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The average total medical fees paid per indicted medical provider in California were 10 times higher than the average paid to other providers in the state between 2013 and 2018, largely because indicted providers treated significantly more injured workers and rendered more services per injured worker, according to a report released Tuesday by the Workers’ Compensation Insurance Rating Bureau of California.
Researchers with the Oakland, California-based rating agency analyzed treatment data on doctors who were indicted on fraud and other crimes as part of its analyses following the state’s passage of reform measures in 2013 that aimed to crack down on frivolous medical practices, according to the report, which is a follow-up study of state reforms.
Tuesday’s report also revealed that the shares of medical payments for medical-legal costs and medical liens to indicted providers were two to three times higher compared with other providers, and indicted providers were also paid a significantly higher share of payments for complex office visits and ML evaluations.
Between 2013 and 2018, indicted providers in the Los Angeles area accounted for about half — between 49% and 55% — of all indicted providers in the state but received between 85% and 98% of the medical payments to indicted providers during those same years.
In addition, the share of indemnity claims involving indicted providers treating cumulative trauma claims — which experts pegged as a major issue in California — represented 13.7% of such claims involving multiple body parts and subjective reports of pain. Cumulative trauma claims continue to be studied in California.
Meanwhile, the report showed that suspended providers, on average, were paid “significantly less” than providers indicted both before and after suspension or indictment. Also, indicted providers were paid significantly less for liens after indictment, indicative of the impact of reform measures on automatic stay of liens, the report stated.
An analysis of 649,000 workers compensation claims in California shows that physical or mental injuries that arise over time from repetitive stress, motion or exposures cost 53% more than claims that stem from a specific event or accident.