Friday, March 16, 2018

OWCP Reform

In May or June I will be travelling to Washington, D.C. to discuss OWCP reform with members of Congress.

One of the things I want to discuss is the amount of money an OWCP physician makes and how this exorbitant amount of money causes bias against claimants.

I will be discussing reform of placing a cap on the amount an OWCP physician can charge.

If you have been to an OWCP-directed second opinion or referee exam, please take a moment to go to ACS and check what the physician was paid.

If you want to help me help all claimants by discussing reform, please send me the proof of what your OWCP physician was paid for your exam. You can send it to: owcpslayer@gmail.com

To find your bill, go to ACS at: https://owcp.dol.acs-inc.com/

After logging in, go to Resolved Bills (paid and denied) and look for a bill that says PROMPT PAY. This is an OWCP physician's payment.

Thank you to everyone who has already sent me their PROMPT PAY bills, I truly appreciate it!

Sunday, January 14, 2018

Fraud, Fraud Everywhere

Today I'm talking about what I call Pop-Up Clinics. That's because they just seem to Pop-Up and do business until things go horribly wrong. 

Pop-Up Clinics are getting more and more popular because it seems too many people figured out they could make money off claimants and claimants are desperate to find someone who will take on their claim.  

Who remembers AmeriMed and Team Work Ready? Remember when those places sounded pretty good?

Most of these Pop-Up Clinics are advertised as a one-stop for OWCP claimants. They indicate they cover the medical, the physical therapy and they'll even manage your claim for free. 

Sounds great, right?

I'm not saying there aren't any legitimate Pop-Up clinics, I hope there are. But the trail I've been on paints a different picture. It's taken quite a bit of research for this article because one link leads to another which leads to another. It's felt like a never ending chain of fraud and abuse. 

Let's start with how these Pop-Up Clinics will 'manage' your claims. The main factor for me is that not one Pop-Up Clinic states the expertise of the people who 'manage' your claim or exactly what they mean by 'managing' your claim and nowhere could I find a single name of a person who will be the one who will 'manage' your claim. 

While some sites claim you'll get an 'expert' or they have 'years' of experience, there's no way to research the person 'managing' your claim, find out what their expertise is, no name to check against Board decisions for a win/loss record, no way to check their reputation. Basically, there's no way to check anything about these people. 

The experience might be they were hired by the Pop-Up Clinic and are learning on the fly. They may have no experience whatsoever with an OWCP claim other than what they've done while working for the Pop-Up Clinic. None of the sites explain how much or how little they'll actually do for you. If you think hiring a professional is expensive, try hiring an amateur.  

The next thing about Pop-Up Clinics is that a lot of them aren't owned and operated by a physician. They're owned and operated by individuals and sometimes a chiropractor. But we all know a chiropractor is not a physician under the Act. 

Another issue for me is that when you go to their websites, most don't list the physicians. I'm confused why a medical clinic touting their services wouldn't list its physicians, why would they hide that information? I find that suspicious. That made me wonder why, so I started digging deeper and was pretty shocked by what I found.

My quest all started with a place called 210 Workers in Texas. I found out about them through a physician I help from time to time who was told by a patient that 210 Workers recently put on a seminar for their postal union. Too bad the union didn't do a little research first. 

210 Workers indicates they'll provide an evaluation, case management and individual treatment plans. 

Their website is pretty basic and doesn't list a single doctor's name who works there. I dug deeper and found out that 210 Workers are 'physical therapy' clinics and the owner, Rafael Enrique Rodriguez, who is not a physician, was indicted on 12 counts of OWCP fraud in October 2017 to the tune of $7.5 million.

The indictment alleges, among other things, that between 2012-2016 Mr. Rodriguez used the names of a physician and physical therapist without their permission (identity theft) and billed OWCP for services that were not provided. Claimants were primarily postal employees.

The indictment alleges Mr. Rodriguez submitted or ordered others to submit, "materially false claims to OWCP for one-on-one physical therapy supposedly provided by a physician or other qualified health care professional, when in truth and fact, the physical therapy was not provided by any licensed physician or other qualified health care professional"

You can read more here:


Next up is A&A Pain and Wellness Center in Texas owned by Anukul Dass and his sister Anurag Dass, who are not physicians. I couldn't find a website for them but their Facebook page indicates the business is physical therapy. 

This one gets a little confusing because A&A is also connected to a company called Zentec. The director of Zentec is Steven V. Hunt, Sr. In his bio he seems pretty impressed with himself as to his accomplishments.

Mr. Hunt acts as a representative for claimants and according to his website also does seminars to teach employees, union reps, doctors and attorneys. 

Except back in November 2017, Mr. Hunt was indicted along with the brother/sister operators of A&A Wellness Center. The 27 count indictment alleges they filed false claims to OWCP for patients that Mr. Hunt directed to A&A. In return, Mr. Hunt got a kickback (allegedly) from A&A for each claim OWCP paid. The indictment alleges OWCP paid out $7.2 million on A&A's claims. 

So in addition to charging claimants for his services as a legal representative and charging for his 'teaching' seminars, it would appear he got even richer through kickbacks from A&A for sending claimants to them (allegedly). It appears Zentec is still in operation.

You can read more here:


I took this a step farther and checked Mr. Hunt's win/loss record with the ECAB. I could only find four cases in front of the ECAB, but Mr. Hunt lost all four. (08-0333 11/04/2008, 15-0286 08/18/2015, 14-1345 12/15/2014 and 12-0886 03/26/2015).

Makes you wonder about those training seminars he does.

As if that wasn't enough to wrap your head around, Zentec's website has a "resources" page. This lists some people identified as physicians but others that don't indicate who they are or what they do. One of the listed resources is, of course the above mentioned A&A, but there's another listing for Shayna P. Lee. 

Turns out Ms. Lee was a psychiatrist. I say was because her license was revoked in 2014 after pleading guilty to a felony charge of theft of Medicaid/Medicare funds. I can find nothing that indicates her license was ever reinstated.

This could be a serious issue if Ms. Lee is/was acting as a physician on a claim, since Ms. Lee has no medical license. If she is in fact signing OWCP documents including reports as a physician, once OWCP finds this out, they could determine the claimant has no valid psychological evidence. 

If Ms. Lee wrote the report(s) that got the claim accepted, OWCP could revoke that claim because Ms. Lee is not a physician. 

From the Texas Medical Board:

"REVOCATION Lee, Shayna Patrice, M.D., Lic. No. H0554, Houston 
On August 29, 2014, the Board entered a Final Order revoking Shayna Patrice Lee, M.D.’s Texas medical license. The Board found Dr. Lee pleaded guilty to the second-degree felony offense of engaging in organized criminal activity regarding the aggregate theft of Medicaid/Medicare funds on July 23, 2012."

You can also go to the Texas Medical License Lookup and find this information as well.

Haven't heard enough yet? Then how about Union Treatment Centers, another one in Texas. Their website is still up and running and indicates they're a "leader" in treating work-related injuries and they'll assist you every step of the way.

Between 2009-2012 Union Treatment Centers allegedly overcharged OWCP for services and supplies and fraudulently billed OWCP for services not rendered, overcharged for examinations and falsely inflated the time claimants spent in therapy. 

As if that wasn't enough, they were also allegedly offering, paying, soliciting and receiving kickbacks in exchange for claimant referrals. 

The settlement includes a  $3 million payment from Union Treatment Centers and a 14 year prison term for Union Treatment Center's CEO, a chiropractor, for kickbacks and money laundering and he is required to pay almost $18 million to OWCP in restitution.

The COO is awaiting trial on conspiracy, wire fraud, kickbacks and aggravated identity theft. 

Their website states; " UTC HEALTH & REHAB adheres to high moral principles and professional standards by a commitment to honesty, confidentiality, trust, respect, and transparency." I am absolutely not kidding, it actually says that. 

This one is convoluted and complicated and includes a whole lot of people including a pharmacy that allegedly paid $800,000 in kickbacks to Union Treatment Center's CEO, the chiropractor. 

Read more here:




Then there's this one that's pretty elaborate and covers multiple Pop-Up Clinics, four medical providers, twenty one claimants, representatives, even a  senior claims examiner. Twenty eight people in all. 

It includes the Pop-Up Clinics, AAA Mental Health, Mind Spa, Solutions Health and Rehabilitation and Convergence Emergence Diversion, Lifeline Counseling and Atkins Counseling Center. 

This one is just too outrageous to list everything, but you can read more here:


Next is FedCare and the Broadway Clinic of Oklahoma. There was a settlement for these two clinics based on allegations each submitted false claims to OWCP for federal employees of fourteen different agencies. FedCare and the Broadway Clinic agreed to a settlement of $2.5 million while not making any concessions of liability.

I don't know about you, but I'd never pay $2.5 million if I knew I didn't do anything wrong.

Both appear to still be in business.

You can read more here:


Then there's Forest Park Medical Center in Texas

This is another one that involves multiple people including 21 physicians and a shell company called Unique Healthcare, another clinic called Kortmed and I'm sure multiple other Pop-Up Clinics.  

The Forest Park Medical Center case involves about $40 million in alleged bribes and kickbacks involving Medicare, Medicaid and OWCP. About $25 million involved OWCP claims. 

Some of the physicians had their own business or clinic which makes it impossible to track down all the of names of those clinics. Several of the parties involved have either pleaded guilty or been found guilty. 

You can read more here:



I also found multiple You Tube videos from various clinics, but all used the same animation which I found really odd. Why would you use the same You Tube video as a competitor?

Based on my research, it's almost impossible to track down all the different names because they can just change the name, have multiple names, change locations or agree to pay a settlement and continue with business as usual. 

Let's not forget that Lenny Perez and Lois Luis met in prison and joined forces when they got out and together the AmeriMed fiasco was created which resulted in both being convicted again and claimants scrambling for new medical care.

All and all it seems like it's just profiteering disguised as medical care.

The moral of this story is that while it's really hard to find providers to take on an OWCP claim, you need to be really careful.

There are legitimate physicians and legitimate clinics that take on the beast that is OWCP and they should be commended for what they do. But the legitimate ones have a reputation you can check, they aren't afraid to list their doctors which you can check and none that I know of have been indicted or paid a settlement for fraud allegations.  

Before you take the easy route, you should do your research, ask for the names of the physicians or other providers who will be involved, check licenses, see if there have been any indictments, fraud allegations or settlements. Because it might be easy to start with but in the long run become a nightmare. 

If the clinic offers claim 'management' ask what that entails, the qualifications of the people who do the 'managing' and the names of the people who will be 'managing' your claim. If they don't want to give you this information, that's a clue. Maybe 'managing' your claim only means they'll file your paperwork which isn't 'managing' your claim at all.

Plus, I've said it before and I'll say it again, never rely on anyone to submit your paperwork. Ultimately, it's your responsibility and the consequences only fall on you if the paperwork isn't submitted. Better OWCP gets it twice than not at all.

A big problem with researching all this is that it takes a long time for the indictments to come through, so who knows how many indictments are in the works. 

There's already stigma with an OWCP claim that every claimant and every claim is a 'fraud'. Unfortunately, there are fraudulent claimants but the majority are legitimate and it's the legitimate ones that have to struggle against a system that believes all claims are lies.

The last thing a legitimate claimant needs is to be associated with providers who have no license, who are under investigation, who have paid settlements or who have indictments coming down.

Bottom line...Protect Yourself and Do Your Research!

Friday, January 5, 2018

2018 Periodic Roll Payment Schedule


Monday, December 18, 2017

ACS Website Address Change

Effective December 31, 2017, the URL address https://owcp.dol.acs-inc.com for ACS will no longer be valid.

To access the Web Bill Processing Portal, you'll have to go to:  https://owcpmed.dol.gov

Tuesday, October 10, 2017

ECAB Decision Search

Several months ago the ability to search ECAB decisions suddenly disappeared.

Personally, I figured they did that on purpose so that claimants and those that represent them no longer had access to decisions on which valid arguments could be made. Hard to cite a decision when you don't have access to the decisions.

Plus, it made it impossible to look up doctors to see how often they went against a claimant or to look up representatives to search their win/loss records.

Since this ability to search decisions disappeared into a puff of smoke, I've been checking to see if it would come back. Giving them the benefit of the doubt, I did wonder if they were making updates to the site, but with each passing day, that seemed less likely.

So I moved on to find another way to access Board decisions and today I found it!

It's a bit different than the old way, but it does work!

Here is the link:

Thursday, October 5, 2017

I Thought My CA-1 Claim Was Accepted

A CA-1 or traumatic injury claim works differently than all other OWCP claims and these differences can be confusing.

A CA-1 is filed when injuries occur in one day or during one shift and are identifiable to specific events such as a car accident, a dog bite, a broken bone, etc...Any injury that happens suddenly in a single day or during a single shift.

When a traumatic injury claim is filed, you have the option of taking your leave or taking Continuation of Pay, (COP) if you cannot work. These options are on the claim form.

COP pays your wages for the first 45 days of a claim. The COP option means the agency is paying you. Most agencies will try to get you to use your leave but you shouldn't have to use up your leave because you were injured at work.

*For postal workers and only for postal workers, the first three days of a claim are on the injured employee. You can use leave or Leave Without Pay, (LWOP) for those first three days if you can't work. If there's disability (you can't work) for more than 14 days, then the leave a postal worker uses for those first three days should be restored (returned to the employee).

If you cannot work due to your injuries, then the COP pays you for those first 45 days while you're not working. Once the 45 day period ends, if you're still unable to work, you would file CA-7's for compensation.

In order for OWCP to pay compensation, your doctor needs to write something for OWCP that specifically addresses the dates of disability, why you cannot work, what job duties you cannot perform and connect these reasons to the work-related injuries.

COP is charged if you're able to work but require medical treatment. For instance, if you have a medical appointment, physical therapy, testing, etc...during the first 45 days after the injury COP covers your time away from work.

COP is charged by the day, so if you have a medical appointment that takes three hours, one full day of COP is charged.

Another way a CA-1 is different is that when there's a traumatic injury your agency should give you a CA-16 within four hours of being notified of the injuries. A CA-16 guarantees payment to the first physician that treats you for non-surgical treatment.

Because the CA-16 guarantees payment, it is not available online and must be given to you by your agency. The CA-16 will indicate the name of the physician. The physician you see is your choice. If the agency writes in a physicians name, it should be changed to reflect the physician you choose.

When you choose the physician, your agency should also give you an OWCP-1500 form as well. This isn't necessary if the agency chooses the physician because those physicians normally have contracts with the agency.

Once you're injured and your agency is notified, you should seek medical treatment as soon as possible but the CA-16 is valid for up to 60 days from the date of injury.

Even if your agency does not give you a CA-16, OWCP should pay for the physician but the CA-16 is a guarantee of payment.

As with any OWCP claim, the employee has the choice of the first physician they see. The agency may want you to go to 'their' doctor, but you have the choice of the physician and let's face it, the agency's doctor is on the agency's side not yours.

If the agency insists on taking you to the doctor, then you should insist that they take you to your doctor. Unless there's a valid reason, such as your doctor is more than 25 miles from the place of injury (or the employee's home), the agency needs to take you to your doctor.

If the agency refuses, then you should make other arrangements for transportation so that the first medical report isn't coming from an agency doctor on the agency's payroll that probably won't accurately diagnose you.

If you have a doctor in your area that is knowledgeable with the ways of OWCPland, it's in your best interest to see that doctor first.

A lot of people who file a CA-1 claim are confused when suddenly it appears that OWCP has changed their mind about accepting the claim. This is another difference between a CA-1 claim and all other claims.

With a CA-1 claim, OWCP authorizes up to $1,500.00 in payments to medical providers without question. Once the claim reaches that $1,500.00 mark, OWCP sends a development letter and the claim has to be proven with evidence just like any other claim.

The development letter will require that you provide OWCP with a medical narrative and often the letter also contains a questionnaire that you must complete. The development letter will give you thirty days to provide the evidence.

A CA-20 is not enough to get any claim accepted, a physician must write a medical narrative.

If you miss that deadline or don't submit what OWCP is asking for, OWCP will deny the claim and you'd have to appeal that decision. If this happens and COP was used, then the COP is converted to your leave.

This can cause confusion because the bills are being paid and the injured employee believes the claim is accepted when it is not and can cause complications because the COP is reversed and your doctors will no longer be paid.

So if you file a CA-1 claim, be aware that unless the injury is minor with less than $1,500.00 in medical bills, you will be expected to prove your claim once you exceed the $1,500.00 allotment. If you're sent a development letter make sure you give OWCP everything they need so that you don't have the complication and delay of having to appeal.

You can check bill status on the ACS site. I've included the link below. When you see that you're getting close to the $1,500.00 mark, it's in your best interest to get a proper medical narrative so you don't miss OWCP's thirty day deadline.

Until you receive a letter from OWCP that indicates the claim has been accepted and what conditions are accepted, your CA-1 claim is not officially accepted.

                                                    MORE INFORMATION:

Choice of physician:
Information about choice of physician is listed on the CA-16 form

20 C.F.R. 702.403:

Publication 810 (chapter 6):

Bill Status:

Other Relevant Articles:
Disability: http://theowcpclassroom.blogspot.com/2017/09/my-claim-was-accepted-but-im-not.html

CA-20's: http://theowcpclassroom.blogspot.com/2016/04/the-ca-20-trap.html

Medical Narratives:



Doctors That Accept OWCP Claimants:

Wednesday, September 27, 2017

My Claim Was Accepted But I'm Not Receiving Compensation

I often hear from claimants that their claim was accepted but they're confused why OWCP isn't paying compensation. This is because there are two sides to every OWCP claim...the medical side and the compensation side and each side must be proven separately.

Every OWCP claim covers medical conditions. When your claim is accepted, specific medical conditions are accepted as work-related and this allows you to receive treatment for those medical conditions that OWCP pays for.

But just because your claim is accepted for medical conditions it does not mean you're also approved for compensation.

Compensation is paid for disability, an inability to perform your job (or any job) and the disability must be proven to OWCP before OWCP will pay compensation.

To receive compensation you need two things....first you have to file CA-7's and second, your doctor must provide medical rationale that explains the disability and the reasons you cannot work.

To avoid delays, your doctor should address the disability in his/her medical narrative that's submitted to get your claim accepted. If this isn't done in the original narrative, the doctor will have to write something specific about the disability.

If you supply OWCP with a completed CA-17 or OWCP-5, this will not be enough for OWCP to pay compensation.

The doctor needs to specifically address the dates of disability. So if your date of injury is 09/01/2017 and you've been unable to work since, the doctor has to specifically state from 09/01/2017 and continuing, you have not been able to perform your job duties. If the doctor doesn't specifically indicate the dates of disability, OWCP won't pay compensation until they receive that information.

Your doctor needs to explain the physical requirements of your normal job duties. This is so it's clear to OWCP that your doctor understands what your job entails.

The doctor needs to explain what job duties you cannot perform and why you cannot perform them. As always, the reason cannot be due to pain as OWCP has determined pain is a symptom. To OWCP, your pain is your problem and not a reason not to work.

So the doctor cannot say you can't work because you're in pain. If the doctor discusses pain, the doctor must explain where the pain is coming from, what is causing the pain and how it affects your ability to work and this must be related to the accepted (or claimed) conditions.

The doctor should explain your symptoms, any loss of range of motion, etc...

Any side effects of medication that's prescribed for your work-related conditions should be explained. This should not be the general side effects of a medication, but how the medication specifically affects you.

Any driving restrictions should be explained.

If your job is repetitive in nature, that should be explained. For instance, postal workers whose jobs tend to be highly repetitive.

As an example, if you have a knee condition and your job entails walking, standing, climbing stairs, kneeling etc...the doctor needs to explain that because of the knee condition, loss of range of motion in the knee, swelling of the knee, etc...you cannot perform the job duties of walking, standing, kneeling or climbing stairs.

If you have to elevate your knee repeatedly during the day due to swelling or if you have to wear a brace, that should be explained and connected to why you can't perform specific job duties like walking or climbing stairs, kneeling or driving.

If you have a spinal condition and your job entails sitting and/or sitting while driving, the doctor needs to explain how sitting further compresses your spine and that you cannot perform the job duties of sitting and/or sitting while driving. If there's a loss of range of motion it should be explained that you cannot bend or twist or turn your head.

If you cannot lift the weight you're required to lift for your job because of your conditions, the doctor needs to explain that you cannot lift as required for your job.

If you need to lay down during the day to take the pressure off your spine and relieve your symptoms, that should be explained.

If you have shoulder conditions and your job entails reaching or reaching above the shoulder and/or lifting, the doctor needs to explain why you cannot reach or reach above your shoulder or lift.

The doctor can't say you 'shouldn't' do a specific job duty or that a specific job duty 'might' harm you.  OWCP doesn't pay compensation for what they call "fear of future injury" so the doctor can't say if you perform these job duties you could be injured further, or it might injury you further. The doctor has to state in definitive terms the job duties you cannot perform and any other reasons you cannot work such as medication.

As with everything in OWCPland, the disability has to be explained to them in specific detail before they will approve and pay compensation. Because OWCP doesn't explain these requirements, it's often the reason that compensation is delayed.