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Suspicious Activity & Fraud: Workers Comp & More
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Worker's Compensation Fraud: The Real Story details and provides dozens of references to back up their research conclusion that the vast majority of workers' comp fraud is being committed by employers, medical providers, and insurance providers while government devotes almost all its efforts to uncovering claimant fraud. A must read!
The Foundation for Taxpayer & Consumer Rights provides details of numerous cases of HMO's abusing the arbitration process. It is stated, "By law, arbitration requires that each side pay their costs when an HMO is involved, regardless of who wins. By the sheer fact that HMOs have endless financial resources, this makes it a cinch for HMOs to prevail."
A consumer group says insurers wrongly blame their own insured. In what may be the least exposed form of insurer abuse, insurance companies often wrongly determine their own policyholders to be "at-fault" in car accidents in order to boost the premium charged to the policyholder.
Former California Insurance Commissioner Chuck Quackenbush has not been indicted one year after his forced resignation for numerous illegal activities. Taxpayers pay his legal bills. The press now ignores that $100,000's were given to his political bank account just days after he proposed an 18.4% increase in workers' comp rates and other workers' comp related accusations. No insurer has been prosecuted. Visit our library files on Quackenbush here. Dozens of articles on the scandal are here.
Riscorp insurance company founder Bill Griffin received a five-month federal prison sentence in August 1998 for his part in a six-year conspiracy involving 800 illegal political contributions worth nearly $400,000 to 27 political candidates who could help his workers' compensation insurance company. Florida Insurance Commissioner Tom Gallagher received the most in illegal campaign contributions and Katherine Harris (now Florida Secretary of State) received more than $20,000 from Riscorp. [Link 2] [Link 3]
13 things your health insurer doesn't want you to know
There are plenty of things your health insurer doesn't want you to know. Here are just 13 of them. Number 1 is "It is sometimes cheaper to let you die rather than to treat you for a serious condition."
Appeals court upholds federal judge's split decision on HMO lawsuit
The 11th Circuit U.S. Court of Appeals allows some charges to proceed. Doctors can now pursue their Racketeer Influenced and Corrupt Organization (RICO) lawsuit accusing Aetna and its Prudential unit, CIGNA, Foundation, Humana, PacifiCare, United Healthcare, and WellPoint of violating their obligation under federal law to provide necessary medical care. Issues involved include providers concealing business practices such as offering incentives to doctors to limit their patients' medical care.
A pariah when injured
A "company doctor" writes about abuse, denial of treatment, and retribution by employers against workers who file workers' compensation claims.
GOP Leader and two others charged in kickbacks
Three men, including a leader among Chicago Republicans and an arbitrator for the Illinois Industrial Commission faced federal charges that they swindled a Michigan-based company in a kickback scheme involving workers' compensation claims. [Link 2] [Convictions]
Employers, insurers commit fraud by lying, denying benefits
While most workers compensation fraud arrests are workers accused of defrauding insurers, district attorneys in two California counties have charged senior insurance company officials with trying to defraud workers. In each case, the officials are accused of withholding information that could have meant higher benefits.
Widespread fraud: Bogus claim
The Press Democrat reports on how business and government leaders claimed up to 30% worker fraud to get reforms passed nationwide yet when the California Legislature ordered insurers to set up investigative teams and report all suspected fraud to law enforcement, suspicious claims made up less than 1% of the total.
Confessions of an insurance adjuster
He says, "The other day, while visiting a law library, I was alarmed to find that in most states, policy wording is being changed so as to favor the insurance company; the policyholders' technical authority (which few policyholders ever exercise) has been eliminated; and many regulations for insurance companies have been changed in the companies' favor!"
Putting a Premium on Patriotism. Many of the people killed or injured at the World Trade Center and Pentagon were covered by workers comp, but not in Florida. Insurers in seeking a rate increase use the argument that they could have been.
Making a Killing: HMOs and the Threat to Your Health. This scathing exposé presents case histories of those who have lost their health or their lives because an HMO denied or delayed vital treatments, tests or surgery.
Burlington Northern Santa Fe Railway Company conspired with lawyers representing railroad workers hearing-loss claims according to a class-action law suit filed. It says Burlington Northern and Portland Oregon law firm Bricker Zakovics Querin Thompson & Ritchey PC (BZQ), collaborated to create easy settlements with predetermined amounts in exchange for not taking hearing-loss claims to court. The suit alleges that more than 4,000 workers were involved.
State Farm Insurance systematically deprived policyholders of medical benefits by retroactively denying coverage months after the insured filed a claim according to a class-action lawsuit that the Washington State Supreme Court ruled to move forward on.
There were 6,722 patient visits for respiratory illness by workers of the 1989 Exxon Valdez oil spill. A Coast Guard safety officer at the spill states, "Nobody complied with any of the health and safety rules, and everybody turned a blind eye." Lawyers believe the actual number of injuries may be far greater. Exxon and its cleanup contractor, VECO Inc., denied government investigators access to these medical records and NIOSH didn't press its authority to get those records. [see article below]
Erin Brockovich and her boss, California lawyer Ed Masry, have teamed up with Anchorage attorney Michael Schneider to look into reports of health problems among the 15,000 workers who helped clean up Prince William Sound after the 1989 Exxon spill. Thousands of spill workers complained of respiratory problems but were told by employers that they had colds or flu.
Dr. George Wineburgh, a specialist, was fired from his job and ostracized by doctors in two counties after he stood up for sick and dying New York miners whose suffering was being ignored by most of the medical community. He states, "I didn't like it. It smelled. Nobody wanted to stand up for the miners, nobody was being clinically objective. It was like they were under the thumb of the mining company."
People in Libby were dying yet the W.R. Grace Co. didn't stop it. Reports detailing the poisoning were kept from the public and the Industrial Accident Board. Other government regulators assisted in making the evidence "confidential." In internal memos, Grace lawyers say confidentiality protects them from having reports used against them in workers' comp cases. Maryland Casualty of Portland, Or. urged Grace lawyers to prevent the entry of the "confidential" state inspection reports into evidence in a workers' compensation case.
The now abandoned mine that caused the deaths and illnesses of hundreds of miners and their families in Libby, Montana has been bought again by its longtime owner, W.R. Grace & Co. Immediately after the purchase, Grace banned Environmental Protection Agency investigators from the asbestos-contaminated site. [Link 2]
California's Workers' Compensation Anti-Fraud Program is detailed in this report by Del Information Services. The program is funded by employer contributions and insurance companies control the money released to district attorney's thoughout the state. The report details how fraud committed by insurers has been ignored by prosecutors.
A Report on the Workers' Compensation Anti-Fraud Program by the California Commission on Health and Safety and Workers' Compensation makes statements contrary to findings found elsewhere in links from this page but its concluding recommendations are strongly directed at preventing employers and insurers from committing fraud against workers.

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