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News - 2017

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

Hippocrates Was a Compounder! (…But He Did No Harm)

Jun
13

CompPharma is a consortium of PBM firms that practice in the workers’ compensation arena.  I’m linking to a new study they just published entitled “Compounds in Comp: A New Look at Patient Safety, Efficacy and Cost.”

 

There is much worth reading in this article including their summary of workers’ comp jurisdictions with limited or no controls on compounding and pricing. You’re probably not surprised that Kentucky, Indiana and West Virginia are three of these locales.

 

While we have our share of disagreements with PBMs, especially as it relates to UR and extent and duration, we agree with the main conclusion of this report:

 

“When FDA-approved medications for the condition are available, the widespread use of topical, non-sterile compounding or sterile compounding cannot be justified.”

 

Call us. We can do better.

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

 

Derby, Preakness & Belmont?

Jun
06

…Not in California.

 

The Triple Crown of fraud was recently shut down by the California Insurance Commissioner along with the Orange County District Attorney. The scheme impacted more than 13,000 patients and 27 insurance carriers with a $40 Million price tag.

 

The Triple Crown of scams involved the following “threefer”:

 

Snake Oil Scam – Non-approved creams costing $15 per tube were billed to workers’ comp carriers for upwards of $700 each. The effects of the creams were unknown, but they came with a $50 per tube physician rebate.

 

Medication Kickback Scam – Oral pain meds were purchased wholesale, re-packaged, with bar codes modified. Carriers were then invoiced at retail. No disclosure was ever given that the prescribing physician and re-packager had a predetermined profit split per script.

 

Bogus Urine Test Scam – The fraudsters were nice enough to supply “urine testers” to the offices of the participating physicians. They ordered lots of tests, even when unnecessary, and then sent them to multiple participating labs for excessive testing.

 

The regulators in California are doing better.

 

At OMCA, we have our own Triple Crown of protocols to minimize unwarranted expenses:

  • Early intervention;
  • Scientific evidence;
  • Ongoing accountability.

 

Call us. We can do better.

 

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

O Canada, We Stand on Guard for Thee

Jun
01

The Canadian National Pain Center just published a white paper listing opioid therapy recommendations for chronic non-cancer pain. Here is my summary:

 

  • Opioid therapy for chronic non-cancer pain? Strong recommendation against.
  • Have an active substance disorder? Strong recommendation against.
  • If you do start opioid therapy? Limit daily dosage to less than 90 mg morphine equivalents.
  • On opioid therapy, but difficulty with tapering? Time for a multidisciplinary program.

 

A wise Irishman once said, “When everyone in the room tells you you’re drunk, it’s time to sit down.”

 

When everyone in the room warns you about the dangers of long-term opioid use, maybe it’s time to pay attention and do better.

 

Call us. We can do better.
William Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

10,000 to 1 Are Poor Odds

May
23

If morphine is a “1” and fentanyl is a “100”, then what is a “10,000”?

 

There is a new synthetic opioid (used as an elephant sedative) that is being laced with heroin, called carfentanil. According to The Washington Post, the equivalent of a few grains of salt can be deadly to drug abusers and unaware first responders. It’s literally 10,000 times more powerful than morphine.

 

The callousness of drug dealers who will push these toxins for a buck is bewildering. The search for the higher-high is unending, and the pushers are willing to accommodate.

 

Labs, coroners and law enforcement are behind the curve on this as the formulas keep changing, and technicians must be hyper-cautious as this drug can be absorbed into the skin or accidentally inhaled as a sample is being opened for testing.

 

Doing better means limiting access to that initial prescription drug high. We in the workers’ comp industry must continue to fight the opioid fight early and often.
Call us. We can do better.

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

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