Investigated California Medical Firm Forgoes $70M Workers Comp Claims

By | October 1, 2009

A Southern California medical management company accused of fraudulent workers’ compensation-related billing has dismissed $70 million worth of filed claims, the largest workers’ compensation mass dismissal of liens in California history.

The company, Premier Medical Management Systems, Inc., has been under investigation and in litigation before the California Workers’ Compensation Appeals Board since 2004, in a suit brought by 23 insurance carriers. The carriers include The Travelers Companies, Inc., and the Explorer Insurance Co., as well as self-insurers such as the County of Los Angeles.

A criminal investigation has also been launched against Premier.

According to the law firm of Heggeness, Sweet, Simington & Patrico, of San Diego, which is representing the insurance companies, Premier set up a network of 130 physician offices and clinics that stretched across the Los Angeles region. It even had one in Beverly Hills.

These health care providers allegedly exaggerated conditions, provided unnecessary treatment, and over-billed.

Premier’s network advertised to and serviced mostly monolingual, Spanish-speaking persons, said Joseph N. Patrico.

Patrico said there was no way to know how many dubious and possibly fraudulent claims might have already been paid to Premier and its medical providers.

“You have got to figure a lot,” he said. “There are 23 carriers, and probably an exponential amount of dollars involved. It was a very widespread group.”

Patrico said his firm expects that a number of the individual medical providers will file a petition for reconsideration with the California Workers Compensation Board judge who signed the consent order dismissing the $70 million in claims.

An attorney representing some of those providers said, during the dismissal hearing, that his clients provided the services detailed in their own claims and want to be paid.

A case outline filed by Heggenes, Sweet, Simington & Patrico in 2007 says that Premier was founded by David Fish in 1998. Fish previously had a different company that solicited workers’ compensation cases in San Diego, called Future Health Care Centers, Inc. The company was sued for the unlawful practice of medicine and chiropractic, because it employed physicians and chiropractors and was owned by two lay persons, and Fish was convicted of capping and steering workers’ compensation cases from a local hospital emergency room.

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