Workers' Comp Industrial Complex: The Middlemen Silencing Injured Workers
Sunday, 03 January 2016 00:00 By Michael Grabell, ProPublica | Report
(Image: Disability trailing via Shutterstock)Las Vegas - A scantily clad
acrobat dangles from the ceiling, performing flips and splits as machines
puff smoke and neon lights bathe the dance floor in turquoise and magenta.
Dancers in lingerie gyrate on poles to the booming techno. Actors dressed as
aliens pose for selfies with partygoers. There's an open bar and waiters
weave through the crowd passing out chocolate truffles.
It's the closing night of the National Workers' Compensation and Disability
Conference & Expo.
The party at Light, a Cirque du Soleil-themed club at the Mandalay Bay
Resort and Casino, capped off the workers' comp industry's biggest annual
networking event. For three days in November, hundreds of vendors wooed
insurers and employers with lavish after-hours parties, giveaways of
designer handbags, photos with Olympic gymnast Kerri Strug, and free rides
in orange Hummer limousines.
A top manager for a major insurance company recalled standing amid the
hoopla a few years back when a company CEO turned to her and marveled: "All
of this because somebody got hurt at work."
Workers' comp is supposed to be simple. If you're injured on the job, your
employer pays your medical bills and part of your wages while you recover.
But over the past two decades, a cottage industry of middlemen has emerged,
which some have dubbed the "workers' comp industrial complex." Even private
equity firms have bought in, seeing profit opportunities in employers' and
insurers' quest to contain spending.
The middlemen offer an array of services, from managing claims to
negotiating medical bills, all promising to reduce costs - although critics
say some actually raise them, as well as the burden on those hurt on the
job.
It's a world largely unknown to the injured workers that the firms
ultimately serve, and often to the employers who spent an estimated $89
billion on workers' comp in 2013.
Over the past year, ProPublica and NPR have detailed how state after state
has reduced the benefits historically granted to injured workers. As a
result, some workers have been evicted from their homes, denied medical care
and put in humiliating situations.
While lawmakers have clamped down on payments to workers, doctors and
lawyers, little scrutiny has been given to these "cost containment" firms -
even though today they arguably have more influence on how injury benefits
are handled than insurers and employers.
Highlighting the bounty, there are now more than 150 workers' comp
conferences a year. There's one for the American Society of Workers Comp
Professionals, one for the Association of Workers' Compensation
Professionals and one for the Association of Workers' Compensation Claims
Professionals. At least 26 have golf tournaments.
At the national workers' comp and disability expo, vendors gave away Apple
watches, bottles of bourbon, and a Vespa scooter. There were free massages
and shoeshines, a superhero caricature artist, more than one mentalist, and
a live alligator named Spike.
Timeline: Annual Workers' Comp Conferences in 2015
With more than 150 workers' comp conferences a year, there's a 50 percent
chance that you could go to one on any day of the year.
Over the past year, conference attendees have heard from Pete Rose, Arianna
Huffington, Ted Koppel, Herschel Walker and Joan Jett & the Blackhearts.
Rarely have they heard from injured workers.
"Even though the injured worker is the center of the claim, they're very far
removed from what actually happens to them," said David DePaolo, editor of
the industry news site, WorkCompCentral. "It's very dehumanizing. Why aren't
injured workers part of the conferences? It's because they're a number."
Private Equity Buying Spree
Last year, workers' comp insurers in California spent 36 percent of premiums
on overhead - more than they spent on medical care. That's over twice what
group health plans can spend on administrative costs under the Affordable
Care Act.
A glimpse of the Vegas expo shows why. There were companies that provide
networks of doctors and companies that review medical bills, firms that
provide expert medical opinions and firms that specialize in complex claims.
There were defense lawyers, data processing firms, rehab facilities,
surveillance companies, outside claims shops, occupational medicine clinics,
pain management services, translators, schedulers, headhunters and
associations promoting other conferences.
There were labs that test injured workers' urine for illegal drugs. There
were even labs that test urine to ensure workers are taking the prescribed
drugs instead of selling them.
In California, the amount of money that insurers spend on medical cost
containment programs has more than doubled from $197 million in 2005 to $471
million in 2014, according to the state workers' comp ratings bureau.
Seeing huge profit potential, private equity firms have gone on a buying
spree.
Sedgwick, a company that processes claims for large employers, was acquired
by two private equity firms for $1.1 billion in 2010 and then sold to
another for $2.4 billion in 2014. One Call Care Management, known in the
industry as a medical "cost containment" firm, was bought for more than $2
billion in 2013, and reportedly bid to buy another vendor, pharmacy benefit
manager Helios, for $2 billion this fall.
Some of the biggest firms - Sedgwick, Genex, Helios, CorVel, MedRisk and One
Call - are little known outside the workers' comp industry. But they have
become powerful players in determining the future of how injured workers are
treated.
The companies say they play a critical role in reducing excessive medical
costs and preventing inappropriate treatment. Southern California, for
example, has recently witnessed a series of scandals involving doctors and
hospital executives who've been accused of bribery, kickbacks and
unnecessary surgeries involving workers' comp patients.
Some firms advertise that they analyze data to find the best doctors and can
get injured workers in to see them faster than the general public. They say
their data tools help employers identify safety problems and manage
long-term claims before they spiral out of control.
Robert Hartwig, president of the Insurance Information Institute, said the
companies have become necessary as medical care, and the regulations for
delivering it across 50 different state systems, have become increasingly
complex. The firms don't just reduce costs, he said, but also improve
outcomes by helping employees get back to work quicker.
"Cost containment is not a dirty phrase," Hartwig said. "If insurers were to
eliminate cost containment because it was costing too much, I can assure you
we would see a rapid escalation in fraud and abuse in the system. And we
would quickly see an explosion in claims costs."
Increasingly, though, decisions to deny care aren't being made by workers'
employers or insurers, but by these myriad claims administrators, managed
care companies and cost-containment firms. Some industry observers say the
firms have added a layer of cold bureaucracy to an already complicated
system. CorVel - a managed care and claims-handling firm whose stock price
has nearly doubled in the last three years - recently sent letters to the
widows of two police officers killed in the line of duty, wishing their
husbands a "speedy recovery."
There's even a Facebook group for injured workers who say they've been
mistreated by Sedgwick.
"I don't think we have created the savings intended and I think we've made
the system a much more complex, difficult to navigate system," said Bob
Wilson, who runs the popular industry site, WorkersCompensation.com.
Wilson said he jokes that even though he's been in the industry for 15
years, he still doesn't understand what some people do. "No wonder injured
workers are getting lost in the system."
Controversy in Cost Containment
As business has boomed, little effort has been made to find out whether the
companies are helping or hurting injured workers.
Ed Welch, former director of the Workers' Compensation Center at Michigan
State University, said managed care is necessary in workers' comp.
"You can look at the field of doctors and say this doctor is really good, he
does a lot of back surgeries, he's very effective, we can negotiate a
price," Welch said. But employers and insurance companies can also use
managed care to limit benefits by finding the cheapest doctors or "doctors
who will very rarely agree that work caused the disability," he said.
One of the field's most controversial niches is firms that supply doctors to
provide second opinions for employers and insurers. This alone is a $4
billion a year industry in the United States, according to one of the
leading firms, ExamWorks, whose stock price has tripled in the past four
years. Treating physicians say such hired experts are often retired doctors
who make quick decisions without fully understanding patients' medical
histories.
A recruitment letter for one medical review firm, which a doctor provided to
ProPublica, promised an "additional revenue stream" and said that "once a
provider is in the rhythm of performing these reviews they should easily be
able to perform 4-5 an hour."
Many cost-containment firms negotiate prices with doctors and other medical
providers and then take a cut of the discount they provide to insurers.
Often, the insurers and claims administrators receive fees and commissions
from cost-containment firms for selling their services to employers, said
Frank Pennachio of Oceanus Partners, an insurance consulting firm.
Some cost-containment companies have found another way to profit, according
to several doctors, insurance consultants and other service providers who
asked not to be named because they must do business with these companies.
They said firms misrepresent the cost of services to insurers, pocketing not
only the percent of savings but also the difference between the inflated
price and the true charges.
"The presence of these companies is becoming so overwhelming that providers
are getting squeezed out," said Steve Cattolica, government relations
director for a doctors' organization, the California Society of Industrial
Medicine and Surgery. Some firms are "raising the costs of work comp health
care without delivering any value."
The Workers' Comp Expo
The 43-story Mandalay Bay casino stands like a shimmering gold cathedral,
towering over the Luxor pyramid and the Excalibur castle on the south end of
the Vegas Strip.
It was the perfect setting for this year's workers' comp and disability
expo, which featured panels on how to prevent claims from spiraling out of
control, what to do about medical marijuana and "Current Trends in Urine
Drug Screening - What the Research Shows."
Conferences like these are where insurer-driven ideas for legislative
reforms spread. And they're also where deals are made, which explains the
attention showered on those holding the purse strings.
One morning, those entering the expo were greeted by a latte bar, hosted by
ExamWorks, with baristas etching elaborate patterns in the milk, like the
face of a lion or Pacman eating a ghost. Convention-goers mingled at booths
and browsed the swag. Strug posed for pictures, drawing people to one firm's
booth while also raising money for charity. Some attendees lined up early to
get wristbands for the after-hours parties.
Prime Health Services, a cost-containment company, held its party at the
Wynn casino's Tryst nightclub with a live band playing in front of the
club's 90-foot waterfall and cocktails containing fake ice cubes with the
company's logo.
Rising Medical Solutions, another cost-containment firm, hosted a Great
Gatsby theme party with guests dressed as flappers. Paradigm Outcomes, a
catastrophic case management firm, held its reception at the lounge inside
the Cosmopolitan's three-story crystal chandelier. And Michael Sullivan &
Associates, a defense law firm in California, held its party at the House of
Blues' Foundation Room, whose website say it features "high-class
debauchery" and "luxurious party rooms to suit any desire - no matter how
wicked."
But none of them could compete with the closing-night blowout hosted by One
Call that featured the acrobat, go-go dancers and glowing aliens clad in
spandex.
"If I was an injured worker at home wondering how I would pay my bills, I
would be sick to see this," said one insurance company manager who asked not
to be named.
One Call, which is based in Jacksonville, Florida, said in a statement that
such events are typically sponsored by companies in the industry as "a cost
of doing business" and that it chose the Cirque du Soleil theme to keep with
the conference's Las Vegas location.
"The focus of One Call Care Management is to make sure that injured workers
receive the best care possible, quickly and efficiently," its statement
said. "Having opportunities for our colleagues to meet and connect is
important for workers' compensation and for any industry."
Not every conference is as elaborate as the national expo. Some focus on
providing continuing education credits for lawyers and claims adjusters.
Many states put on annual educational conferences to update stakeholders on
new trends and regulatory issues.
This year, there were conferences in 104 cities in 41 states - more places
than in the country song, "I've Been Everywhere." One hotel, the Beau Rivage
Resort & Casino in Biloxi, Mississippi, hosted three workers' comp
conferences in 2015.
There are so many conferences that there is even a website called
CompEvent.com, which serves as a kind of Ticketmaster for them.
At this year's Risk and Insurance Management Society conference in New
Orleans, MedRisk - a network of physical therapy and diagnostic imaging
centers for workers' comp - led a parade through the French Quarter,
complete with Mardi Gras performers and a brass band, to its reception at
Latrobe's on Royal.
And not to be outdone, the 70th Annual Workers' Compensation Educational
Conference in Orlando featured a concert by rock 'n' roll legends Joan Jett
& the Blackhearts.
In a video posted on Twitter, attendees bopped their heads as they sang
along to her hit, "Bad Reputation."
This piece was reprinted by Truthout with permission or license. It may not
be reproduced in any form without permission or license from the source.
MICHAEL GRABELL
Michael Grabell has been a reporter at ProPublica since 2008, producing
stories for USA Today, Salon, NPR, MSNBC.com and the CBS Evening News.
Before joining ProPublica, he was a reporter at The Dallas Morning News. He
has twice been a finalist for the Livingston Award for Young Journalists.
RELATED STORIES
Workers at Nation's Top Hospital Strike for Fair Wages
By Jaisal Noor, The Real News Network | Video Report
"Workers Are Constantly on the Edge of the Knife"
By Amy B Dean, Truthout | Interview
Workers in Maine Buy Out Their Jobs, Set an Example for the Nation
By Rob Brown, Brian Van Slyke, Noemi Giszpenc, Truthout | Op-Ed
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Workers' Comp Industrial Complex: The Middlemen Silencing Injured Workers
Sunday, 03 January 2016 00:00 By Michael Grabell, ProPublica | Report
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reference not valid.
. (Image: Disability trailing via Shutterstock)Las Vegas - A scantily
clad acrobat dangles from the ceiling, performing flips and splits as
machines puff smoke and neon lights bathe the dance floor in turquoise and
magenta. Dancers in lingerie gyrate on poles to the booming techno. Actors
dressed as aliens pose for selfies with partygoers. There's an open bar and
waiters weave through the crowd passing out chocolate truffles.
. It's the closing night of the National Workers' Compensation and
Disability Conference & Expo.
The party at Light, a Cirque du Soleil-themed club at the Mandalay Bay
Resort and Casino, capped off the workers' comp industry's biggest annual
networking event. For three days in November, hundreds of vendors wooed
insurers and employers with lavish after-hours parties, giveaways of
designer handbags, photos with Olympic gymnast Kerri Strug, and free rides
in orange Hummer limousines.
A top manager for a major insurance company recalled standing amid the
hoopla a few years back when a company CEO turned to her and marveled: "All
of this because somebody got hurt at work."
Workers' comp is supposed to be simple. If you're injured on the job, your
employer pays your medical bills and part of your wages while you recover.
But over the past two decades, a cottage industry of middlemen has emerged,
which some have dubbed the "workers' comp industrial complex." Even private
equity firms have bought in, seeing profit opportunities in employers' and
insurers' quest to contain spending.
The middlemen offer an array of services, from managing claims to
negotiating medical bills, all promising to reduce costs - although critics
say some actually raise them, as well as the burden on those hurt on the
job.
It's a world largely unknown to the injured workers that the firms
ultimately serve, and often to the employers who spent an estimated $89
billion on workers' comp in 2013.
Over the past year, ProPublica and NPR have detailed how state after state
has reduced the benefits historically granted to injured workers. As a
result, some workers have been evicted from their homes, denied medical care
and put in humiliating situations.
While lawmakers have clamped down on payments to workers, doctors and
lawyers, little scrutiny has been given to these "cost containment" firms -
even though today they arguably have more influence on how injury benefits
are handled than insurers and employers.
Highlighting the bounty, there are now more than 150 workers' comp
conferences a year. There's one for the American Society of Workers Comp
Professionals, one for the Association of Workers' Compensation
Professionals and one for the Association of Workers' Compensation Claims
Professionals. At least 26 have golf tournaments.
At the national workers' comp and disability expo, vendors gave away Apple
watches, bottles of bourbon, and a Vespa scooter. There were free massages
and shoeshines, a superhero caricature artist, more than one mentalist, and
a live alligator named Spike.
Timeline: Annual Workers' Comp Conferences in 2015
With more than 150 workers' comp conferences a year, there's a 50 percent
chance that you could go to one on any day of the year.
Over the past year, conference attendees have heard from Pete Rose, Arianna
Huffington, Ted Koppel, Herschel Walker and Joan Jett & the Blackhearts.
Rarely have they heard from injured workers.
"Even though the injured worker is the center of the claim, they're very far
removed from what actually happens to them," said David DePaolo, editor of
the industry news site, WorkCompCentral. "It's very dehumanizing. Why aren't
injured workers part of the conferences? It's because they're a number."
Private Equity Buying Spree
Last year, workers' comp insurers in California spent 36 percent of premiums
on overhead - more than they spent on medical care. That's over twice what
group health plans can spend on administrative costs under the Affordable
Care Act.
A glimpse of the Vegas expo shows why. There were companies that provide
networks of doctors and companies that review medical bills, firms that
provide expert medical opinions and firms that specialize in complex claims.
There were defense lawyers, data processing firms, rehab facilities,
surveillance companies, outside claims shops, occupational medicine clinics,
pain management services, translators, schedulers, headhunters and
associations promoting other conferences.
There were labs that test injured workers' urine for illegal drugs. There
were even labs that test urine to ensure workers are taking the prescribed
drugs instead of selling them.
In California, the amount of money that insurers spend on medical cost
containment programs has more than doubled from $197 million in 2005 to $471
million in 2014, according to the state workers' comp ratings bureau.
Seeing huge profit potential, private equity firms have gone on a buying
spree.
Sedgwick, a company that processes claims for large employers, was acquired
by two private equity firms for $1.1 billion in 2010 and then sold to
another for $2.4 billion in 2014. One Call Care Management, known in the
industry as a medical "cost containment" firm, was bought for more than $2
billion in 2013, and reportedly bid to buy another vendor, pharmacy benefit
manager Helios, for $2 billion this fall.
Some of the biggest firms - Sedgwick, Genex, Helios, CorVel, MedRisk and One
Call - are little known outside the workers' comp industry. But they have
become powerful players in determining the future of how injured workers are
treated.
The companies say they play a critical role in reducing excessive medical
costs and preventing inappropriate treatment. Southern California, for
example, has recently witnessed a series of scandals involving doctors and
hospital executives who've been accused of bribery, kickbacks and
unnecessary surgeries involving workers' comp patients.
Some firms advertise that they analyze data to find the best doctors and can
get injured workers in to see them faster than the general public. They say
their data tools help employers identify safety problems and manage
long-term claims before they spiral out of control.
Robert Hartwig, president of the Insurance Information Institute, said the
companies have become necessary as medical care, and the regulations for
delivering it across 50 different state systems, have become increasingly
complex. The firms don't just reduce costs, he said, but also improve
outcomes by helping employees get back to work quicker.
"Cost containment is not a dirty phrase," Hartwig said. "If insurers were to
eliminate cost containment because it was costing too much, I can assure you
we would see a rapid escalation in fraud and abuse in the system. And we
would quickly see an explosion in claims costs."
Increasingly, though, decisions to deny care aren't being made by workers'
employers or insurers, but by these myriad claims administrators, managed
care companies and cost-containment firms. Some industry observers say the
firms have added a layer of cold bureaucracy to an already complicated
system. CorVel - a managed care and claims-handling firm whose stock price
has nearly doubled in the last three years - recently sent letters to the
widows of two police officers killed in the line of duty, wishing their
husbands a "speedy recovery."
There's even a Facebook group for injured workers who say they've been
mistreated by Sedgwick.
"I don't think we have created the savings intended and I think we've made
the system a much more complex, difficult to navigate system," said Bob
Wilson, who runs the popular industry site, WorkersCompensation.com.
Wilson said he jokes that even though he's been in the industry for 15
years, he still doesn't understand what some people do. "No wonder injured
workers are getting lost in the system."
Controversy in Cost Containment
As business has boomed, little effort has been made to find out whether the
companies are helping or hurting injured workers.
Ed Welch, former director of the Workers' Compensation Center at Michigan
State University, said managed care is necessary in workers' comp.
"You can look at the field of doctors and say this doctor is really good, he
does a lot of back surgeries, he's very effective, we can negotiate a
price," Welch said. But employers and insurance companies can also use
managed care to limit benefits by finding the cheapest doctors or "doctors
who will very rarely agree that work caused the disability," he said.
One of the field's most controversial niches is firms that supply doctors to
provide second opinions for employers and insurers. This alone is a $4
billion a year industry in the United States, according to one of the
leading firms, ExamWorks, whose stock price has tripled in the past four
years. Treating physicians say such hired experts are often retired doctors
who make quick decisions without fully understanding patients' medical
histories.
A recruitment letter for one medical review firm, which a doctor provided to
ProPublica, promised an "additional revenue stream" and said that "once a
provider is in the rhythm of performing these reviews they should easily be
able to perform 4-5 an hour."
Many cost-containment firms negotiate prices with doctors and other medical
providers and then take a cut of the discount they provide to insurers.
Often, the insurers and claims administrators receive fees and commissions
from cost-containment firms for selling their services to employers, said
Frank Pennachio of Oceanus Partners, an insurance consulting firm.
Some cost-containment companies have found another way to profit, according
to several doctors, insurance consultants and other service providers who
asked not to be named because they must do business with these companies.
They said firms misrepresent the cost of services to insurers, pocketing not
only the percent of savings but also the difference between the inflated
price and the true charges.
"The presence of these companies is becoming so overwhelming that providers
are getting squeezed out," said Steve Cattolica, government relations
director for a doctors' organization, the California Society of Industrial
Medicine and Surgery. Some firms are "raising the costs of work comp health
care without delivering any value."
The Workers' Comp Expo
The 43-story Mandalay Bay casino stands like a shimmering gold cathedral,
towering over the Luxor pyramid and the Excalibur castle on the south end of
the Vegas Strip.
It was the perfect setting for this year's workers' comp and disability
expo, which featured panels on how to prevent claims from spiraling out of
control, what to do about medical marijuana and "Current Trends in Urine
Drug Screening - What the Research Shows."
Conferences like these are where insurer-driven ideas for legislative
reforms spread. And they're also where deals are made, which explains the
attention showered on those holding the purse strings.
One morning, those entering the expo were greeted by a latte bar, hosted by
ExamWorks, with baristas etching elaborate patterns in the milk, like the
face of a lion or Pacman eating a ghost. Convention-goers mingled at booths
and browsed the swag. Strug posed for pictures, drawing people to one firm's
booth while also raising money for charity. Some attendees lined up early to
get wristbands for the after-hours parties.
Prime Health Services, a cost-containment company, held its party at the
Wynn casino's Tryst nightclub with a live band playing in front of the
club's 90-foot waterfall and cocktails containing fake ice cubes with the
company's logo.
Rising Medical Solutions, another cost-containment firm, hosted a Great
Gatsby theme party with guests dressed as flappers. Paradigm Outcomes, a
catastrophic case management firm, held its reception at the lounge inside
the Cosmopolitan's three-story crystal chandelier. And Michael Sullivan &
Associates, a defense law firm in California, held its party at the House of
Blues' Foundation Room, whose website say it features "high-class
debauchery" and "luxurious party rooms to suit any desire - no matter how
wicked."
But none of them could compete with the closing-night blowout hosted by One
Call that featured the acrobat, go-go dancers and glowing aliens clad in
spandex.
"If I was an injured worker at home wondering how I would pay my bills, I
would be sick to see this," said one insurance company manager who asked not
to be named.
One Call, which is based in Jacksonville, Florida, said in a statement that
such events are typically sponsored by companies in the industry as "a cost
of doing business" and that it chose the Cirque du Soleil theme to keep with
the conference's Las Vegas location.
"The focus of One Call Care Management is to make sure that injured workers
receive the best care possible, quickly and efficiently," its statement
said. "Having opportunities for our colleagues to meet and connect is
important for workers' compensation and for any industry."
Not every conference is as elaborate as the national expo. Some focus on
providing continuing education credits for lawyers and claims adjusters.
Many states put on annual educational conferences to update stakeholders on
new trends and regulatory issues.
This year, there were conferences in 104 cities in 41 states - more places
than in the country song, "I've Been Everywhere." One hotel, the Beau Rivage
Resort & Casino in Biloxi, Mississippi, hosted three workers' comp
conferences in 2015.
There are so many conferences that there is even a website called
CompEvent.com, which serves as a kind of Ticketmaster for them.
At this year's Risk and Insurance Management Society conference in New
Orleans, MedRisk - a network of physical therapy and diagnostic imaging
centers for workers' comp - led a parade through the French Quarter,
complete with Mardi Gras performers and a brass band, to its reception at
Latrobe's on Royal.
And not to be outdone, the 70th Annual Workers' Compensation Educational
Conference in Orlando featured a concert by rock 'n' roll legends Joan Jett
& the Blackhearts.
In a video posted on Twitter, attendees bopped their heads as they sang
along to her hit, "Bad Reputation."
This piece was reprinted by Truthout with permission or license. It may not
be reproduced in any form without permission or license from the source.
Michael Grabell
Michael Grabell has been a reporter at ProPublica since 2008, producing
stories for USA Today, Salon, NPR, MSNBC.com and the CBS Evening News.
Before joining ProPublica, he was a reporter at The Dallas Morning News. He
has twice been a finalist for the Livingston Award for Young Journalists.
Related Stories
Workers at Nation's Top Hospital Strike for Fair Wages
By Jaisal Noor, The Real News Network | Video Report"Workers Are Constantly
on the Edge of the Knife"
By Amy B Dean, Truthout | InterviewWorkers in Maine Buy Out Their Jobs, Set
an Example for the Nation
By Rob Brown, Brian Van Slyke, Noemi Giszpenc, Truthout | Op-Ed
Show Comments
