The Texas Tribune’s Elise Hu has found that the Texas Department of Insurance’s Division of Workers’ Compensation has more than its share of dirty laundry, much of which is finally starting to see the light of day. The division is in charge of sanctioning physicians who are defrauding the state’s worker’s comp system by overbilling and overtreating patients. A recent spate of firings and resignations, along with a review by the Texas Sunset Advisory Commission, have helped illuminate just how dysfunctional the whole thing has become.
The crux of the matter: Staff recommended sanctions against almost 70 physicians, Hu wrote, “Yet since 2005, division records show, the state has sanctioned just five doctors with removal from the workers’ comp system — and only in cases involving paperwork violations rather than harm to patients.”
The broken enforcement system, the former employees say, stems from [Commissioner Rod Bordelon]’s insistence on putting the due process rights of accused doctors ahead of the rights of their allegedly abused patients. That misplaced focus, the employees believe, results in part from political pressure on Bordelon.
Hu discovered that the cases that were unceremoniously shuttered by Bordelon involved millions and millions of dollars in workers’ comp claims, and that the system didn’t have sufficient safeguards against abuse.
Lockhart, Watts, Nemeth and Ford (the employees who either resigned or were terminated) say they left with great disappointment at the lack of enforcement. “You can make a lot of money if you’re a doctor practicing in the workers’ comp system, if you are so inclined,” Ford says. “If you’re dishonest, or if you learn how to game a system, there’s lots of money — I mean, millions of dollars to be made.” The agency document that details investigations into the nine doctors showed that, during the one-to-two year monitoring period, seven of them billed insurers more than $1 million, two billed more than $2 million, and one billed $3.2 million.
It’s a convoluted story heavy with details and angry quotes, but if you’re just looking for a summary of how the terminated employees feel, this seems to be a pretty good one:
“[The office’s] focus since late 2005 has been to protect wealthy doctors who have learned how to game the system and take advantage of injured claimants,” Ford says. “The motives for this protection are open to speculation. Money, political pressure, and career advancement are at the top of the list.”