Tuesday, May 9, 2017

Agency Contractor Improperly Inserting Themselves Into Claims

It has come to my attention that there is a third party contractor called Managed Care Advisors, (MCA) agencies are using to monitor/manage OWCP claims.

MCA employs physicians and nurses that are improperly inserting themselves into claims and contact is being made with your providers (physicians, physical therapists, etc…) in varying ways including by letter. 

I wrote about this issue in a previous article but at that time did not know the contractor was MCA.

The letters I've seen that are being sent to your providers are written not on MCA letterhead, but on what seems to be Homeland Security letterhead so it appears these are official requests by the agencies under DHS. MCA may also be using letterhead of other agencies as well but as of today, I haven't seen those. 

One such letter was sent by an MCA physician to an employee’s physician and completely and totally misrepresented the facts. Let me put it this way, very little of this letter was actually true, most of it is fabricated and is about as unprofessional and outside the bounds of OWCP as I've ever seen. 

The employee had been medically disqualified and retired for some time but MCA's physician stated in the letter to her doctor the employee was "NOT" retired (yes, he used all caps). 

As if that wasn't inappropriate enough, MCA's physician then states, "The American taxpayers are paying for her medical care and salary compensation via federal workers' compensation (FECA)."

It went on to say a "recent" second opinion indicated the employee had "NO residuals" of the accepted injuries, had minimal objective findings on examination and that all the accepted conditions "had resolved". The letter stated the second opinion indicated the employee could "return to her date of injury job without restrictions".

The letter stated the employee's doctor could request a copy of this second opinion from the CE which is completely false as well and alluded that the employee worked for Border Protection when, in fact she worked for another agency. 

It's unknown where MCA's physician got his information since the employee did not have a recent second opinion and is in fact retired. Was he using an old second opinion and stating it was recent or did he just make it all up...we don't know yet.

The letter ended by inappropriately asking the physician to release the employee to return to work and instructed the employee's physician to FAX this release to MCA. It also stated the employee's physician could set up an appointment with MCA's physician to "discuss this case with me" which again is highly inappropriate. 

Had the employee's physician complied or responded without discussing the letter with the employee, this would have resulted in the employee’s compensation and medical benefits being terminated by OWCP, effectively ending her legitimate claim. 

Another letter to an employee's physician from an MCA nurse misrepresented a C.F.R. and the FECA stating this C.F.R. permitted the physician to disclose information under FECA without a release form. This made it appear it would be legal for the provider to release information without a medical release because the employee had a workers' compensation claim.

However, this information isn't true if you actually read the C.F.R.s or the parts of the FECA Manuals that apply.

This letter was an obvious attempt to obtain medical records under false pretenses without the employee's knowledge or authorization and once again, the employee had no idea the letter had been sent. 

I can't say this enough...Your agency and/or contractors like MCA CANNOT attend medical appointments, CANNOT participate in your treatment, CANNOT make treatment recommendations, CANNOT schedule appointments, CANNOT discuss your claim or your injuries with your medical providers and they CANNOT attempt to change your physician’s opinion.

What they are allowed to do is ask your provider about work limitations and possible job assignments…nothing more.

The agency and/or its contractors CANNOT contact your medical providers in person or by telephone.

Your agency or its contractors can contact your providers in writing. If the agency or its contractors is contacting a provider, it MUST be in writing and a copy of the letter MUST be sent to both you and OWCP at the same time it's sent to your provider. If the provier responds, a copy of that response MUST be sent to you.

However, MCA employees are not copying the employee or OWCP so the employee does not know this is happening unless a provider alerts them. As you can see from the cases above, this behavior could be VERY detrimental to you and your claim.

Your providers have no responsibility to respond to ANY agency request for medical information. Even if asked by the agency about your work ability, the provider does not have to respond. Your providers are only obligated to send medical information to OWCP. 

If you have an accepted OWCP claim, I strongly urge you to contact your providers and inquire if they have received a letter or had other contact by either a nurse or physician who appears to be working for the agency. In some cases, they inappropriately represent themselves as OWCP nurses.

I would also urge you to tell anyone else you know who has an OWCP claim. The word needs to get out about this. 

The bottom line is, you have NO obligation to allow the employer's nurse or physician access to you, your claim or your providers. But if they do contact your providers, again...it MUST be in writing and you MUST get a copy of the letter and it can only discuss your work limitations. If they don't adhere to this, they're violating 20 C.F.R. 10.506.

We are working on addressing this issue legally, but need your help. If such a letter has been received by one of your providers, please forward a copy to me at owcpslayer@gmail.com

The more proof we have, the more likely we are to resolve this issue and end MCA's inappropriate actions and involvement in claims.   

In addition, I have created two templates you can cut and paste to protect yourself; one to give to your providers so that your medical documents are not being inadvertently released and the other which you can use if you previously signed an agency medical release and want to revoke that release.

You can find these templates on the How To page: http://theowcpclassroom.blogspot.com/p/letter-templates.html

Related article: http://theowcpclassroom.blogspot.com/2016/05/field-nurse-is-yours-legit.html