The Good, The Bad and The Ugly

Greetings colleagues and friends, these past few weeks have been overwhelming so forgive me if you’ve been heavily anticipating a fresh and new article, fear not for this one is just that, fresh out of the oven. Before I do so though, I wanted to thank those of you who have responded to me on some of the opinions or insights I’ve been writing about. Having a healthy opinion forum allows for greater ideas to flow and strong points to be heard. It is important for us all to understand the unpredictable ebb and flow of our business landscape not to mention gaining valuable insight on hot topics from multiple sides. A sincere Thank You in taking a moment to read the articles!

So, with the 2nd half of May upon us I wanted to change things up a bit and instead of writing a lengthy article on one topic I wanted to throw into the mix a categorized “opinion and topic forum” highlighting some of the “Good” that we see and read along with the “Bad” and finally we can’t forget about some of the “Ugly”. The topics will range based on relevant current affairs and should make for a healthy addition to having quick informative insight on the go.

Before we take a leap into our first edition of “The Good, Thee bad and The Ugly” I wanted to highlight my week in hopes that perhaps our paths may cross. I’ll be in beautiful San Diego visiting some of you so please contact me if you’d like me to answer any questions you may have in person. The 6th Annual LatinoComp Golf Tournament to be held at beautiful yet challenging Angeles National Golf Club which should make for a great Friday. Let’s be honest, even though I will be golfing you bet your lucky stars that I will be multi-tasking any office inquiries in between golf swings. As always, my phone will remain on so that I may field any important questions that you may have. I anticipate a great turnout. Lastly, for some of you in the Oxnard and Ventura areas, if you haven’t smelled the roses and eaten fresh strawberries at the California Strawberry Festival in Oxnard. The 34th Annual event should see over 60 thousand strawberry lovers and tons of amusement for children and adults alike. Hope to see you there this Saturday.

Without further ado.

The Good

The California Assembly approved and passed AB 44 which was authored and lobbied by the respected Assemblywoman Eloise Gomez Reyes, D-San Bernardino. During the horrific act of terrorism that took place on Dec. 2nd, 2015 in San Bernardino, the aftermath left many of the affected employees without treatment nor meds, twenty-two people to be exact. A result of the lopsided & blind UR/IMR process. While the system is full of pitfalls and many reasons for the other side to deny authorization in the event of any act of terrorism, those affected will have a smoother and quicker pace to the overall Work Comp process. In essence they’ll be receiving treatment and medication expeditiously rather than left on the shelf and playing the waiting game. Moreover, advocates will be assisting providers in obtaining proper authorization. This should be helpful for those medical providers whose staff do not properly know how to submit RFAs with proper MTUS language and evidence based medicine findings. One of many reasons for denials on RFAs. None the less this is a Victory for those who’ve been Psychologically altered for life. May God bless them and grant them the strength to overcome the potential PTSD they may all have for the rest of their lives.  My heart goes out to the survivors and those who lost their lives.

The Bad

The Defendants in the Aspen Medical Resources vs the Orange County DA Fraud Unit had their day in court. Aspen, one of many shell companies or names it held had been under investigation for erroneously padding and billing their DME products specifically the Hot / Cold Compressor. Durable Medical Equipment had a surge and hay day just under 10 years ago but considering many schemers being caught it underwent a Fee Schedule and tighter regulations. Since the 3 dubious players were bilking Insurance Carriers to the tune of close to $140+ Million they are required to relinquish the Lien holdings, pay a joint restitution of $8.6 Million and like most White-Collar Crimes that involve lots of money, may not see time in jail but rather house arrest or any monitoring program at that. The Defendants are black listed from ever holding a Professional Medical Corp. or any LLCs that provide service in the medical arena. Bravo to the WC Fraud Unit who are vigilantly tracking, investigating and prosecuting the fraudsters within our community.

The Ugly

DaVita Healthcare Partners, Inc. is at it again. Within the last 6 years they’ve been prosecuted and convicted of Medicare fraud to the tune of nearly half a Billion dollars so my question is why are they still allowed to exist. I wanted to make the finale somewhat entertaining so please follow the link for a laugh but also some relevant information on Dialysis care and what these schemers are doing to bilk the system and take risky short cuts with the patients who are being treated. Some of those patients can be your loved ones so I hope this helps somehow some way. Volume is the name of the game, get patients in and get them out is their mantra. With that customer service, I don’t understand why people continue to use them. “Find other avenues for better results”, this I say and use daily.

Last Week Tonight with John Oliver is informative and downright funny. Sometimes when your day to day is overwhelming, a laugh is a great remedy for exhaustion. Enjoy!

https://www.yahoo.com/news/john-oliver-tackles-profit-kidney-081337363.html

(Rated R for language, not for the sensitive or for children)

 

So much for keeping this short.

As always, Thank You for your ears, your wisdom and your confidence.

See you all soon.

 

Laura M Wilson