Workers Compensation Problems and the Insurance Cartel

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October 05, 2007

Insurance companies have formed a cartel and have used the Texas Medical Board (TMB) as its hammer to prevent physicians from delivering necessary care to workers compensation patients.

This problem has developed as result of Texas Workers’ Compensation (WC) legislation. The insurance companies have been invited to participate in the drafting of the Workers’ Compensation guidelines and have gladly accepted this opportunity to help write our current WC legislation. What did you think would happen when the fox began to manage the hen house? Having no checks or balances invites abuse.

The insurance companies have used the anonymous complaint provision, adopted by the TMB, to eliminate physicians whose treatment of injured workers costs them too much money.

In California, the insurance companies’ cartel got the ACOEM guidelines passed as the overriding rule for WC, yet no significant input from any spine organization went into those guidelines.  Well, guess how much money the cartel saves without paying for spine surgery, my guess the number one outlay for them in WC?  And, of course, the savings are passed along to the consumer…no, wait, not unless the “consumer” is the group of executives who are “consuming” our health care system.

In the first year of HMO in Texas WC, there was a three-fold increase in reported profits in the WC insurance industry.  But forget the percentages, look at the absolute numbers: profits went from $500 million to $1.5 billion in one year.  Now you can understand the gambit that the cartel plays.  The stakes are enormous!  It is well worth the cartel investing millions of dollars for lobbyists to get that kind of return!  Their lobbyists can influence a lot of legislators with that kind of money, and I wouldn’t be surprised if some of the leaders of the big medical organizations are on the receiving end of some of that largesse.  There are more than a few doctors who, having been driven from the market by managed care, have gone over to the dark side. 

For example, consider former Texas Medical Board (TMB) member, Dr. Keith Miller, who worked for Blue Cross.  The cartel needed to control the TMB so that any doctor who opposed their will would be disciplined or have his license removed. There is nothing like having help on the inside to guarantee the outcomes. 

The doctors who most likely do the bidding of the insurance cartel are those who do little in their medical practices, yet seem to make a good living.  In the old days, it would be called “no visible means of support” and would land you in jail in my hometown.

That is how the former TMB member Miller looks to those of us who are working in the trenches every day. He appears to be one of the doctors who have betrayed us to their master, the insurance cartel. These doctors have become addicted to the easy money that the cartel pays for fake peer reviews, independent medical exams, false testimony in courts, writing false guidelines, etc.  They have found receiving the insurance cartel’s money so easy that they have abandoned the one thing that other physicians actually do -take care of patients. Once they have accepted the insurance cartel’s money these physicians are hooked, and the threat of withdrawal of the easy money will make them do just about anything.  It’s sort of the equivalent of heroin. 

The proof of my theory will be found in the mass of documents which will be obtained through the discovery process of a civil lawsuit.  By acquiring the financials of the cartel members and of their minions, we will be able to trace the payments over the years. Because so much is at stake, the insurance cartel will fight our efforts to the death.

The first step must be to reform the Texas Medical Board and prohibit the filing of anonymous complaints against physicians, especially by insurance companies. No one should be permitted to serve on the TMB who receives compensation from insurance companies or who provides testimony in behalf of insurance companies.