Au­dit finds hefty work­ers’ comp back­log

re­port backs claims of for­mer em­ploy­ees fed up with in­ac­tion

Austin American-Statesman - - BUSINESS - By Elise Hu

State au­di­tors found mud­dled chains of com­mand, in­com­plete or missing files, and a mas­sive back­log of cases when they dug into the en­force­ment process at the Di­vi­sion of Work­ers’ Com­pen­sa­tion, ac­cord­ing to a re­port re­leased Thurs­day. The au­dit is on­go­ing, but it sup­ports the claims of for­mer em­ploy­ees who left the di­vi­sion this year amid com­plaints of stalled ac­tion on dozens of cases against physi­cians ac­cused of abus­ing the sys­tem.

“Tens of mil­lions of dol­lars of un­nec­es­sary care has been ex­posed and iden­ti­fied to the di­vi­sion, and they didn’t do a stinkin’ thing about it,” said Dr. Ken Ford, the di­vi­sion’s for­mer as­sis­tant med­i­cal ad­vi­sor. “It’s a tragedy.”

The di­vi­sion’s Of­fice of the Med­i­cal Ad­vi­sor iden­ti­fies and in­ves­ti­gates doc­tors for overtreat- ing pa­tients, over­charg­ing in­sur­ers or oth­er­wise vi­o­lat­ing the rules of the state work­ers’ comp sys­tem.

The find­ings are sent on to en­force­ment, whose attorneys are re­spon­si­ble for is­su­ing dis­ci­plinary or­ders or lit­i­gat­ing the cases. In some in­stances, they take doc­tors to trial at the State Of­fice of Ad­min­is­tra­tive Hear­ings. But for­mer em­ploy­ees and the state au­dit re­veal that hun­dreds of cases are stalled or dis­ap­pear­ing as they reach the en­force­ment stage.

The re­sult, over the past half decade: Hun­dreds of cases in which med­i­cal qual­ity re­view­ers rec­om­mended doc­tors for sanc­tion or re­moval from the sys­tem have sat un­touched or un­su­per­vised.

Ac­cord­ing to the au­dit, 81 cases were never logged, more than 20 per­cent of cases were closed with­out clear doc­u­men­ta­tion, and 661 en­force­ment cases have been open for an av­er­age of 15 months with­out ac­tion. One case has been open since 2006, and more than 60 cases

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