Archive for the ‘Insurance Industry’ Category

New York Doctors Rally In Albany for Tort "Reform"

New York’s doctors, led by the state Medical Society, rallied last week for tort “reform,” blaming lawsuits for the increase in insurance premiums. According to a medical society press release, 1,500 physicians traveled to Albany last Tuesday to protest on the steps of the State Capitol. The issue they brought to the legislators was high medical malpractice premiums, which I reported last July jumped 14% (see: Why New York Medical Malpractice Insurance Jumped 14%).

As you can see from that link (You did read that link, didn’t you? I hope so because it’s important), the jump was related to artificially low rates set by the New York Insurance Department for years combined with the state swiping almost $700M from the rainy day fund.

But when the doctors rallied in Albany, it was injured patients that were their targets. In a surreal moment, Dr. Robert Goldberg, the head of the Medical Society, offered up in a press release this humdinger of Doublespeak:

Physicians firmly believe that patients who truly suffer injury due to medical error should be fully reimbursed for economic damages, but non-economic awards must be reined in and the litigation process must be made equitable.

In other words, caps on lawsuits must be imposed on the most badly injured individuals because it would be inequitable to fully compensate them. Equity, it appears, demands giving some level of protectionism to the person that caused the injury. George Orwell would certainly be proud.

One of the reasons this bit of propaganda is important is because payments to the injured had nothing to do with the rate hike. In fact, both the number of malpractice case and the amount of payments made have been relatively flat nationwide since 1991.

And the nationwide trend does not differ in New York. In November 2007, Public Citizen put out a report (that I discussed previously here: Will NY Doctors Be Hit With $50,000 Surcharge?) that reached these conclusions, among many others:

  • There have been fewer medical malpractice payments in the past five years than in any five-year period on record;
  • Amounts paid out, when adjusted for inflation and population, have either risen slightly in the past five years or declined slightly, depending on the measure used;
  • Only about 1 percent of New York’s doctors are enrolled in the state’s program for physicians deemed too risky by commercial insurance providers. Yet these doctors’ payments have been so massive that they and other losses have drowned the program in more than $500 million in red ink this decade;
  • A sliver of doctors are responsible for nearly half of the dollars paid out for medical malpractice in New York. Physicians who made three or more malpractice payments between 1990 and 2006 — accounting for no more than 4 percent of New York’s doctors — were responsible for nearly half (49.6 percent) of medical malpractice dollars paid out on behalf of doctors in the time period.
  • Costs for cases involving brain damage, blamed by some for rising insurance rates, are in fact modest in comparison with other types of cases. The category for injuries including brain damage ranks 5th of 10 in total amounts paid out. This fact exposes the lunacy of the radical proposal to deprive newborn babies of their legal rights and cede their care to a state-run fund.
  • Researchers have found that premiums consistently make up only a small percentage of doctors’ total expenses and that rising premiums have not, historically, depressed physicians’ incomes.

Has any of this stopped the doctor’s lobby from claiming that hitting victims a second time, by depriving them of a right to fully recovery, will help? Of course not. The only real questions are these:

——————–
Full disclosure: I have lobbied New York’s legislators several times in the past to keep the courthouse doors open for the injured, and am currently scheduled for a return visit in May with the New York State Trial Lawyers Association.
——————–

Addendum – see also:

  • Patient Safety Express (The PopTort):
    “Only 4% of New York’s doctors are responsible for half of all of the state’s medical malpractice payouts. How many more people have to be infected by deadly diseases, or killed by incompetent practitioners before the state will act?”

  • Patient Safety Express, Day Two (The PopTort):
    This morning, the “Patient Safety Express” made its way to Albany. The 15-foot syringe and handful more medical malpractice survivors made it through the metal detectors at the State Capitol to tell their stories to the media….

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:

——————————————————————————

By Anonymous

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!

Comments:

Eric,

Was the Dr’s response sent to you directly, or what is its source?

# posted by Anonymous Joe D’Addario : March 03, 2008 10:24 AM

Guest blogs that have appeared here, including this one, have been sent to me directly.

# posted by Blogger Eric Turkewitz : March 03, 2008 10:27 AM

He should have asked his lawyers whether or not making a statement on the interweb is a good idea.

# posted by Blogger . : March 03, 2008 6:13 PM

I verified this doctors claim that Dr. Mcgee is under investigation. According to State Farm at 1981 Marcus Avenue, SIU, this is true. I called DD and spoke to an older woman who admitted McGee was on ther panel a long time ago but did not know to the extent he did exams and offered no further information. Thank you dotor for shedding light on this matter. May the judge see the transparency of this case and absolve the pawns swiftly. I have never heard of Bruce Rosenberg and after reading the allegations I am not sure you doctors are the target of this cat and mouse game. This seems to be some kind of extortion for you hard working stiffs to finance his upcoming legal bill with State Farm et al. Has anyone tried to settle with him? I am sure 5K can “buy” you out of this mess.

# posted by Anonymous Anonymous : March 06, 2008 4:37 AM

It is a sad day for our legal system when the crooks get to call the shots..I am familiar with McGee and he is the one who should be the defendant – “State Farm vs McGee”. It is absurd to see those doctors who have been my witnesses and very good ones named as defendants strictly for a “shake down”. Does anyone know if State Farm indemnified them or are they paying up the %#$%^ to defend this matter? I hope the judge gives it to Plaintiffs counsel for wasting time bringing this case forward. Did anyone even read the summons? He is suing the acupuncturists for performings IMEs on claimants because the term is deemed Independent “medical” exam and they do not have medical degrees. Unless I read that wrong….Eric, please let me know if I am crazy or is this summons filled with manure…
NYNFattorney

# posted by Anonymous Anonymous : March 06, 2008 2:48 PM

why are such upstanding citizens anonymous. Could they be PR reps for the carriers.

# posted by Anonymous Anonymous : March 06, 2008 8:25 PM

please let me know if I am crazy or is this summons filled with manure…

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.

# posted by Blogger Eric Turkewitz : March 06, 2008 8:49 PM

I have been reading this blog and have been hesitant to post. I was named in the suit. All I can say is that there is not even a grain of truth to any of the allegations. I am an honest and ethical doctor and would never in a million years deny someone treatment in some alleged, purported scheme. It simply does not happen at all. There is nothing to “discover.” I regularly recommend coninued care and treatment.

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…

# posted by Anonymous Anonymous : March 06, 2008 9:22 PM

i am named in the suit as well and have been hesitiant to post.If discovery were not so burdensome in cost I would welcome them to come and take want they need from my office to vindicate myself. But given the cost I can only hope this goes away soon or I will be mortgaging my house to finance this BS. Eric, would it be more appropriate for claimants who have been denied care to bring a case forward for no coverage vs. a doctor alleging he could not make a living b/c he was denied 3rd party benefits? I have never examined one of his patients that NEVER had an EMG or 3 MRIs. How about the patients that say they are going to therapy because they were told “they had to go”. I sure that was a slip of the tongue… How can a 3rd party have the right to bring this case foward? BOTTOM LINE-there is nothing to discover…anyone who knows McGee’s work “Slimy McGee” knows that truth. But I guess eric, since you are not privy to that and you have never met his patients you could not understand how grossly injustice this is. You have also never met the doctors but knowing about half of them they are some of the squeakiest clean practicing gentlemen and women I have known. I know firsthand that Drs Cole and Wendy Cohen and Isaac Cohen are excellent practitioners as well and also well known for there high standard of care…Isaac Cohen, I thnk just started doing IMEs 3 months ago…explain how he was involved in this conspiracy since 1998. Eric Baron and Joseph Cole were probably still in training when McGee thinks this charade began…They cant be more then 35 years old. Many of the allegations just do not make sense. Bottomline, you just do not know McGee to understand the irony in this case. FYI-I have not even been served yet so maybe this will be resolved with the SF named docs before I even lay out a dime…

# posted by Anonymous Anonymous : March 07, 2008 7:05 AM

I have just started following this blog as well as a wife of a named defendant. I am sure a few readers know who I am and I request that you do not invade my request for using the anonymous feature.

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.

# posted by Anonymous Anonymous : March 07, 2008 7:33 AM

Peter Stark, NYS health and education law. It is sad that so many “good” doctors have not given the required attention to their business and professional conduct rules and responsibilities. Don’t these “good” doctors know that they are not allowed to work for non professionals, Split or share fees with anyone other than equally licensed professionals, disclose Doctor patient HIPPA information or not follow NYS and Federal law with regard to charges for services rendered. I can’t recall the cliche about lying down with dogs or something about stones and glass houses. If you all haven’t realized it by now their is a new Sheriff in town for professionals and it’s name is COMPLIANCE. All are supposed to be equal on the scales of justice. JUSTICE IS BLIND.

# posted by Anonymous Anonymous : March 08, 2008 11:18 PM

Peter,
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….

# posted by Anonymous Anonymous : March 09, 2008 11:06 AM

Only the healthcare professionals, “IME” co’s and the insurance industry can answer the question posed. Why should healthcare service providers that care for injured citizens be held to a different standard. They have families too. So far it appears that it is “slimy” to use skills to help real people than cater to the industry that bailed out on the people hurt by “Katrina” taking record profits and bonuses while at the same time shedding risk by cancelling homeowner contracts because the risk is too great.

# posted by Anonymous Anonymous : March 09, 2008 3:07 PM

http://money.cnn.com/magazines/fortune/fortune_archive/2003/12/08/355094/index.htm

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”

# posted by Anonymous Anonymous : March 09, 2008 4:25 PM

I did not see any mention of McGee in that four year old Fortune article.

# posted by Blogger Eric Turkewitz : March 09, 2008 5:24 PM

Reading blog today…becoming laughable. The bottom line is this, this has nothing to do with Katrina, HIPPA, etc. It is a specific claim that IME docs named and the IME companies and Insurance companies are in some “scheme.” Utter nonsense. People, it does not occur or exist…it is as simple as that. That is why the case will eventually be tossed out with all of the other frivolous, nonsensical law suits filed everyday in this country.

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.

# posted by Anonymous Anonymous : March 09, 2008 5:37 PM

I think what he was trying to say with the article reference was that anyone that knows “of McGee”, knows that these are the types of things he is engaged in, which I would assume is why all the major carriers are investigating him and had froze all payments to him for lack of compliance with the investigation.

# posted by Anonymous Anonymous : March 09, 2008 5:51 PM

One last comment for me…about this issue that the IME companies engage in fee splitting with doctors. One thing that confuses me is why then does the State of New York fully acknowledge the existence and legitimacy of these IME companies at the NYS WC Board website in which the state requires such entities to register with the State of New York:
www.wcb.state.ny.us/content/main/imedocs/ime_entity.pdf

I guess they should add the State of NY to the law suit as well….good night all.

# posted by Anonymous Anonymous : March 09, 2008 7:54 PM

Kind of like how Florida wouldn’t let Allstate write ANY new policies based on Allstate’s failure to cooperate with Florida’s investigation.

No one has ever responded to a lawsuit with “yeah, you got me.”

# posted by Blogger . : March 09, 2008 7:59 PM

Actually, that may not be true. I think that dry cleaner openly acknowledged losing that guys pants, but I think they just felt that 10 million for a pair of slacks was just a bit too high. Finally, after all of these years, I get the joke, what do you call 100 attorneys at the bottom of the ocean?

# posted by Anonymous Anonymous : March 09, 2008 10:27 PM

BTW, Eric thanks for letting me post my sarcastic attorney joke. In fact, I actually like most attorneys…just thought I would let you know that.

# posted by Anonymous Anonymous : March 09, 2008 10:55 PM

In reference to the Fortune article, in case you don’t know or remember State Farm conspired with Pete Smith then Assistant Atty General of Suffolk (who has since long ago resigned due to this fiasco)to indict over 500 MD’s, and clinics that had anything to do with NF.
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!

# posted by Anonymous Anonymous : March 09, 2008 11:50 PM

hey, even my 6 year old knows the answer to that joke….

# posted by Anonymous Anonymous : March 10, 2008 5:13 AM

“90% of the cases were thrown out of court”

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

# posted by Anonymous Anonymous : March 10, 2008 8:33 AM

I am a Dr with a practice focused on treating people injured in automobile accidents.
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???

# posted by Blogger todd : March 11, 2008 9:04 PM

Well, Todd you read that in the paper because it is true….As for your assessment of IME docs, that is your opinion. But, remember in this case, there is an allegation that there is an overt conspiracy between insurance companies and IME docs, etc. That does not occur at all, which is why the case has no merit. An IME is nothing more than a professional opinion. As for myself, I regularly recommend continued treatment and have not been “cut off” from performing IME’s, as you claim. What is amazing is that, McGee is complaining about this, but where are the claimants complaining that they have been cut-off? Could it be that the patients don’t care? I have been conducting IME’s on a part-time basis for many years. I can recall only one complaint letter from a claimant for discontinuing treatment – hey not a bad track record.

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…

# posted by Anonymous Anonymous : March 12, 2008 7:59 AM

IN response to the last comment.
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.

# posted by Blogger todd : March 12, 2008 11:49 AM

Todd, nothing you say at least as it pertains to me, is true. For starters, I felt perfectly fine after 6 days, not 6 weeks. Obviously, that is not typical, I was merely pointing out that some patients are just a bit “overtreated.” Do you think that patients are not ever overtreated or overtested? I also never heard of your “unwritten” rule either. I have been conducting IME’s for many, many years and have recommended continued treatment in literally hundreds and hundreds of cases. You are just like McGee, you know nothing about me, never met me, and know nothing of my practices. Yet, you pass judgment. But, I guess you are entitled to your opnion. But, remember, in this legal suit, McGee is alleging RICO, which is an allegation of criminal activity and conspiracy…do you honestly believe that this is true? I know the answer, there is not even a singe grain of truth to it at all.

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.

# posted by Anonymous Anonymous : March 14, 2008 7:49 AM

Todd, an “unwritten rule” does not constitute conspiracy. In a court of law there needs to be evidence. Especially in a RICO suit. There is a very high burden of proof on plaintiffs side to prove this conspiracy theory. Without any proof the most there is in this case is a bias and there is no law broken. furthermore, i refer you to read the posting on this site called NY’s no Fault law problems with “serious injuries” it is in the March 2008 archives.

# posted by Anonymous Anonymous : March 14, 2008 11:15 AM

Hmm,
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.

# posted by Anonymous Anonymous : March 14, 2008 2:25 PM

How can anyone with a clear conscience try and defend the
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

# posted by Blogger karl : March 17, 2008 5:55 PM

Karl
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?

# posted by Anonymous Anonymous : March 20, 2008 12:00 PM

“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 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

# posted by Anonymous Anonymous : March 22, 2008 7:53 AM

Who ever the attorneys involed in the case HURRAY for you. I am an educated professional who was an innocent passenger — If someone has cervical herinations pressing into the spinal cord would you push down their head as hard as you could? THE MEASLY settlement I will proably get out of this case isn’t enough for the pain and humilation I have suffered at these IME’s. If you are a neurologist would you mock a patient with speech and lanuage problems whom is already in anguish about it? Would you grab a person leg with lower lumbar disc’s herination and pull it as high and fast as you could. OH IS JUST TO SEE IF THE MRI WERE RIGHT or is this for your AMUSEMENT! What goes around comes.

# posted by Anonymous Anonymous : March 26, 2008 8:16 PM

You had a “bad” IME, so now you support a systematic and frivolous law suit filled with lies? Whatever happened to “Two wrongs don’t make a right?”

# posted by Anonymous Anonymous : March 26, 2008 11:07 PM

TO TWO WRONGS DO NOT MAKE A RIGHT try 4 out 5 IME DOCTORS and then there were the 2 out of 2 for the defense. I filled out the intial forms in all the offices involved and asked for copies — I also verbally told the DOCTORS about my DISC’s HERNATIONS but in my denials my conditions in and besides the DISC HERNATIONS are never mentioned — SURPRISE SURPRISE. Do all these doctors have ADD, NEED READING GLASS or an English literary test. One DOCTOR went as far as I do not want to know what is wrong with you. THEIR MEDICAL LICENSES SHOULD BE REVOKE.

# posted by Anonymous Anonymous : March 27, 2008 5:15 PM

I have a client several months post disc fusion surgery, who was then involved in a serious car accident. Diagnostic tests confirm that he now has a compression fracture in the lumbar spine area. He has been in bed, and on heavy pain medication for months. He is being treated by one of the top NYC spine surgeons. That didn’t stop one of the doctors named in the suit from concluding, after a 3 minute exam, that my client was able to go to work, and terminating his lost wages. He charitably gave him 6 additional weeks of PT. I say a pox on all their houses. Let them give back some of their ill gotten gains.

# posted by Anonymous Anonymous : April 01, 2008 4:35 PM

Wait, let me get this straight. So, the doctor who is supposedly in some conspiracy with insurance companies to deny claimant’s continued treatment, recommended addtional physical therapy…hmmm.

# posted by Anonymous Anonymous : April 02, 2008 7:42 AM

The insurance industry has confused and manipulated the system by obfuscating NY Workers Comp Law and NY No Fault law.Since there is no such exam under the no fault law the consent a patient gives is defective and there is a DR. patient relationship established. Maybe there is a claim for malpractice after all.

# posted by Anonymous Anonymous : April 17, 2008 5:18 AM

The worst situation is where there is no arms length transaction between the insurance carrier and the doctor. That exists in its most blatant form at a location on Maiden Lane that goes under the name Med-Eval. It is a direct connection to Countrywide Insurance Company. Countrywide has marketed this wonderful service to unsuspecting carriers including Praetorian, QBE, and Ocean Harbor Insurance. This is a pure cut-off mill that is operated directly by the insurer with transcriptionists shuttling between this office and their main office at 40 Wall Street a few blocks away. The claimants go through at such a rapid clip that no one can get any examination. They have one doctor “practicing” at this location who must be 90 years old and cannot speak in full sentences. Not only is his speech unintelligible, he is probably demented. The cut-offs go out like clockwork and all three examiners the chiropractor, neurologist, and orthopedist always agree. Give me a break. Why are we paying for insurance? The State of New York whose governor was chasing call girls should have been chasing down these criminals.

Anonymous

# posted by Anonymous Anonymous : April 18, 2008 9:30 AM

Can we address this fee splitting garbage? Who is splitting fees? The IME is valued at a particular number and the physician is paid in accordance with that. Each physician is paid a different amount of money and agrees to a specific dollar amount. THERE ARE NO BILLING CODES FOR AN IME nor are there any laws pertaining to the amount of reimbursement each physician should have. An “IME” company gets paid for the management of the file. YOUR INSURANCE POLICY waives your right to privacy by the way. The IME company then selects a physician for various reasons.

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.

# posted by Anonymous Anonymous : April 24, 2008 5:11 PM

Who are you kidding? The IME business is a multimillion dollar racket. There are a number of doctors that do only IME’s and are making a bundle. And what overhead are you talking about. Some patients are being IME’d by inept,half dead/half abrasive doctors in converted garages with one person at the front desk!

# posted by Anonymous Anonymous : April 27, 2008 2:32 AM

“The IME business is a multimillion dollar racket.”

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.

# posted by Anonymous Anonymous : April 27, 2008 5:18 PM

Recently at a IME by a Pain Management Dr. I was told to move my neck, after showing limited movement and seeing the reports of a herniated disc in my neck causing impingment upon the nerve root, I was deemed “cured” and not to have a permanant injury! I bet my life, if I went to this mans office,with the same reports he was shown, first he would require to see the actual films of the MRI, then he would say I needed further treatment! This whole No Fault system is a scam, But with the money the insurance companies have Not one thing will be done to reform the industry!

# posted by Anonymous Anonymous : April 28, 2008 9:33 AM

Speaking of the Garages – I looked up each and every DOC (excepting one) that saw me and intersting enough all of them have private pratices or work in hospitals no where near the IME Mills you are examined in – they are simply there to make a fast buck — they themselves are causing the HMO mess because when no fault denies your health insurance winds up picking up the bill… sure they can subrograte but how much is this costing the HMO? I think also realizing the cost of healthcare (paid lots of bills myself) I myself will be more likely to sue a DOC if anything happens to me under there care because I am in fear that my health insurance will not coverage complications and I will not be able to pay for help. My healthcare due to my accident is costing me a mortage payment every month. My health insurance will not coverage certain MEDS OR treatment.

# posted by Anonymous Anonymous : June 13, 2008 9:00 AM

Iam a physician in Florida directly affected by sham IME’s. How can any doctor take $1200 for an IME which involves NO treatment, liability, decision making, follow up or any other patient care issue then recommend the treating physician get $89 for patient care?

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.

# posted by Anonymous Anonymous : July 08, 2008 9:13 AM

The case of Sundahl vs. State Farm was just dimissed by a federal judge. It was a very, very, similar bogus suit like the Allstate one – and guess who filed it? You guessed it, good ol’ Brucey!

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?

# posted by Anonymous Anonymous : April 13, 2009 11:00 PM

Hey anonymous, why are you questioning Mr Bruce integrity, at least he has the guts to stand up to these insurance companies..and how do you know the Sundhal case was dismissed?

# posted by Anonymous Anonymous : June 04, 2009 4:24 PM

I see you posted twice…hmm, could this anonymous be the infamous Bruce himself? I wonder?

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.

# posted by Anonymous Anonymous : June 05, 2009 9:20 PM

Eric said: “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.”

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?

# posted by Anonymous Anonymous : June 07, 2009 10:39 AM

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.

# posted by Blogger Eric Turkewitz : June 07, 2009 9:51 PM

The problem with BR is that he makes such outlandish claims and accusations, that it borders on incompetence. I mean to go in front of these federal judges and to say there is no such thing as an “independent” medical exam..c’mon.

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

# posted by Anonymous Anonymous : June 07, 2009 10:45 PM

Ok bloggers whats the update on the allstate Rico suit? What is the website so I can look at it? I’m wondering how BR did.

# posted by Anonymous Anonymous : July 11, 2009 7:13 PM

The “update” is that there is none…with it being the summer, I guess not much will happen at this point. However, the last desperate attempts of BR were back in April in which he provided “supplements” to the suit by submitting irrelevant newspaper clippings and information about Hurricane Katrina. I know it is funny, but hey, you asked :-)

# posted by Anonymous Anonymous : July 11, 2009 8:51 PM

There is an update:

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.

# posted by Anonymous Anonymous : July 14, 2009 9:34 PM

Some have commented that the initiation of the law suit way back when was due to McGee and others being pursued by State Farm….apparently that is true…below is a copy of an order of a federal judge affirming a prior judges decision.

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:

http://royamura.googlepages.com/StateFarmv.CPTMedicalServs..pdf

# posted by Anonymous Anonymous : September 21, 2009 7:27 PM

It is interesting to note that Rosenberg claimed in his lawsuit that peer review or IME entities are “adjusting” claims, etc. and therefore illegal, bogus, etc….this was actually addressed by the NY State Insurance Department back in 2004.

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 § 4901 (h)-(i) (McKinney 2000); N.Y Pub. Health Law § 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 § 4901 (McKinney 2000).

N.Y. Ins. Law § 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 claims…” 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 § 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:

http://www.ins.state.ny.us/ogco2004/rg041001.htm

# posted by Anonymous Anonymous : December 01, 2009 9:23 PM

I was unfortunate enough to had been scheduled an IME with one of the doctors that Mc Gee had accused of falsifying medicala records.

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…?

# posted by Anonymous Anonymous : January 10, 2010 4:26 AM

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rico and the other happenings
first, another rico suit against state farm has popped up: gregory sundahl, individually and jesse sundahl, individually and on behalf of all others similarly situated v. state farm mutual automobile insurance compay,

posted by . @ April 08, 2008 5:29 PM
ghost of the flea: litigants never learn
there’s something about eric turkewitz at new york personal injury law, that makes people want to spill their guts to him. we all remember the flea, the great anonymous medical blogger who happened to be a pediatrician in a med mal case

posted by SHG @ March 10, 2008 2:28 AM
Blawg Review #150: Updated!
UPDATE This piece from today’s Wall Street Journal Law Blog post by Dan Slater about the 60 Minutes story on legal ethics broke after the Blawg Review went up, but I think it’s important enough that it deserves a place in the review,

posted by cgreen@trustedadvisor.com (Charles H. Green (posted by Administrator)) @ March 10, 2008 1:12 AM
blawg review #150
welcome to this week’s presentation of blawg review, the 150th issue of the blog carnival for everyone interested in law. i was introduced to blog carnivals by my friend and colleague david maister, one of the co-authors of the trusted

posted by cgreen@trustedadvisor.com (Charles H. Green (posted by Administrator)) @ March 10, 2008 1:12 AM
allstate and state farm sued (rico)
i’m bumping this post up due to the interest in this issue shown on mr. turkowtiz’s blog as well as my own. have a look at the comments on the new york personal injury blog post. several doctors, relatives, and other interested people

posted by . @ March 09, 2008 6:56 PM
Good Hands, Meet Your Neighbors…
Our friend Eric “The Lawblogger” Turkewitz has another hot scoop: “Allstate Insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams.”

posted by Henry Stern, LUTCF, CBC @ March 02, 2008 10:37 PM

Allstate Slammed With RICO Charge Over Sham Medical Exams

Allstate Insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams. The rigged exams were done to deny payments for future treatment, according to a civil complaint filed in the United States District Court for the Eastern District of New York. McGee-v-Allstate.pdf

This racketeering allegations were filed by a physician, John McGee, just one month after he filed a similar racketeering complaint against State Farm. The doctor charges that Allstate conspired with medical evaluation companies and physicians to contest the necessity for care and treatment rendered by McGee to his patients. Allstate, through these companies and physicians, conducted “independent” exams to see if treatment was still needed, but which exams McGee says were rigged. Those companies and doctors are co-defendants in the suit. He alleges a scam to “defraud over a million dollars through the creation and submissions of thousands of fraudulent documents created for the sole purpose of denying [McGee] his constitutional rights to practice medicine in the state of New York.”

According to McGee, the defendants were producing boilerplate medical evaluation reports and falsely represented that the tests were independent under New York’s No-Fault law. The medical evaluators profited, it is alleged, due to the increase in business from Allstate while Allstate profited by not having to pay for medically necessary future treatments.

McGee also alleges that kickbacks are involved, with Allstate paying an amount in excess of the No Fault fee schedule, with a portion getting kicked back to the evaluation company.

The defendant evaluation companies include D&D Evaluations, Medimax and Allegiance Healthcare. These companies had merged to become another defendant, Hooper Evaluations, in 2006, and are owned by Hooper Holmes, Inc. (AMEX-HH). The company has seen its stock tank from $4.30 last April to $0.65 cents at its close on Friday.

[A related story on allegedly “independent” medical exams is here: How to Fool a Jury (Is It Insurance Fraud?)]

Plaintiff’s counsel is Bruce Rosenberg of Bellmore, New York, who also filed the suit against State Farm.

Full Disclosure: I have pending personal injury litigation where Allstate and State Farm are the insurance carriers and where one or more defendants may be involved with medical exams.

Update: 3/3/08 A Doctor Sued, In Insurance Company RICO Suit, Responds To The Charge

Comments:

Eric – [A related story on allegedly "independent" medical exams is here: How to Fool a Jury (Is It Insurance Fraud?)]???? As the comments to that story indicated, it really is not a “related story”. It really is a totally different matter. Nothing in the lawsuit as reported speaks of leaving things out. It appears to allege that the reports set forth untruths, for if not, then what is the big fuss.
# posted by Blogger Louis Schepp : March 02, 2008 11:05 PM

 

It’s related in that it deals also with “independent” exams, a company that provides those services, and the allegation of dishonesty in creating them.
# posted by Blogger Eric Turkewitz : March 03, 2008 6:48 AM

 

Something doesn’t make sense. If McGee is being “investigated” by State Farm et al then why would they choose him to be on an IME panel?

Also what doctor in NY that treats PI patients has not been “investigated” by State Farm et al?

# posted by Anonymous Anonymous : March 04, 2008 12:16 AM

 

State Farm is commencing a RICO suit against McGee, he wanted to beat them to the punch.
# posted by Anonymous Anonymous : March 07, 2008 5:03 PM

 

State farm was bring the same suit that was brought again Rozenberg et al.
He knew it was coming…..
# posted by Anonymous Anonymous : March 08, 2008 6:18 AM

 

By what law or right could SF or Allstate bring a claim. Maybe either you or the Insurance company or their lawyers should read the contract that was sold to the citizens of the state of New York and by which are receiving hundreds of millions of dollars.
# posted by Anonymous Anonymous : March 08, 2008 11:28 PM

 

several fundemental issues are here. The first is that several of the “named cases” in the McGee V Allstate were never seen at all. The second, is that MCGEE, has been known for YEARS to treat without necessity and has failed to document physical findings that would be consistent with the treatments rendered. Moreover, McGee, will create evaluations to appear like radiculopathy at almost EVERY claimant he treats. Months later, it would appear the claimant really has a rotator cuff tear or a tear in the knee, requiring surgery because McGee’s false physical findings while benefitting his own pocket as he provides unnecessary tests and treatments NEVER actually gets a patient the treatment they do need. McGee and his attorney, like Rozenberg and his attorney, were under suspicion because they have been fraudulently rendering testing and treatments. This was a pre-emptive strike to avoid the suspension of his license and possible jail time. IF he were to prove something as outlandish as this, then Allstate could not press on with their charges. HE IS ALSO suing STate Farm and all of their IME vendors.
# posted by Anonymous Anonymous : April 24, 2008 4:27 PM

 

I was injured in an auto accident Dec 2003.I’ve been receiving physical therapy since, and eventually surgery for right scapula winging Oct 2007..As far as IME doctors & Allstate. It is bad enough injured parties loose time & pay @ work for PT, then we have to take time off for IME’s..This is insane, the only purpose is to DENIE, DENIE, DENIE our injury & treatment.

BRM 5/19/2008 Albany NY

# posted by Anonymous Anonymous : May 18, 2008 5:38 PM

 

5/20/2008–IME’s are for one reason only..DENIE, DENIE, DENIE, so our insurance companies do not have to pay for our medical expenses and treatment. It’s bad enough we loose time & pay from work for treatment. Then we have to see an IME that only skims through our medical records & has no idea what we have been or going through. I HOPE ALLSTATE GETS WHAT THEY DESERVE AS WELL AS ALL INSURANCE COMPANIES.. SOMEONE SHOULD CHANGE THE LAW…WHAT GIVES IME DOCTORS THE RIGHT TO DENIE US TREATMENT????
# posted by Anonymous Anonymous : May 18, 2008 5:44 PM

 

Hey has everyone lost interest? Why isn’t there any new comments? Personally, I hope everyone involved keeps involved and teach all the insurance companies that “WE” don’t have to take their abuse, and their IME doctors insults, claiming we don’t need treatment.
# posted by Anonymous Anonymous : July 24, 2008 8:24 PM

 

Feb 20,2009–Has everyone given up going after these insurance companies that keep sending us to IME doctors to denie our claims? How can they refuse us treatment for injuries they have medical proof for. Whats the update on this case?
# posted by Anonymous Anonymous : February 20, 2009 8:40 PM

 

DOES ANYONE HAVE AN UPDATE AS TO ALLSTATE RICO CHARGE AND THE CASE? I’M STILL FIGHTING WITH ALLSTATE TO APPROVE MY SURGERY..PLEASE RESPOND..
# posted by Anonymous Anonymous : March 27, 2009 12:49 PM

 

Yeah,there is an update: Apparently Bruce Rosenberg filed a similar lawsuit on behalf of two patients where there were similar allegations. the case is Sundahl vs State Farm, et al.. The case was tossed out by a Federal judge on 3/31/09. The Allstate case will likely be tossed next since it is essentially the same. Sorry, Bruce you cannot go into court as a mickey mouse attorney and make up lies about people with not a single shred of evidence. LOL, LOL
# posted by Anonymous Anonymous : April 14, 2009 12:27 AM

 

To the anonymous person who commetted on april 14, 2009. How do you know the case was thrown out & what makes you think Mr.Rosenberg will also loose the Allstate case? Where did you get the info from. I give Mr. Rosenberg alot of credit for standing up to these insurance companies, tell me another attorney who would do this.
# posted by Anonymous Anonymous : May 26, 2009 7:10 PM

 

How do I know? Lets, see (scratching head)…I can READ. I have the order of the judge in front of me, which indicates the case is to be dismissed with prejudice dated 3/31/09 in Central Islip by judge Joanna Sybert….it is public record. The case with Allstate will be thrown out eventually because it is all lies and just things Rosenberg made up. I am 100% sure of that.

You applaud Rosenberg for smearing doctors and just making up lies about people…well, thats interesting…Don’t worry, what comes around goes around :-)

# posted by Anonymous Anonymous : June 05, 2009 8:17 PM

 

The State Farm Case involving the IME docs and IME vendors was dismissed today with prejudice by the Federal judge. Interestingly, most Federal RICO claims, if dismissed are done so, without prejudice. However, the cases brought by the so called attorney, BR, were so preposterous, that the judge dismissed them with prejudice. And, please to all bloggers, do not ask me how do I know it was thrown out since I am looking at a copy of it now.

Interestingly, because the Federal judge does not have “jurisdiction” over State matters, the court dismisses the State claims without prejudice. Anyway, how ya’ feeling now Brucey? :-)

# posted by Anonymous Anonymous : July 14, 2009 7:48 PM

 

Some have commented that the initiation of the law suit way back when was due to McGee and others being pursued by State Farm….apparently that is true…below is a copy of an order of a federal judge affirming a prior judge’s decision.

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 against him…hmmm…now why would he NOT want to be deposed? What is McGee afraid of? I know, but I will leave that open to interpretation…here is the document:

http://royamura.googlepages.com/StateFarmv.CPTMedicalServs..pdf

# posted by Anonymous Anonymous : September 21, 2009 7:27 PM

 

I had an IME in Jan 2009. The IME doctor recommended surgery for two tears in my right shoulder that was the result of a serious auto accident. Forward another month and the same IME changed the report and never recommended surgery. Again, one month later I see the same IME. I walk into the office and he tells me that my shoulder is healed before he turns around. The IME doctor spends a total of 10 seconds examining my arms. I get a letter from Allstate stating that they will no longer cover my injuries.

With all the documentation I have I know the doctor gave Allstate the information they wanted. If the IME doctor had not given Allstate the report they wanted I would have been at an IME exam every month. The nurse at one of these IME’s told me that she has seen people at the IME more than a dozen times.

# posted by Anonymous Anonymous : February 28, 2010 11:32 AM

 

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ghost of the flea: litigants never learn  
there’s something about eric turkewitz at new york personal injury law, that makes people want to spill their guts to him. we all remember the flea, the great anonymous medical blogger who happened to be a pediatrician in a med mal case
posted by SHG @ March 10, 2008 2:28 AM
Blawg Review #150: Updated!  
UPDATE This piece from today’s Wall Street Journal Law Blog post by Dan Slater about the 60 Minutes story on legal ethics broke after the Blawg Review went up, but I think it’s important enough that it deserves a place in the review,
posted by cgreen@trustedadvisor.com (Charles H. Green (posted by Administrator)) @ March 10, 2008 1:12 AM
blawg review #150  
welcome to this week’s presentation of blawg review, the 150th issue of the blog carnival for everyone interested in law. i was introduced to blog carnivals by my friend and colleague david maister, one of the co-authors of the trusted
posted by cgreen@trustedadvisor.com (Charles H. Green (posted by Administrator)) @ March 10, 2008 1:12 AM
allstate slammed with rico charge over sham medical exams  
the physician also alleges that kickbacks are involved, with allstate paying an amount in excess of the no fault fee schedule, with kickbacks to the evaluation company…bd. allstate insurance was hit late last week with a 78 page
posted by Ducknet Services @ March 03, 2008 9:13 PM
allstate slammed with rico charge over sham medical exams  
posted on new york personal injury law blog. allstate insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams. the rigged exams were done to deny payments
posted by Eric Turkewitz @ March 03, 2008 10:18 AM
Good Hands, Meet Your Neighbors…  
Our friend Eric “The Lawblogger” Turkewitz has another hot scoop: “Allstate Insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams.”
posted by Henry Stern, LUTCF, CBC @ March 02, 2008 10:37 PM

New York’s No-Fault Law Problem With "Serious Injuries"

New York has a No Fault law that applies to injuries from car accidents that limits the rights of people to bring suit unless they have a “serious injury.” And my upstate colleague Jim Reed at ZiffLaw described a fundamental problem with that law, via an email exchange with a prospective client: If you are lazy and “milk” the injury, you qualify to bring suit under New York’s statute, but if you struggle back to work, and work despite the pain and limitations you might have, you don’t qualify. The “serious injury” law, in other words, works as an incentive for people to be lazy and complain instead of being as productive as they can.

This problem arises because, under New York’s No-Fault Law, one can only bring a suit after an auto accident if the “serious injury” fits one of these definitions:

  1. A personal injury that results in death;
  2. Dismemberment;
  3. A significant disfigurement;
  4. A fracture;
  5. The loss of a fetus;
  6. Permanent loss of use of a body organ, member, function or system;
  7. Permanent consequential limitation of use of a body organ or member;
  8. Significant limitation of use of a body function or system; or
  9. A medically determined injury or impairment of a non- permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment” (See, for example, Oberly v. Bangs Ambulance; Insurance Law § 5102 [d]).

This significant restriction on bringing suit was a trade-off for the guaranteed health benefits of the No-Fault Law that started in 1973 and was amended in 1977 to the present formulation. But it also works in the counter-productive manner of encouraging people to stay home and not work. And that makes for bad public policy.

It also means that a fractured pinky that heals in a few weeks would qualify as “serious” under the law, but soft tissue back pain that lasts for years might not, especially if objective results don’t turn up on radiological studies or the physician does a poor job documenting the injury and the specifics of the limitations.

It is this conundrum that brings up the problem with “medical mills” that some folks complain about. In order to document the injury properly, one needs physicians who are familiar with the legal requirements of satisfying a statute that includes a “significant limitation of use of a body function or system.” That may not be the type of language that doctors learn in medical school or the way they were taught to make their medical records, creating a problem and cottage industry of those doctors who will document the way the legislature wants, and who will also find the time to testify in court.

And it brings yet another problem: Treating doctors may need to exaggerate certain claims of the patient to fit into legislatively defined categories in order to keep the tap open from the insurance company that is paying the bills, because the real injuries may not qualify. And the insurance company, by contrast, as an incentive to hire “independent” doctors to check the patient and rig the exams to show no injuries to close down the tap, even if the injuries are real. In fact, this is the subject of two lawsuits that have been brought in New York, that are discussed here:

Now some of these problems will exist anyway, even without the statutory framework. But it seems to me that the statute has exaggerated the problem, and it may be time for New York to revisit the subject to clean things up.

State Farm Hit With Civil RICO Claim Over Sham Medical Exams

State Farm has been sued for racketeering in New York with a claim that it conspired with “Independent Medical Exam” companies and medical practitioners to produce fraudulent and sham medical reports. The suit, filed January 30th in the Eastern District of New York, is brought under the Racketeer Influenced Corrupt Organization Act (RICO). (This story has not been previously reported.)

State Farm acted in concert with “IME” companies and doctors to furnish fraudulent and boilerplate reports, according to the suit. The objective was to procure “scientifically dishonest reports in order to terminate benefits.” The Complaint is here: McGee-v-StateFarm-RICO-Complaint.pdf

Of particular interest is that the plaintiff is not an injured accident victim that was wrongfully deprived of insurance benefits, but John McGee, a physician practicing rehabilitative medicine. The physiatrist asserts that claims submitted to State Farm are being wrongfully denied, thus depriving him of the revenue he should be receiving for the treatment he rendered. He alleges that “sham” examinations were done by the defendants to procure false findings so as to cut off the benefits, resulting in the claims he submitted being denied.

The Complaint alleges that State Farm and the other defendants communicated that the evaluations and reports must deny that its insureds needed future treatment and that there was a lack of medical necessity for prior treatment. The Complaint goes on to state that State Farm engaged the other defendants with the expectation that reports received would be favorable to the insurance carrier, and to the detriment of the insured.

McGee states that “State Farm made it known to the other defendants that if they did not provide sufficient denials within the evaluation reports then State Farm would not use their IME services.”

The defendant “IME” companies are Independent Physical Exam Referrals, Inc., and Metro Medical Services, LLC.

According to the website of Independent, they play no role in the production of the report:

We have addressed the “independent” part of the examinations by requiring all reports to be independently processed by the medical provider, typed and forwarded on their own stationary. IPER does not participate in the production of the reports, thus ensuring an arms length transaction for our clients. IPER reviews all reports by a registered nurse only to ensure that essential components of the report are present and that your questions are answered. The medical opinions rendered are those of the examining physician and based upon his/her clinical assessment and review of medical records.

This description, however, is directly at odds with the allegations of the complaint, which states that “boilerplate medical evaluation reports” are used. That may be an easy thing to prove if identical language is used in many different reports.

Whether these companies are like Integrated Risk Services Inc. — a company I wrote about Tuesday that specifically states it doesn’t want information favorable to the plaintiff included — remains to be seen. (See: How to Fool a Jury (Is It Insurance Fraud?))

Another part of the Complaint alleges that State Farm pays an excessive fee to the IME company for the doctor’s services, and that the money is then shared with the IME company or a kick-back is given to non-medical personnel. The complaint sets forth (in paragraph 19) that felonies have been committed with respect to the sharing of medical fees with non-medical personnel.

Thanks to my anonymous tipster for the heads up.

The plaintiff is represented by Bruce Rosenberg of Bellmore, New York.

Update 3/2/08 – Allstate was just hit with a similar suit: Allstate Slammed With RICO Charge Over Sham Medical Exams

Update 3/3/08 A Doctor Sued, In Insurance Company RICO Suit, Responds To The Charge

How to Fool a Jury (Is It Insurance Fraud?)

This is a lesson on how to fool a jury. And how to get caught. It’s about doctors and lawyers and ethics that belong in the sewer. It’s about potential insurance fraud. And it is an exposé of a very seamy side of personal injury trial practice. And I will name names. It might be the most important post I’ve made since I started blogging, and it comes out of a Manhattan trial that just concluded.

The story emerges because doctors who performed “independent” medical exams in a personal injury case were told, in writing, to game the system. A document was discovered in the file of a neurosurgeon that included this: If prognosis appears good, then state that – otherwise be silent.

We start with a basic aspect of personal injury practice: When you claim injuries to your body in a lawsuit the other side is entitled to have a doctor (or two) examine you to see if your claimed injuries are legitimate. Courts and defense lawyers like to call these “independent” exams. But are they?

The scene is Supreme Court in Manhattan (this is the main trial court, not the top appellate court). And on the stand is Harvey Goldberg, a physiatrist that was hired by the defendants to examine the plaintiff, Gerard Malloy. Malloy had suffered a terrible back injury when he tripped over an exhaust fan that had been left in a darkened hallway in a building. In the well of the courtroom stands David Golomb, one of the city’s top trial lawyers, cross-examining Goldberg.

But all is not right with the report from the exam that Goldberg holds in his hands, because something seems to be missing. Like his opinions. So Golomb asks him, on a hunch, if there was another version of the report that did contain his opinions. Ummmm, well, now that you mention it, there had been another version comes the reply. Golomb presses on and discovers that Goldberg had not only been asked to edit his original report, but complied. He apparently took his opinion on the cause of Malloy’s injuries out of the original report. The testimony looked like this from a transcript provided to me:

Q: So why is the report dated more than [one month after the exam], December 12 of 2006? Why? If you don’t know, you can say that too, Doctor.
A: I don’t know.
Q: Was there a prior version of this report? Was it sent to anybody to look over or edit?
A: There may have been a prior draft that was corrected.
Q: Changed? We don’t know, do we?
A: There was an instance of the causality originally being requested, and then I was told that the causality was not requested.
Q: So if I understand you, you were told by the people asking you to prepare this report not to offer any opinion on what the cause of Mr. Malloy’s injuries, if any, or problems, if any, were? Did I just understand that answer correctly?
A: Yes.

Why was removing causation so important? Because plaintiff Malloy had been in a car accident five years earlier, and the issue of whether it was the car accident or the trip that caused the back injury was pretty darn important. And Goldberg was asked to take his opinion out. And he complied, thereby creating a new report that he knew was incomplete.

Remarkable? Keep reading because it gets worse. The next day neurosurgeon Douglas Cohen prepares to take the stand, as he had also examined Malloy for the litigation. But before Cohen takes the stand, Golomb sees the doctor talking with the defense lawyer in the hall. And the defense lawyer is holding a paper in his hand that came from the doctor’s file. And the lawyer is looking surprised, and very unhappy. And he knows that Golomb is watching the interaction.

With Cohen on the stand, Golomb discovers what that paper is. It is the instruction sheet for the doctor directing him to omit opinions from the “independent” report that are favorable to the plaintiff. Those marching orders, published here for the first time, included (IntegratedInstructions.TIF, another version of the file IntegratedRisk-Instructions.jpg):

  • Point out whatever findings or claims are not related [to the lawsuit]. Otherwise be silent on causal relationship.
  • If prognosis appears good, then state that – otherwise be silent
  • If you can state that plaintiff can participate in all normal activities, do so. If not, be silent

This instruction sheet form from the folks that hired him came from a company called Integrated Risk Services Inc., whose job it was to set up these “independent” medical exams. The instructions appear clear that this was not to actually be an independent report, but in fact, was designed to be a deliberately incomplete and therefore deceptive report. And Cohen had errantly brought it with him to court. That form instruction sheet, by urging deliberate omissions, essentially asked the doctors to falsely claim their exams and reports where “independent.”

So who runs this company and asks these doctors to do this?

A review of the website for Integrated Risk Services, Inc. reveals that this is “ATTORNEY MANAGED INDEPENDENT MEDICAL CONSULTATION SERVICES.” Attorney managed, eh? I wonder which attorney is urging deceit for “independent” exams? A corporate search through the New York Department of State web site reveals the company registered without a name in a post office box in Great Neck, New York, while the web site for the company gives a different PO box in Syosset, New York, also without any names. Nice.

Edit: On 3/25/08 Steven Fruchtman, an attorney out on Long Island, called to say that the company was his. My prior investigation, which tracked the company down through a residential address of his father, has now been rendered moot and been removed. Steven Fruchtman informs me that his father has nothing to do with his business.

Is it called lying when you deliberately omit pertinent opinions in an exam you are claiming is “independent?” Is it suborning perjury by asking someone else to do that on the witness stand? Is it insurance fraud to be so deceptive if the objective is to deprive an individual of insurance funds to which they may entitled? If a plaintiff was deceptive, would the insurance industry and big business scream fraud and go running to the American Tort Reform Association? Is there one standard or two?

I leave it to you, dear reader, to ponder whether ethical violations have occurred for doctors and attorneys involved. And this is not just left to the reader, but to the NYS Department of Health. And to the attorney ethics committees of the state if, in fact, this was an attorney managed company and perhaps, to the NYS Attorney General should any of them stumble upon this little exposé.

Update, 3/25/08: After Steven Fruchtman called today, I made edits to this post as a courtesy to him, including the removal of information regarding his father. He has been invited to comment here if he sees errors.
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Full Disclosure: I know David Golomb for over 25 years and he trained under my father when he was a newly minted attorney.

My Car Accident – A Short Postscript


I had an accident on a local parkway on December 7th that I wrote about, after a car stopped suddenly in the left lane, I stopped, and was then rear-ended.

So here is the end of the story: There were no injuries of any kind to anyone that I know of. The little twinge I felt the night of the accident was just that, a little twinge of zero significance.

As to the property damage, my loss was covered 100% by the car that plowed into me. This isn’t always the case, as new blogger Jim Reed discusses today.

Since I occasionally take my shots at various insurance companies on this blog for various acts of malfeasance, then fairness dictates I should also acknowledge a company when it does the right thing. The car that hit me was insured by Liberty Mutual.

Progressive Insurance Blunders Again

Some lawyers are dumb. I don’t know how else to put it. And this particular pratfall has to be the fault of an attorney.

Last month I wrote of Progressive Insurance spying on a church group — and taping private support group discussions where people were confidentially bearing their souls — in order to obtain information on a claimant that was a member of the group.

After the Atlanta Journal Constitution busted this tactic on its pages, the CEO of Progressive apologized for the appalling conduct and said:

“When I read that story I was appalled and, frankly, didn’t believe that it could possibly be accurate. I have since learned that the essential facts in the story are correct. What the investigators and Progressive people involved in that case did was wrong –period. I personally want to apologize to anyone who was affected by this incident.”

So what happens now? According to yet another story in the AJC yesterday, Progressive is now defending a violation of privacy lawsuit that arose out of the spying on the confessionals, and now says its spying was reasonable. But this isn’t because the defense lawyers are clueless and created the defense inadvertently. Progressive’s spokesperson, according to the article, has defended the defense. That means, to me, that the idea either came from, or is being defended by, the general counsel to the company.

So when the CEO said it was wrong. Period. I guess he didn’t really mean “period” as in we-have-no-excuse-or-justification-and-won’t-even-try. Because now the conduct is reasonable.

Some folks, it seems, know the fine art of taking a bad situation and making it worse.

(hat tips: The Consumerist and Shigley)

Addendum: Perlumtter & Schuelke weigh in with frivolous defenses driving up litigation costs.

(Eric Turkewitz is a personal injury attorney in New York)

Links to this post:

November 26 roundup
All-automotive edition: Court won’t unseal settlement arising from <05 million Aramark/Giants Stadium dramshop case for fear girl’s father will try to get his hands on money [NJLJ, NorthJersey.com, Childs; earlier]

posted by @ November 26, 2007 12:02 AM

carnival of the capitalists #211
the editor of blawg review, who toils in anonymity with the help of tireless sherpa guides to the blogosphere, is proud to be hosting this week’s edition of the longest-running blog carnival, the carnival of the capitalists.

posted by Editor @ October 22, 2007 12:01 AM

I’m sorry. No, I’m not.
New York Personal Injury Law Blog: Progressive Insurance Blunders Again: Some folks, it seems, know the fine art of taking a bad situation and making it worse.
posted by lilyhill @ October 18, 2007 12:00 AM

Progressive Insurance Spies On Church Groups

Progressive Northern Insurance stepped waaaaaay over the line in investigating claims, when its investigation included infiltrating and taping private, church sponsored, support groups where people unrelated to any litigant were confidentially bearing their souls.

According to the Atlanta Journal-Constitution, a pair of detectives hired by Progressive became members of the Southside Christian Fellowship Church in August 2005 in order to get damaging information on two church members involved in a 2004 traffic accident.

The detectives talked their way into a private support group where members discussed abortions, sexual orientation and drug addiction, and taped the sessions, the newspaper said.

The CEO of Progressive then apologized after they were caught red-handed by the newspaper.

Under the label of “Insurance Industry” at the right, I have chronicled some of the misconduct in the insurance biz over the last year, but this story has to take the cake.

(hat tip to California Personal Injury and Insurance Blog via Bob Kraft’s P.I.S.S.D.)

Why New York Medical Malpractice Insurance Jumped 14%

You may have seen the screaming New York headlines: Doctors hit with 14% increase in medical malpractice rates! Doctors in high risk specialties paying 6-figure insurance premiums! Insurance reserves so low carriers may become insolvent! Blame the lawyers! came the cry from the doctor’s, for surely it must be due to medical malpractice cases. A little protectionism called tort “reform” would go a long way to curing the problem. Right?

Ahh, but truth is another matter. Was it really medical malpractice lawsuits that lead to this increase? Let’s take a candid look at some actual facts:

  • New York’s Superintendent of Insurance, who sets the amount of rate increases, says this jump comes “After years of artificially low rate increases” and that “the rate increase comes after years of setting rates below what was needed.” He did it now in order to avert a possible “irreversible crisis.” (Did doctors previously complain that their rates were too low?) So, the Superintendent says, New York must play catch-up with a big rate hike;
  • The State of New York had previously “appropriated” $691M of medical malpractice insurance reserves to balance the state budget from the Medical Malpractice Insurance Association. This association had been established by the state to satisfy any deficiencies attributable to the premium levels for malpractice policies, and for reinsurance. That surplus would have been used (if not taken for other purposes) for maintaining the solvency of New York’s three medical malpractice insurance carriers.

OK, so the “crisis” was caused by lousy state policy under the George Pataki administration, by setting artificially low rates while also swiping the rainy day fund. Surely, however, the problem was also caused in part by increasing medical malpractice cases and payouts, right?

Well, no. In fact a study has shown that the number of medical malpractice cases in New York has remained static, and the amount of payouts has kept pace with other health care costs. When premiums go up, but the payouts are flat, you know you have a problem. But not one created by those who were injured by negligence.

And have high medical malpractice insurance rates in downstate counties chased away physicians, as the fear-mongers suggest? Not even close. It seems the number of doctor in New York jumped by 16% from 1995 to 2003, an increase greater than our growth in population. And the New York Times reported just last week in Few Young Doctors Step in as Upstate Population Ages, that while there was 6 percent growth in the number of doctors from 2001 to 2005, for a total of about 77,000 doctors, the way they are spread throughout the state is wildly uneven. The Times wrote:

While newly licensed doctors flock to New York City, Long Island and Westchester County, where there is already a glut, far fewer choose to practice in the vast upstate region.

As the article makes clear, and as New Yorkers know, upstate has suffered economic woes in past years, much of which was related to the loss of industry. This isn’t a doctor issue. People move to the big city for a multitude of reasons, just as they always have.

Perhaps the problem is an onslaught of frivolous litigation? Nope, not that either, according to a report in the New England Journal of Medicine that disproves the myth of frivolous malpractice litigation.

Here’s a suggestion for the new Eliot Spitzer administration: Government clearly created this insurance problem, as your Superintendent admits. You therefore need insurance reform. So don’t try to fix it on the backs of the most badly injured of New Yorkers with some type of “tort reform” because that won’t fix a government created problem. Even insurance company insiders will tell you that “tort reform” will not bring on lower rates.

And while the governor’s brother is a neurosurgeon in a downstate county, and therefore probably both at the top end of malpractice rates along with his colleagues and in a good position to lobby his brother, it’s hard to evaluate the significance of such expenses without also knowing what their income is. Complaining about a low-six figure premium while taking home a seven-figure income for a high-risk specialty will not bring too much sympathy.

Now here is a reform that the doctor’s may want to entertain: With up to 98,000 people per year dying from medical errors, and with 68% of New York’s medical malpractice payouts coming from just 7% of the doctors, maybe, just maybe, a little more gazing in the mirror might be in order? Perhaps the medical lobby should inform their physician-constituents about the facts, instead of simply handing them propaganda to put in their waiting rooms?

So what do I expect from all this? Not insurance reform, for that would be the obvious thing. And not greater enforcement from the State Health Department on recurrently problematic doctors. It hasn’t happened yet, so why expect it now? No, I believe many will use this governmentally created mess as an excuse to strip rights away from those most severely injured by malpractice. You can almost hear the screams for caps (even though we already have them) and health courts coming from the protectionists who want to shield the negligent from taking responsibility for their mistakes.

While New York’s physicians already enjoy wide immunity from litigation payouts due to the horrible economics of taking medical malpractice cases, except in the most disastrous of matters, I fully expect their lobbyists will want more, more, more. And the facts be damned.
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Addendum, after Eliot Spitzer resigns: Eliot’s Mess: The Ramifications for Medical Malpractice “Reform” in New York

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(Eric Turkewitz is a personal injury attorney in New York)

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