reports based on diagnostic tests that turned out to be fraudulent. In his letter to the judge who sentenced him, Heric pledged that going forward, he would use “whatever talents I may have in service to the community.”
Heric then found a new line of work in the workers’ compensation medical system. His job was to review data on injured workers’ sleep patterns and issue reports needed to bill insurers.
Five years later, prosecutors accused Heric of fraud again. They say he was writing virtually identical reports that gave rise to sham billing. One expert testified in court that Heric’s sleep-study reports were so bad that they failed to address one worker’s serious breathing problems for months, a lapse that he said could harm “the general public.”
To read the full article, visit Reveal.
In other news:
Fair Warning: Brian Joseph investigates the dangerous conditions that workers face in the recycling industry, beginning the story with worker Erik Hilario, 19, who died in a fire at Newell Recycling in Georgia. The article notes that an analysis of OSHA records found that scrap yards and sorting facilities receive about 80 percent more citations per inspection than the average inspected workplace. In addition, recycling drop-off centers have become somewhat notorious for wage violations — for instance, labor officials in California compared wage theft problems in the industry to those typically found in garment sweatshops and in the agricultural industry. Joseph writes: “One of the largest sectors in recycling, scrap yards, has long had high fatality and injury rates. In 2014 its fatality rate was 20.8 deaths per 100,000 full-time workers, more than nine times higher than manufacturing workers overall. The same year, garbage and recycling collectors had the fifth-highest fatality rate among the dozens of occupations analyzed by the Bureau of Labor Statistics. No one tracks how many workers die across all recycling sectors. But at scrap yards and sorting facilities, at least 313 recycling workers were killed on the job from 2003 to 2014, according to the BLS.”
Los Angeles Times: Peter Jamison explores the impact of union exemptions included in a number of local minimum wage hikes across California. He starts the story with bellhop Bill Martinez, who could have seen a 71 percent boost in his paycheck after Los Angeles passed a law raising the minimum hourly wage at large hotels to $15.37. But because the law included an exemption for union hotels, Martinez is now making less than nonunion workers. The exemptions are drawing a good bit of outrage, Jamison reports, including criticism from fellow unions. Supporters say the exemptions could make employers more amenable to unionization and enables unions to negotiate better packages and benefits for members. Jamison reports: “Even union workers exempted by the ordinances of L.A. and other cities will see their pay gradually rise under the state minimum wage increase. However, because of the law’s incremental rollout — the statewide minimum will not reach $15 until 2022 — they are still positioned to miss out on tens of thousands of dollars compared with their non-union counterparts.”
Chicago Tribune: Alexia Elejalde-Ruiz reports that Chicago is poised to join the growing number of cities nationwide that now require paid sick leave for workers. The city’s Working Families Task Force released a report earlier this month recommending that Chicago workers be able to accrue at least five paid sick days every year. The report, which is intended to serve as a blueprint toward an eventual city ordinance, also found that offering paid sick leave would add about 0.7 to 1.5 percent in labor costs for most employers. Not surprisingly, the local Chamber of Commerce is opposing a sick leave ordinance. Elejalde-Ruiz writes: “A report from Women Employed estimated 460,000 private-sector workers in Chicago don’t have access to paid sick days. Another report, from the National Partnership for Women & Families, put the number at 2.1 million people in Illinois.”
Huffington Post: Dave Jamieson reports that a judge has ordered that two coal miners be reinstated after being fired for insulting Bob Murray, CEO of Murray Energy. The cases involves a bonus program at one of Murray Energy’s coal mines in West Virginia in which miners could earn extra pay if they avoided safety violations and achieved production goals. United Mine Workers of America opposed the program, arguing that it conflicted with safety goals and could discourage workers from reporting safety problems. Two miners made their opposition to the bonus program well known, writing on their voided bonus checks: “Kiss My Ass Bob” and “Eat Shit Bob.” Fortunately, a judge sided with the fired miners. Jamieson reports: “And as far as the judge is concerned, the miners had a legal right to say as much. Not because they’re entitled to free speech — but because they have a right under the law to band together to improve their working conditions.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.