A Doctor, Sued In Insurance Company RICO Suit, Responds To The Charge
Last night I posted about the just-filed Allstate RICO suit, that includes charges that doctors and medical exam companies conspired with Allstate for “independent” sham exams and reports designed cut off treatment for patients. I also had written of a similar suit against State Farm.
Now, one of the defendant doctors responds:
Part of the problem with McGee’s case is that he is under investigation by Allstate, Geico and State Farm for insurance fraud. This was explained to us by the carrier I am on the suit with. They further explained to us that by law they have the right and have exercised the right to freeze his payments since he was not cooperating with the investigation. They felt this is a retaliatory suit. If he felt so strong about his claims why did he not contact the attorney general? (I will answer that)….Because this case is about money….it is a civil case..bottom line dollars and cents.
I would also like to point out that Dr. McGee was on the DD panel for some time also performing IME’s. Personally, I feel that although I am named, I dictate all my reports, one by one verbatim. While they might sound a like and look a like, they are all done by me, my voice recording saved to back this up. As for the fee splitting every IME company in the industry uses the same method for payment.
As someone who performs IMEs I also treat a large amount of patients with private insurance and no fault (unsolicited). I apply my standard of care in my office setting to my IME setting. Over the past 15 years, I have gotten more praise from my patients then one doctor deserves. This is because I think I have always advised them to stay active with walking and swimming. I generally do not recommend physical therapy for more then a few months at a time. I find that staying fit, walking, swimming, home exercise programs and stress management are very useful tools for soft tissue injuries mainly neck pain and back pain. As an electro diagnostic consultant I do refuse to do EMG’s that do not enhance patient care; That was not popular with my partner(s). As an IME provider I have called claim reps over some serious issues. My most memorable being a man with a damaged prosthetic from an accident who on my 2nd IME still did not have it fixed due to the claim rep not approving it. I also have had to send claimants to emergency rooms more then once for possible cellulitis for surgeries a few days prior for injuries alleged to be from the accident I was evaluating them for. It certainly was not the popular thing to do but, first do no harm is the oath I stand by…I had 1 claimant who saw her doctor a day before who reported bowel and bladder issues and then when I examined them they had no rectal tone…I am sure you know what that means-another medical emergency!
I do admit that I do recommend no treatment after about 5 months only if there are no positive findings on physical examination. So many times these claimants are mislead that if they quit there jobs and feign pain that they will get a large amount of money. TO me this just breeds laziness. I would hope at that time there treating physician offers them encouragement, home exercise programs, healthy lifestyle tips etc…So many times I hear that there physician has literally dropped them.
No one has ever, ever, ever, asked me to change an opinion. The allegations of false reports is bogus and coming from John McGee who is famous for owning Bill Mills to me has no merit. Furthermore, on the Allstate summons page 34 paragraph 95 he mentions that the documents to prove this have not yet been discovered. That will not fly in a RICO case. I have already had the case reviewed by a half a dozen attorneys familiar with RICO who all agree that the elements needed for a true RICO case are not there. There needs to be a crime within a crime with hard evidence-not assumptions. This case has no concrete evidence just a bunch of assumptions.
I have a years worth of voice recordings to show my reports are authentically mine and I know that I have never excepted a bribe or for that matter have been offered a bribe, ever. I have done IME’s on claimants who have then asked for me to treat them…..I do admit I make more money from IME’s but time wise I spend more time treating. That is probably due to that fact that I take medicare whose reimbursement for time is about a 1/3 of the time of an IME and my medicare patients all have co morbidities. So I see and treat more patients by a measure of time but dollar for dollar I get paid more per IME. But on top of that I make more money from investments outside of medicine so how much I make in medicine would be moot as money is not the only motivator for doing IME’s in my case.
Also as a doctor who performs IMES, I ironically find that the large IME companies, mainly the ones named in the suit really could care less about if I continue or discontinue treatment. My recommendations have been questioned by smaller companies and not to my surprise I never got work from them again..That is not a problem for me. It might be a flaw in the system but I would not want to work with a company that put me under pressure to change my reports. I would also like to give you my opinion on causality after reading Harvey Goldberg’s testimony. I do very few liability exams so causality is usually not a problem in the no fault sector. There are a few carriers that never ever want it addressed. Then there are companies that always want it addressed. I feel that in No fault causality is really a legal term. That is because I was once deposed and asked how I could feel that a cause and effect relationship existed with no police accident report was reviewed or AOB form. I had based it on the claimants history of the accident. To me when I have to start analyzing the insurance documents…I have left the field of medicine and have entered into the legal arena.
I would never omit a CR statement based on the outcome of an exam but if I was asked to leave it out regardless of my opinion prior to the exam I cannot see the fault in that as a physician. I have been told sometimes to take it out of my report as the directions I was provided with indicate that “causality has already been established” or some other believable statement. To me the most important merits to the report are that my history and physical examination remain my opinion. After that M&S, apportionment and CR can be addressed at any future time since it is based on those elements.
To conclude in my opinion Dr McGee is not going to be credible for so many reasons. Besides for owning so many bill mills, being under investigation himself and also being on IME panels his claims are just not how it is done with these companies. Maybe that was his experience on a panel which makes me question his integrity and intent even more. Of interest, there is a case now involving RICO which involves personal injury attorneys referring claimants to the same doctors over and over….we should all stay tuned for how that one ends……
One more experience I want to share. I was recently asked to testify in a civil courthouse on a bill for a diagnostic test in dispute. To my surprise the insurance carrier produced as a witness the claimant who denied even having the test…It was settled in 20 seconds….I was paid for the day and home before 10 AM!
Was the Dr’s response sent to you directly, or what is its source?
Having never spoken with the witnesses, and having no personal knowledge as to the facts, I’ll withhold judgment.
My only guess is that this won’t go away soon and that there will be a lot of discovery that needs to take place.
But, what I find most amazing is that someone who has never met you, does not know anything about you can just make up blatant lies about you, sue you in a court of law and smear your name. What a great system we have…
I have one point I want to get off my chest. Frivolous lawsuits not only cost money but they hurt families. They take wonderful people and parents and turn them into distant creatures. My husband was wrongfully named along with a bunch of other wonderful practitioners. I cannot wait to the day of vindiction so I can have back the man I married and my children can have there usually fun and cheery daddy back. I wish this as well for all the other named mothers and fathers who were wrongfully named. Stay tough, stay strong!
I have one question for you Eric, if these doctors were guilty do you think you would have such an open forum like this with so many people with so much to say about this? No, because they would have too much to hide.
You are assuming that the alleged charges only apply to these doctors; however, this is the way every IME company pays every doctor on there panels. So is it a problem with these doctors or with the system? That would make every doctor who has ever performed an IME guilty of the same crime…..does common law ring a bell here….
see link to learn more of what McGee is part of….People in the “know” know this is what McGee is about and that is what makes this suit infuriating….
Mr. “Waiting to be served”
In fact, the law states that insurance carriers are allowed to have their claimants examined by a doc of their choice. It is not a crime to render a professional opinion within ones specialty.
As for McGee, anyone with half of a brain knows the reality…how long will you people continue to deny and distort the truth?
Oh, and btw, HIPPA does not even apply to No-fault, WC, etc. I mean for gods sake, how could it…did you not ever see cases with identifying data posted on the net about patients and cases. If you would like I can supply the government webpage where WC, disability, and No-fault cases are specifically considered exempt from confidentiality regulations.
I guess they should add the State of NY to the law suit as well….good night all.
No one has ever responded to a lawsuit with “yeah, you got me.”
90% of the cases were thrown out of court. However, MD’s reputations were tarnished by this clown who was deified in the Fortune article. Slime you State Farm!
Yeah, because that means anything. Are you suggesting that what the article talks about does not occur at all at least to some degree? Denial aint’ just a river in Egypt
I have been saying for years that insurance companies and the doctors that perform IMEs are dishonest.
We always read in the papers that treating doctors/chiros/lawyers are committing fraud by helping people injured in accidents.
Finally someone with guts are going after the big insurance companies.Lets face it 99 percent of my patients who have been sent for an “IME”have been cut off from care.Even people with documented disc herniations.This is a corrupt business.The doctors who perform IMES know that if they give additional care than the IME companies will not use them anymore to do exams.(This is an unwritten rule)
I believe that that the plantiffs will win this case once a jury sees that the ime doctors denied 99.999 percent of the patients they examined and never allowed an EMG,MRI,supplies, etc when conducted a peer review.Its laughable when people on this site say dr mcgee was under investigation by allstate/state farm.EVERY SINGLE doctor who does PI has been investigated by them.I believe these IME doctors should be criminally prosocuted in additon to being sued civil court.
They have the nerve to say they are impartial???
I remember once I was in an accident, and my neck hurt pretty bad – I had a whiplash injury. I never sought treatment or put in any claim – never had any PT, accupuncture, chiro, neuro, PMR, MRI’s, NCV studies, medical supplies, no pain meds, etc. Six (6) days later my neck pain resolved and I felt fine…fancy that…
Patients don’t care if they are cut off because most doctors will treat them for free after the cut off date.So the medical office has to sue the insurance company to get paid which can take 6months to a year.So most people do complain and say”IM in pain and the IME doctor spent 5 minutes with me, how can he cut me off”Also, just because you got in an accident and felt fine after 6 weeks doesnt mean everyone feels that way.You are obviously biased.You basically just said that since you felt fine after 6 weeks than obviously everyone should be fine.Thats ridiculous.YOU KNOW THAT THERE IS AN UNWRITTEN RULE THAT THE IME COMPANIES AND INSURANCE COMPANIES EXPECT YOU TO CUT OFF CLAIMANTS OTHERWISE YOU WILL NOT GET ANYMORE WORK AND YOUR INCOME WILL BE AFFECTED.Doesn’t that affect “your professional opinion”We all know it does, you are not fooling anyone.I would love to get you on the stand in a court room and present 500 of your reports cutting people off and maybe about 10 reports giving people additional care.
As for patients complaining, that is not totally true. A patient can complain and request a different IME or second opinion. That has happened with me where one doctor conducted an exam the claimant did not like, so the lawyer requested a second IME within my specialty, and the carrier ganted it without a problem. Lastly, as for patients that are in continued pain for months after a soft tissue injury is complex and not as simple as you think. I believe there are complex factors at play there and simply blaming the “evil” IME doc is the easy way out.
In response to the last post.I was talking about IME doctors in general.I dont know who you are so I was not commenting on how you practice.
Im assuming you were named in the suit.I agree that some patients are receive too much treatment and testing.The whole system is corrupt in my opinion.
Insurance IME exams Sure,I will
agree that they have the right
to monitor abuse but so many people
are being cutoff who are in need of care
Before I had my exam I was told expect to be cutoff My surgeon told
me they are paid 600 and exam
I was subject to a 2 minute IME exam by a doctor who did not even address my 3 herniated disks and that I was seeing a pain specialist and on constant pain meds
I timed the exam
The final report was clearly a
boilerplate one size fits all fill in the blanks report
Can any of the attorneys explain to
me why an IME doctor can not be sued on a personal basis when the
report is so contrary to the factr
that is a lot of money for an IME. do you know what company set that exam up? Was that for a liability examination or for a no fault case. Who is your insurance carrier that they pay such a premium to do IMEs? Chubb?
report is so contrary to the fact”
Because it is just a professional opinion. The same way that it would be ludicrous to sue a plaintiff doctor solely for an exaggerated opinion regarding a patient’s injuries. Thus, if you could sue the IME doctor for his or her opinion, then it would only be fair that you could sue the plaintiff doctor for his or her opinion.
BTW, I am not an attorney
Also, each of these entities are registered with NYS and have never been closed down as illegal. A physician is not WORKING for ANY IME company. They are sub contracted. So before you begin to state these types of accusations Mr Education Department, perhaps understanding the full parameter of the subject would behoove you.
THE TRUTH of the matter is, most physicians have been asked to reduce their fees BECAUSE there is SO MUCH FRAUD in the industry that a cost containment is required. MOST doctors doing IME exams are not getting a fantastic compensation for it and they still have to pay rent, staff, malpractice, etc.
Regarding the physician who responded, the experience he described is the experience of most physicians. I am sure there are some unscrupulous ones out there (like Dr Smith in the 90′s) however, with the paltry compensation the IME vendors provide for each evaluation, NOBODY is getting rich off of these and certainly has no reason what so ever to make up a negative exam.
IF ANYTHING the opposite would be true. IF ANYTHING, you would see MORE positive evaluations guaranteeing another physical examination because of the low fees if someone were unscrupulous.
Well for starters, any business or service in its entirety is “multimillion.” I mean selling paper clips is a multimillion dollar business – does that make it wrong? As for it being a “racket” – you would need to be more specific – I am assuming it is only a racket in cases in which further patient care is denied. When further treatment is recommended, I guess then it switches to being legitimate.
Not too mention – the only reason there are IME’s is because there is no-fault treatment. They are both inherently correlated. Like in 2003 when all the mills were shut down and docs indicted, since there was less treatment, there were less IME’s. It is not rocket science.
Doing “only IME’s may not be right, but it is not criminal. Just like there are plenty of treating docs that only accept no-fault cases and work in “mills” – who cares? I know I don’t. These are not crimes on either side. That is why ALL attorneys think this case stinks.
“Abrasive docs in garages….” Never met any doc that does IME’s in coverted garages, but I am sure it may have happened. Again, not criminal….lastly, I do not like grouchy people either.
But, so far I have not heard any legitimate “criminal” or “fraudlent” activities.
In all my years in this business I’ve seen a few reports stating there is an injury of any kind. Rarely are any of them related to the accident. Maybe twice have they actually stated it was. Almost never is there future care needed or long term disability. The reports are laughable and completely disregard or misstate facts.
Recently the reports have become accusatory. I believe we are close to lawsuits in our area. These are the ones that disgust me.
What is even more funny is that Rosenberg referenced an article in the NY Times to “support” the frivolous lawsuit with Allstate. Where did he get his law degree from? From a cracker jack box?
Well, as you may have already read, the Sundahl case was dismissed by the judge on 3/31/09. It is PUBLIC RECORD that is how I know. The Allstate case will 100% be dismissed because I know for a fact that every allegation in the suit is false and completely without merit. BR wasted everyone’s time with these “cases”, including the courts, doctors, insurance carriers, and even McGee…it is the attorneys choice to accept or not accept a case.
BR does not have “guts”, as you say…he is a heartless soul that cares only about himself and his selfish motives. What comes around goes around…his day will come…sleep well.
After the dismissal of the Sundhal case with prejudice (which is essentially identical to the Allstate and State Farm cases), how confident are you in that statement a year later?
I haven’t read the decision yet. But assuming that both are dismissed prior to discovery, let me say this:
If it is the only time I am wrong in my career than I’m living a charmed existence.
Then to claim that there is this big RICO conspiracy going on, but to not present a SINGLE shred of factual evidence to back that up…that is someone who is desperate with an ulterior motive -at least that is my impression. Personally, I would not make up lies about anyone and then present that in a public forum, especially in a court or legal setting. In plain Enlgish, it is immoral and unjust.
Then he claims that it is fraudelent to mail an appointment letter to remind the claimant that they have an appointment…what? I mean, as I said earlier, him wasting the time of the courts, doctors, attorneys, etc. is just pathetic and he is the lowest of the low in my opinion.
Anyway, thanks for your input Eric…take care
The State Farm Case involving the IME docs, Carriers, and IME vendors was dismissed today with prejudice by the Federal judge. I have a copy of the order in front of me. Since this case is identical to the Allstate case, one would assume, that the Allstate case will be dismissed next. It is nice to see the justice system actually work. Personally, I feel that there should be a consequence for attorneys that bring frivolous lawsuits to the court systems…my two cents.
What is interesting is that apparently McGee did not want to be deposed because he felt that the information provided in a deposition would result in disciplinary action by a licensing board…hmmm…now why would he NOT want to be deposed? What is McGee afraid of? I know…here is the document:
It was concluded by the Department that “An organization that functions as a mere conduit or intermediary between no-fault insurers and the healthcare professionals performing utilization review is not itself “performing utilization review.” See N.Y. Ins. Law Â§ 4901 (h)-(i) (McKinney 2000); N.Y Pub. Health Law Â§ 4901 8-9 (McKinney 2002). Since the organization is not engaging in the actual utilization review, it is not a utilization review agent and therefore not required to report to the Superintendent of Insurance pursuant to N.Y. Ins. Law Â§ 4901 (McKinney 2000).
N.Y. Ins. Law Â§ 2101(g)(1) (McKinney 2000) defines “independent adjuster” as “any person, firm, association or corporation who, or which, for money, commission or other thing of value, acts on behalf of the insurer in the work of investigating and adjusting claimsâ€¦” It is further noted that, “Past opinions have indicated that the determination of whether the proposed activity constitutes investigating and adjusting claims hinges upon whether discretionary authority is exercised in investigating and adjusting claims rather than simply performing ministerial functions…Since data processing is a ministerial act and the organization will not be engaged in either investigating or adjusting, it will not be acting as an independent adjuster. Therefore licensure pursuant to N.Y. Ins. Law Â§ 2108 (McKinney 2000) is not required.
It is amazing what you can learn from just reading. Maybe if Rosenberg read this, he would not have filed the frivolous lawsuits, but not likely.
The actual document can be found here for those interested:
To make a long story short, I record all my medical sessions with any IME doctor that the insurance carrier send to me (For my own personal record of course). Sure enough, this one doctor reported to the carrier that he had performed numerous examinations, etc during our one session together. None of this was true..I never participated in any exam during the one and only appointment I had with that particular IME doctor..and I have a recording to prove it.
What Im unsure of is what to do next. Should I wait until I actual take my claim to court and wait for him to lie and then bring forth the recording or should I send a copy to the DA’s office and Medical board…?
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