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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:

http://www.mysanantonio.com/news/local/article/Operator-of-physical-therapy-clinics-indicted-12266974.php

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:

https://www.insurancejournal.com/news/southcentral/2017/11/13/471015.htm

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:

http://nlpc.org/2016/10/18/texas-chiropractor-sentenced-workers-compensation-scam/

https://www.justice.gov/usao-wdtx/pr/union-treatment-center-pay-3-million-and-be-permanently-excluded-federal-health-care

https://www.justice.gov/usao-wdtx/pr/vidor-tx-pharmacist-pleads-guilty-role-health-care-fraud-scheme

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:

https://www.justice.gov/usao-ndtx/pr/28-charged-95-million-fraudulent-billing-health-care-fraud-scheme-siphon-and-steal

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:

https://www.justice.gov/usao-wdok/pr/oklahoma-medical-clinics-pays-25-million-settle-allegations-false-claims-medical

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:

https://www.justice.gov/usao-ndtx/pr/executives-surgeons-physicians-and-others-affiliated-forest-park-medical-center-fpmc

https://www.justice.gov/usao-ndtx/pr/anesthesiologist-and-forest-park-medical-center-founder-pleads-guilty-40-million

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!














2 comments:

  1. Question for you, Jesse. I have an “approved claim”, original doctor ultimately told me to “find a different career.” I sought a second opinion on my own. This doctor has recommended surgery. Request has been denied by the “DME”. Reconsideration has been sent with supporting documents. My question is or rather statement; the “DME” report says, “ultimately the treatment is up to the treating physician.” But yet the surgery is denied.
    Also, I have been on LWOP for a different reason, once surgery hopefully is approved, can I submit for compensation?
    Thank you in advance for your time.

    ReplyDelete
  2. The statement by the DME (DMA) would be an argument to make as it's contradictory. On the one hand the doctor is saying the surgery isn't necessary and on the other hand the doctor is saying it's up to the treating physician.

    OWCP's physicians, including their DMA's have the same requirements for their reports as a claimant's doctor. They must provide the medical rationale for their opinions, the opinions must not be contradictory, etc...

    If there is disability due to the accepted conditions, then you can request compensation.

    ReplyDelete