In theory, workers’ compensation is a beautiful system put
in place to ensure injured or sick employees get coverage for the treatment
they need to get well and get back to work. In theory, employers benefit too,
as it protects them against costly lawsuits from employees who get hurt or fall
ill while on the job. Unfortunately, the reality is that workers’ compensation
is a flawed system prone to abuse and corruption, and often times, it’s
employers who get the shaft with huge bills and unwarranted expenses.
One major cost containment issue employers face in workers’
compensation claims is overtreatment.
This occurs when an injured employee goes to the doctor and is prescribed more treatment than is necessary for him or her to recover properly. Often, overtreatment is the result of medical providers simply wanting to line their pockets. After all, a physical therapist, for example, only makes money when patients come to see them, so it’s in their best interest to recommend the maximum length of treatment possible for an injured worker — despite the fact the worker could heal with much less treatment.
This occurs when an injured employee goes to the doctor and is prescribed more treatment than is necessary for him or her to recover properly. Often, overtreatment is the result of medical providers simply wanting to line their pockets. After all, a physical therapist, for example, only makes money when patients come to see them, so it’s in their best interest to recommend the maximum length of treatment possible for an injured worker — despite the fact the worker could heal with much less treatment.
While it’s important to point out that overtreatment is not
the norm, employers do need to be aware that it happens. It’s important that
you watch for the red flags that medical providers may be overtreating your
employees so you can challenge these excessive expenses when necessary and
control your costs.
Here are some common warning signs of overtreatment by
medical providers in workers’ comp cases:
- The doctor keeps the patient coming back for an extended period of time: One major red flag of overtreatment is when the medical provider keeps bringing the worker back for appointments for several months after the incident. Follow-up visits are normal, but when a doctor keeps the patient on a long-term rotation of coming back in for appointments several months down the line, it may be unnecessary and excessive.
- The bill is higher than expected: Typically, payers have an idea of how much treatment is going to cost for an injured employee. But sometimes, bills arrive and they are far higher than expected. Unfortunately, some medical providers may see a workers’ comp claim is involved, and the costs go up. In some cases, billers will “unbundle” and try to charge separately for different services that are typically to be combined in one pre-negotiated rate.
- The doctor dodges phone calls: When a doctor refuses to answer questions or return phone calls from payers, it’s a huge red flag that something shady may be going on and that the doctor is overtreating the patient to keep them coming back for more and more costly treatment.
Truth be told, this list could include dozens of signs
indicating overtreatment by medical providers. However, it’s not always the
specific warning signs that are important. It’s about being vigilant during
every workers’ comp claim and having a process in place to identify
overtreatment when it happens.
One effective way to combat the issue is to partner with a
reputable medical bill review company. Having a partner who audits every
medical bill your company receives can help ensure that excessive treatment and
charges are caught and challenged to save your company money.
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