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How Medical Mills Destroy Workers’ Comp Claims

May 25, 2013 By Paul Giannetti

When a worker is injured on the job, the first step is generally to get checked out by a medical clinic. The worker is told he has a litany of problems, will need a certain barrage of tests, and can expect a long list of treatments.

The worker, naturally, believes what his clinic is telling him and submits a worker’s comp claim based on that information.

Unbeknownst to him, unfortunately, the clinic isn’t actually diagnosing him. It’s lining its own pocket.

How Medical Mills Work

Medical mills are clinics run by dishonest professionals (in some cases, the doctors and nurses at the clinic aren’t even professionals – they’re unlicensed crooks) who inflate their medical diagnoses so that they can over-bill the insurance providers covering workers’ comp.

Simply put, medical mills bill insurance companies for procedures that were never provided or that weren’t necessary to begin with.

For example, a medical mill might take just one series of X-rays to diagnose an injury, but bill the insurance company for three series of X-rays. They may also perform wholly unnecessary tests so that they can bill for them, or diagnose non-existent injuries so that they can bill for “treating” a problem that never existed.

What Happens to the Worker

In many cases, the worker is unaware that he or she is being scammed. They may never see the insurance bill themselves – after all, it’s being taken care of by workers’ compensation – and so are unlikely to notice and call attention to any inflated billing. Medical mills deal directly with the insurance company, which makes it easy for them to claim whatever injuries, treatments, and tests they want.

Depending on the type of scam, the worker can actually be damaged permanently by the medical mill’s scam. If the medical mill informs the worker that he has a dangerous diagnosis that requires a lot of expensive tests and treatments, the worker now believes that this diagnosis is a part of his medical history, and will naturally inform his future doctors about it and adjust his own health practices accordingly.

An incorrect diagnosis such as this can cause serious problems for the worker over the course of his life.

Similarly, if the worker believes he has received certain treatments when he has not (since the medical mill billed for the procedure but did not perform it), he could unwittingly mislead a future doctor when asked, for example, if he has recently had a tetanus shot.

This is particularly a problem in the case of fake clinics run by fake doctors; the worker may be told he’s received treatment for a very real injury, when in fact nothing has been done to mitigate the damage.

What Happens to Workers’ Comp

When medical mills get away with over-charging insurance companies for workers’ compensation claims, everyone suffers. The companies must pay higher premiums to offer workers’ compensation, which can prevent some of them from offering as much coverage to their employees as they would like.

Workers can lose jobs because companies simply cannot afford to keep up the premiums on the number of workers they currently have, or see their pay reduced because the company is trying to offset the inflated cost of insurance.

The company as a whole often suffers, since doing the right thing and offering proper workers’ comp is insanely expensive, and the company cannot survive against less-honorable competitors.

Medical mills are a serious threat to workers’ comp. If they’re not stopped, it may not be possible for good companies to continue to provide quality coverage for their employees – and no one wants that.

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