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Wednesday, May 25, 2016

Field Nurse-Is Yours Legit?

As if there wasn’t enough to contend with, a new issue for claimants has come to my attention and it's getting more widespread. It is important that this information gets to ANY claimant who finds themselves with a nurse on their claim.

Agencies are assigning nurses to OWCP claims and in some cases, these nurses are misrepresenting to a claimant and/or their providers that they were assigned by OWCP or that they are contracted by OWCP.

In some cases, the agency nurses are misrepresenting that even though employed by the agency, they have the right to access your medical records and get involved with your providers because you were injured at work.

THIS IS NOT TRUE

In some cases, the agency and/or its nurses are preventing an injured worker from seeing a qualified physician by recommending a physician or telling the injured worker they have to see a particular physician. You do NOT have to have an agency-recommended physician as your treating physician.

In some cases, the agency and/or their nurses are directing claimants away from certain physicians, saying the physician is under investigation when they are not. This is currently most widespread in Arizona.

I’ve said it before and I’ll say it again, DO NOT believe your agency without proof what they’re saying is true. It’s hard enough to find a physician that will take an OWCP patient, now the agencies are trying to eliminate physicians, especially the good ones, that do accept OWCP claimants by telling lies about the physicians to scare claimants away.

For injured Border Patrol employees, there is at least one agency nurse in Arizona that is currently not licensed in the state of Arizona and is inappropriately inserting herself into claims as if she has a legitimate right.

In some cases, the agency and/or their nurses are inappropriately obtaining your medical records from your medical providers. When you’re injured, your agency does not receive or manage your medical records…OWCP does.

In some cases, the agency and/or their nurses are contacting your providers in person or by telephone. The agency and/or their nurse CANNOT contact your medical providers in person or by telephone.

However, your agency can contact your providers in writing. If any agency is contacting a provider, it MUST be in writing and a copy of the letter must be provided to both you and OWCP at the same time it’s sent to your provider. The agency can ask your provider about work limitations and possible job assignments.

If the agency writes your provider and the provider is going to respond, they should respond to OWCP. The doctor has no obligation to respond to the agency. Your agency is not involved in the decisions of your claim. Your agency doesn't review or weigh medical evidence. Your agency does not manage any part of your claim. Your obligation is to OWCP not your agency.

Your obligation to your agency is to notify them when you have been released to work and to provide any physical restrictions through a completed CA-17. 

If the agency needs information, they can contact OWCP and if they are legally entitled to the information, OWCP will give it to them. 

If your agency contacts you for medical reports, you should send the reports to OWCP and NOT the agency, but you can and should provide the agency a current CA-17.

The agencies and/or their nurses are inserting themselves into claims and asking providers for information such as billing codes. Legitimate OWCP Field Nurses don’t need to ask for billing codes. Since all your bills go through OWCP, they can easily find out what’s being billed. They don’t need ask your providers for billing codes.

Your agency and/or their nurses CANNOT attend medical appointments, CANNOT participate in your treatment, CANNOT make treatment recommendations, CANNOT schedule appointments and CANNOT discuss your claim or your injuries with your medical providers.

Because of these new agency tactics, ANY nurse assigned to your claim should be properly identified as an OWCP Field Nurse. 

When OWCP assigns a Field Nurse to your claim, you will be notified in writing. If you did not receive a letter from OWCP assigning a Field Nurse to your claim, there is a chance the nurse contacting you is not assigned by OWCP but is an agency nurse.

ALL claimants should ask their Field Nurse for the letter OWCP sent them and identification to confirm they are in fact the OWCP Field Nurse assigned and not an imposter sent by the agency to wrongfully obtain your medical information and documents.

Once you know the nurse's name, you should also confirm the nurse has a current and valid license in your state.

If an agency nurse inserts themselves into your claim, I suggest you contact OWCP in writing and let them know the agency is acting outside its bounds of the Act.  A copy should also be sent to your agency and the agency should be told to remove their nurse from your claim immediately. That the nurse is not to contact you or any of your providers again. And most important, your providers need to be notified in writing that the agency nurse has no legal right to any information involving your claim.

If an agency nurse is or has been assigned to your case and improperly obtained medical information, you can also file a complaint with your state’s nursing board for improperly inserting themselves into your claim and/or directing the course of medical treatment, possible Privacy Act and/or HIPAA violations and violating 20 CFR §10.506. You can also talk to your union about filing a grievance.

You do NOT have to interact in any way with an agency nurse or an OWCP Field Nurse for that matter. 

It is not in your best interest to allow your agency access to your medical records or your providers. They are not entitled to the information and if the agency requires information regarding your claim, they should be told to contact OWCP. 

A CA-17 indicating your physical restrictions is all the medical documentation your agency should require. If they need anything else, the agency should be told to contact OWCP. 

Your agency has NO authority to insert themselves into your claim. If the agency requires information about your claim, they should be told to contact OWCP. If the agency is legally entitled to the information, OWCP will provide it to the agency.

If I haven't said it enough: The agency should contact OWCP if they need information about your claim. 

Also something to remember, Field Nurses are Voluntary. Even if you’re assigned a Field Nurse by OWCP, you do not have to allow them access to you, your home, your providers or your medical records.

Claimants unfortunately have to protect themselves and the best way to do that is by knowing your rights. You are NOT required to cooperate with an agency nurse in any way, shape or form and if one has inserted themselves into your claim, you should immediately put a stop to it.

Policy and Law:

From the FECA Field Nurse Handbook Part Three:

6. EA (employing agency) Nurses: Several EAs have developed their own nurse intervention programs. Whereas the concept of early intervention is in keeping with current case management techniques, the activities of these EA nurse programs should be coordinated with the OWCP adjudicatory and case management activities.

a.      Specific guidelines established for EA Nurses and EA Nursing Programs include:

(1)  The IW's (injured worker's) participation in an EA nurse intervention program is voluntary;

(2)  An EA nurse intervention program is limited in its scope and authority, and has no jurisdiction over issues under the purview of OWCP;

(3) OWCP FN (Field Nurse) intervention activities/actions supersede the EA actions and the EA nurse should suspend any independent actions during the course of OWCP nurse intervention; and

(4) OWCP officially recognizes only one EA point of contact responsible for coordinating compensation and RTW (Return to Work) efforts (e.g. the EA ICS (injury compensation specialist) or EA duty station supervisor).

b.     Communicating with EA Nurses. As noted above in 6a(4), the FN should only be communicating directly with the identified EA point of contact. The EA nurse is not recognized as a point of contact for case-related communications, however, the EA nurse can act as an EA resource during RTW conferences. The EA nurse may assist the EA and FN with issues related specifically to the RTW effort and identification of light duty work (as well as identification of any barriers the IW may encounter upon RTW). The FN may recommend to the EA point of contact that the EA nurse be made available to participate in RTW discussions and work site evaluations; however, such RTW discussions and work site evaluations should not be delayed in order to accommodate the EA nurse's schedule.


The agency may monitor the employee's medical care through requests to the employee, or his or her physician, within certain guidelines contained in the FECA's regulations, specifically 20 CFR §10.506. This section says:

"The employer may monitor the employee's medical progress and duty status by obtaining periodic medical reports. Form CA-17 is usually adequate for this purpose. To aid in returning an injured employee to suitable employment, the employer may also contact the employee's physician in writing concerning the work limitations imposed by the effects of the injury and possible job assignments. (However, the employer shall not contact the physician by telephone or through personal visit.) When such contact is made, the employer shall send a copy of any such correspondence to OWCP and the employee, as well as a copy of the physician's response when received. The employer may also contact the employee at reasonable intervals to request periodic medical reports addressing his or her ability to return to work."


The Border Patrol's union has noticed the problem and have written this article:


Related article on OWCP’s Field Nurse program: http://theowcpclassroom.blogspot.com/2011/03/field-nurse.html




owcpslayer@gmail.com

Monday, May 23, 2016

Lenin "Lenny" Perez and AmeriMed Diagnostic Services-Update

See original article at: 
http://theowcpclassroom.blogspot.com/2015/09/lenin-lenny-perez.html 


03/31/2016 Lenin "Lenny" Perez whose company claimed they were advocates for injured federal employees pleaded guilty to conspiracy and receiving illegal remuneration (kickbacks), charges which each carry up to five years in federal prison. 

The amount of the kickbacks exceeded $1,000,000.00 with approximately $250,000.00 paid to his daughter.


Mr. Perez' daughter, Liane Perez-Rodriguez pleaded guilty to making a false statement and faces up to five years in federal prison. By pleading guilty, Ms. Perez-Rodriguez admitted lying to investigators.


Ms. Perez-Rodriguez had a "no-show" job at AmeriMed Diagnostic Services in Florida which according to documents, was created to funnel AmeriMed clinic money to her father, Mr. Perez. 


Ironically, Ms. Perez-Rodriguez's real job was as a legal secretary in the Public Defender's office. 


Lois Luis who helped run AmeriMed also pleaded guilty to conspiracy and receiving illegal remuneration (kickbacks) and also faces up to five years in federal prison for each charge. 


Mary K. Manso, chief executive officer at AmeriMed pleaded guilty to obstructing a health care investigation and also faces up to five years in federal prison. According to her plea agreement, Ms. Manso lied to federal investigators about kickbacks at AmeriMed and helped AmeriMed launder $2,500,000.00 obtained through fraudulent billing practices. 


Department of Justice news release:https://www.justice.gov/usao-mdfl/pr/federal-workers-compensation-kickback-conspirators-plead-guilty-0

10/18/2016: Mr. Perez died at the Pinellas County jail while awaiting sentencing. 




owcpslayer@gmail.com