502.495.5040

Greed Is Not Good

Jun
13

Greed is not good. Sorry, Gordon Gekko.

 

If you happen to be home watching TV in the middle of a week day, you will be inundated with phone numbers to call for help with your medical claim, car wreck, and of course the dreaded workers’ comp injury. These catchy 1-800 numbers are not law firms or physicians. Rather, they are high pressure boiler rooms that will direct you to a very accommodating medical/legal professional. It’s at this juncture that the referral/finder fees start to churn.

 

I’m linking to a press release from the Riverside County, California District Attorney about a typical scheme that resulted in unnecessary, ineffective and expensive treatments. In a nutshell, the con job went like this:

 

  • Injured workers contacted a benevolent-sounding scheduling company;
  • The schedulers referred claimants to their preferred physicians;
  • The physicians had quotas to fill for medical equipment, imaging and other procedures, and these quotas could only be met from referring to entities owned by the schedulers;
  • Miss your quotas and the referrals would dry up;
  • Make your quotas and the kickbacks would flow.

 

There is nothing new in this flim flam. We have seen it for decades.

 

We know what works to fix this.

 

It starts with controlling your provider network.

 

It ends with comprehensive, evidence-based Utilization Review and treatment guidelines.

 

Fundamentals > The Con.

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, Workers’ Compensation