Probation targeting doctors who enable workers' comp fraud
This is the second of two reports. You can read Part One here.
In its crackdown on false workers’ compensation claims, the L.A. County Probation Department is focusing not only on employees with questionable claims, but on the doctors who may be helping them game the system.
Chief Probation Officer Jerry Powers says the vast majority of workers’ compensation claims are legitimate. But he says that when he was hired in 2011, 15 percent of his staff was out on disability or workers’ compensation leave. The L.A. County Board of Supervisors instructed him to crack down on false claims.
The foot soldiers in Powers’ effort are field investigators like John Perico and Jennifer Kaufman. They serve in the "return to work" division; they investigate the injury claims of fellow probation officers by conducting home visits, double checking case files, and interviewing witnesses. They also check on the workers’ doctors.
One day last spring, Kaufman and Perico drive their unmarked black car into the parking lot of an office building in south L.A. They’re checking the disability claim of a worker who’s been out some time based on a note from a doctor.
"A little alarming"
"We want to just verify the validity of the note - that the doctor really exists and this note was generated by the doctor," Perico says.
They make their way through the lobby, into a small office with a receptionist and a woman waiting in a chair. They won’t stay long, but they’ll learn a lot.
Dr. Cuthbert Pyne is a weary, soft spoken octogenarian. He tells the pair that he did write the note for the probation employee who’s on disability leave. He says the patient had weight loss surgery back in December.
"But that’s got nothing to do with her work status, correct?" Kauffman asks.
"No," says Pyne.
"Are you treating her for any sort of physical injuries at all?" asks Perico.
"No," the doctor says.
Pyne tells the investigators the patient has been given a note saying she can’t work at her own request.
In the parking lot after the visit, Perico says, "I think some of the information the doctor provided us was a little alarming, to say the least." He expresses surprise that Pyne admitted that he had given his patient a work release because she asked for it, and not because he was treating her for a physical problem.
Pyne tells KPCC that he’s just trying to help, asserting that many medical offices aren’t sympathetic to workers and their general health problems.
Most of the patients he sees are dealing with depression, Pyne says, "because of the pressures of work. Some drive 100 miles to work. They have families. They are getting divorced."
Pyne has been in trouble before. In 2012 he pleaded no contest to filing false Medi-Cal claims. He was fined and placed on three years’ probation.
"There's an informal grapevine out there"
While not commenting on Pyne’s case, probation chief Powers says there is a problem with doctors who are all too willing to approve workers’ compensation claims.
"There’s an informal grapevine out there" of doctors "who are more than willing to sign [probation workers] off duty so they can gain benefits," says Powers.
He says he doesn’t know how large that grapevine is. There are hundreds of doctors who handle probation staffers’ workers’ compensation claims.
Probation says it has reached out to a number of doctors who have a high approval rate of department employees’ workers’ compensation or disability claims, although it won’t say how many, or which ones. Officials say sometimes they show doctors surveillance footage of workers engaged in physical activity while out on disability or workers’ compensation. But the doctors frequently have an explanation for the physical activity, says Cynthia Maluto, head of probation’s return to work unit.
"Things don’t change after the meetings," she says.
No doctors have been prosecuted for helping probation workers fake injuries since Powers took over the department. But probation officials say the main goal is to work with doctors to get more department staffers back on the job.