Know who you invite into your circle of trust.

Earlier this month, I wrote a post on an all too familiar topic promoting awareness in unethical practices, devious schemes, deceptive proposals and dubious characters. Some of whom may be lurking closer than we think. So you guessed it, I’m writing another one, considering how we seem to be reading about it weekly. We see it nationwide and it happens to cross many different genres of business. I’ll try to keep it short and to the point.

In all truth, I am afraid and angry about this type of “monster”, if you will, that seems to wrap it’s tentacles within OUR workers compensation community rather consistently! 

This affects the honest, hard working and passion filled providers of service, leaving a wake of uncertainty left for the injured to make sense of. 

It disrupts our lobbying efforts and our pursuit to protect the rights of the injured, continuously adding mountains of additional work with red tape we have to process, follow and hope to get paid for. I’m saddened by humanity and how savage business can be.  We have to constantly keep our guard up and be ahead of the curve. 

In reference to the ongoing fraud saga that emanated in San Diego, stretched as far north as LA County and has resulted thus far with the conviction of a pair of dubious players, among several others who danced with the devil in Operation Backlash; From what I last recall, there were 20 something defendants who comprised and looped business within their best interests and their own circle of trust.  This scheme was comprised of a pretty plain and simple network of ancillary medical services all webbed together so that a potential candidate, or in this instance a patient, can plinko down their stairwell of services and collect, or create a lien, at every stop of the way. Stark Law and Safe Harbor suggest that this racket is a “No No”, not to mention the pure unethical nature of it all. So within this honeycomb network, there are some creative pop-ups known as “shell companies.” Shell companies are just that, a facade, a front, a fake aimed to depict something it really isn’t. One with a purpose. That purpose being to accumulate riches by way of stepping on the weak and stepping over compliance, regulation and law. Their main motive is to position themselves in every possible sector, to milk the system and create a hefty return; a fraudulent hefty return at that!

So within this scheme you need to fuel the fire, and the main focus is to generate patient flow. Some are represented and some are not, some have been guerilla marketed at swap meets, church or the even the market. There are glorious bill boards and print marketing that suggest being able to obtain thousands of dollars in compensation. Some stories I’ve heard also suggest that “recruiters” sit in the lobby of industrial occupational clinics and try to persuade potential injured workers with money and promises of receiving better disability and stronger settlements. These same “scouts” work within the community and funnel the weak into a hopper, which distributes them into their network of ancillary services later to be collected on for numerous forms of treatment which in turn carry a value. This value turns into a book of business in the form of liens and the cycle repeats itself. Be aware of these pop ups or what I call “Jacks-of-All-Trades and Masters-of-None”. They swing from one service point to another and like a chameleon, they camouflage themselves behind fake smiles and incentivized friendships. Snakes in tall grass my friends, be careful and be at the ready to sever ties once you get an inclination, or support, backing what you thought couldn’t be true. We are here together, so together we must stand to help expose and oust some of these entities and people. 
In closing, I still have hope for a better tomorrow. We have a State that has already implemented an annual $100+ Million Workers’ Compensation Anti Fraud Budget which is staying very busy in pinning indictments on these slippery fish. There have been plenty collected over the last 3 to 4 years and it costs quite a bit of money to go up against their fat pockets and litigate arguments. 

Last but not least, there is consideration in having the DWC create an Anti Fraud Unit, one that lawmakers convened over yesterday. An amendment was made to Assembly Bill 1697 reflecting such a possibility. I personally approve of this measure. It’s time to clean up the Work Comp community and we have some good momentum to do so. 

As always, I thank you all for your support, motivation and confidence. Wishing you all a healthy future and a better tomorrow.  

Side note: I was happy to see some of you Tuesday evening during a panel discussion I was fortunate to be a part of. If you missed it, I may do a short piece on SIF and some of the strategic gems we passed along. 
Until then, have a fantastic close to your work week. 

– Laura M Wilson