502.495.5040

Modality Mumbo Jumbo

Jun
28

We talk a lot in these newsletters about the complicated workers’ comp scams that involve cream compounding, prescription repackaging and laboratory testing. But sometimes the most lucrative frauds are the simplest and have been around forever. This latest one from the West Coast involved almost $200 Million in liens filed against workers’ comp carriers and upwards of $70 Million of insurance losses.

 

This DME company acquired “machines” that provide hot and cold modalities for claimants. These machines were effective in alleviating inflammation and even provided pain relief. The DME company would rent-out the machines and then invoice the carrier from $15,000 to $18,000 per patient.

 

Many carriers paid the invoices. However, the insurance companies that refused to pay were hit with liens filed at the Workers’ Comp Appeals Board. The DME company was very aggressive in pursuing and justifying the liens, and many comp carriers just rolled over and paid the bill.

 

Seems that I forgot one thing. The dual-modality “machines” were nothing more than glorified heating pads and ice packs.

 

Sometimes taking a stand and refusing to roll over is the only way to do better.

 

Call us. We can do better.

 

William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Posted in Medical Cost Containment, OMCA