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Monday, August 13, 2018

OWCP Codes

A list of OWCP codes can be found here:

https://www.dol.gov/owcp/dfec/regs/compliance/dfecdd/CMFDataDictionary20091211.html


Sunday, July 15, 2018

Bad Information Abounds

Today, I stumbled on a July 2018 article on a blog written by a law firm that claims they have been assisting injured federal employees since 1994.

The article was about OWCP's field nurses and after reading it, I came away shocked and have been shaking my head ever since. 

According to this law firm, that claims they handle OWCP claims and have been doing so for 24 years, a claimant should be as cooperative as possible with an OWCP field nurse.

The article says:


"First, it is important that you remain calm and concede to have a nurse attached to your OWCP federal workers’ compensation case. This is because refusal would look like you are being uncooperative which might make FECA cut off or reduce your payouts. As such, you should speak to the attending nurse and accept their requests to attend your doctor’s visits. However, resist the urge to tell them about your condition should they ask you; this is because they are not on your side and may just be looking for a loophole or piece of information to influence OWCP’s decision to take you off compensation. Your answers should be ‘yes’ or ‘no’, and should always refer them to your physician the minute they start asking convoluted medical questions."

The article goes on to say:

"...it’s in your best interests to be as cooperative as you can without being verbose to avoid sabotaging your compensation."

And of course the article ends by saying call us.

I'm having heart palpitations reading this article. 

First, FECA doesn't cut off your benefits. FECA is the law, the Act under which OWCP benefits are paid. 

Second, the OWCP field nurse program is VOLUNTARY. You DO NOT have to "concede" to have an OWCP field nurse attached to your claim and you don't have to be cooperative.

How do I know this? It's in part three of the FECA Manual, which anyone can find at 3-0201-6(c)(5): 

"Although the intervention program is voluntary, participation should be strongly encouraged."   

Third, OWCP CANNOT reduce or suspend your benefits if you are "uncooperative" with their field nurse. That's the vocational rehabilitation process, not the field nurse program. 

Being "uncooperative" doesn't "sabotage" your claim because the field nurse program is VOLUNTARY. 

Time after time, the ECAB has stated:

The regulations do not equate the assignment of an OWCP nurse with vocational rehabilitation. 

Here's an ECAB decision that lays this out:  

https://www.dol.gov/ecab/decisions/2006/Dec/06-0777.htm

This case sums up the error of reducing or suspending benefits stating:

"Appellant's refusal to cooperate with the nurse intervention program does not constitute a failure or refusal to cooperate with the early or necessary stages of vocational rehabilitation under section 8113 of the Act. The Office's application of section 8113 to reduce appellant's monetary compensation to zero was in error. Consequently, it did not meet its burden of proof in reducing appellant's monetary compensation benefits."

Forth, you DO NOT have to allow a field nurse to attend your medical appointments and you DO NOT have to allow a field nurse access to your doctor or refer them to your doctor if they ask medical questions. Why? Because the field nurse is VOLUNTARY.

I know physicians who handle OWCP claimants and when an OWCP nurse walks into their office, the doctor or the staff tells them to get out and never return because these physicians know the damage an OWCP nurse can do to a claim.

It's bad enough that claimants are subjected to inaccurate information from OWCP and by their employer, but to have a law firm that doesn't even know the basics out there drumming up claimants to hire them is truly concerning to me. 

I'm sure this law firm has no problem taking a fat retainer from a claimant and also charging them an hourly fee and yet they believe you must cooperate with a field nurse or risk "sabotaging" your claim or risk your compensation being "cut off" or reduced. 

Claimants aren't expected to know all the rules and regulations in OWCPland, but if an 'expert' is taking your money, it's their job to know. 

In my opinion, this article, which was just written, gives extremely bad advice that could damage your claim much more than if you didn't allow OWCP's nurse on your claim. 

For instance, if OWCP's nurse is allowed access to your doctor and tells your doctor something that isn't true and this results in a change in your treatment or status, or bullies your doctor into releasing you back to work when you're clearly not ready for that, that's much more damaging than OWCP getting cranky because you know the field nurse program is voluntary and you don't choose to cooperate. 

If this law firm doesn't know that, what else don't they know? 

I've said it time and time again, be careful who you hire. 

Just because someone says they know what they're doing, it doesn't make it true and this article shows that a law firm that claims they've been dealing with OWCP claims for almost a quarter of a century doesn't even know the field nurse program is voluntary. 






Monday, May 14, 2018

OWCP-Washington, D.C.


I have returned from my whirlwind Washington trip where I spent four days talking about OWCP and changes that could be made to help claimants.

I concentrated on changes that I believe would be effective, but avoided talking about ‘reform’ which is a scary and daunting thought to most people and let’s face it, reform probably wouldn't work anyway.

My theory is OWCP doesn’t follow its own regulations now, so even with the best reform in the world, unless OWCP followed those new regulations, the same adversarial system would exist.

So instead I discussed changes I believe would help level the playing field and give claimants a chance against the system. Since time is limited when meeting with a Senator or staff member (sometimes only a few minutes), I started with what I believe would make the most difference to claimants.

The three things I believe would make a difference are:

1)   Putting a cap on what OWCP physicians can receive for an exam. In my opinion, this takes away the financial incentive to provide a report against a claimant and would eliminate some of the biased doctors who are only in it for the money.

When these biased doctors leave because they can’t get millions a year, it also forces OWCP to bring in new doctors who may not be as biased.

If nothing else, this would save the American taxpayers millions of wasted dollars a year.

2)   Allowing every OWCP-directed exam to be recorded by the claimant.

This would provide the claimant with proof of what did or did not happen in the exam, what exam was or was not performed and give a claimant proof should OWCP use a negative report against a claimant giving the claimant a leg to stand on.

3)   Update the FECA manuals to specifically explain ‘Medical Rationale’.

It is obvious that the medical community and OWCP have differing opinions of what medical rationale is. OWCP only says it’s a “reasoned” or “rationalized” medical opinion.

But when a claimant’s physician includes a “reasoned” or “rationalized” medical opinion, OWCP still denies a claim due to a lack of medical rationale without explaining what the doctor didn’t provide.

I discussed that OWCP should have to update the FECA manuals to specifically explain what they consider to be medical rationale and provide one example of what they would accept as medical rationale and one example of what they will not accept as medical rationale.

This way a claimant can provide their physician with this section of the FECA manual and the physician can provide exactly what OWCP requires. This would lessen the need to repeatedly go to a physician for another report (and another and another) and significantly shorten the acceptance process ending the need for multiple appeals.

As a side effect, this change may bring more physicians willing to take an OWCP patient because they’ll know exactly what OWCP needs from them.

I spoke with three Senators and more staff members than I can count and also pitched these same ideas to NARFE's vice president of advocacy. 

Obviously not everyone was interested in what I had to say, but I am encouraged that there were several that did listen, took notes, asked questions and seemed interested in what I was saying.

Since it is the staff members who will be able to bring these issues to the Senators and/or Congresspeople, I will follow-up with those that were interested and hopefully form relationships with them and with a little luck, these changes will be made and that will help claimants fight against a system that seems so set against them. 

While I don't expect things to change overnight, I am hopeful that I can forge relationships and get the right people interested in making these simple, yet important changes.

I will continue the fight.

*A huge thank you to Mark who made my Washington meetings possible. I couldn't have done it without him and am forever grateful for his time and infinite wisdom.


Thursday, March 29, 2018

NRP-BEWARE Of USPS Letter

Yesterday, a client contacted me about a letter she received from the USPS in regard to the NRP settlement.

This letter states in part:

"During the course of this case, it came to light that certain individuals were never assessed under the National Reassessment Process. In AJ Stilp's Order, she held that individuals who were not subject to the National Reassessment Process do not fall within the class definition in the above-referenced case and are not class members. If you are receiving this Notice, you are one of the individuals who has be found to not meet the definition of class membership in the above-referenced case.

YOU ARE HEREBY NOTIFIED that you are not a member of the class in the above-referenced case."

The problem is, my client was assessed under NRP.

My client received this letter and believed it. She believed she was being notified she was not a member of the class because the USPS had determined she wasn't assessed under NRP.

Luckily, my client contacted the law firm handling the case and told them about this letter and she was told that her name WAS on the list of individuals who are part of the class and she needed to file her claim paperwork.

Had she not followed up, she might have continued to believe she was not part of the Class Action and could have missed the April 12, 2018 deadline for filing her paperwork.

If you've received this letter, make sure it's accurate and not the USPS' way of lower the number of members of the class by sending bogus letters to employees telling them they aren't part of the Class Action.

Here's a copy of the letter:



Monday, March 26, 2018

NRP Class Action Settled

To any postal employee affected by the USPS' National Reassessment Process, otherwise known as NRP, the class action has finally been settled.

After 12 long years, the EEOC's final decision found in favor of the employees, finding that the USPS discriminated against injured employees. The final decision finds that the USPS targeted these employees by canceling jobs that accommodated their restrictions, created a hostile work environment, improperly used their private medical information and forced some injured employees to resign.

Claims for monetary awards are due NOW. The deadline for individual Class members is 30 days from the date when you receive written notice about the case.

Since the USPS could 'accidentally' fail to notify Class members, it is being suggest that you submit a claim by April 12, 2018 to be safe.

Failure to submit a claim may result in loss of individual relief.

Information on how to file claims can be found here: http://nrpclassaction.com/

Here is the final version of the Class Action: http://nrpclassaction.com/files/pdfs/decision-on-request-for-reconsideration-03-09-18.pdf

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:

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!