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Thought Leadership

The stereotype no one complains about

Another day, another TV exposé on a workers’ compensation fraudster. A former postal worker was collecting $3,000 a month for a supposed shoulder injury that prevented her from standing, reaching or grasping. Yet there she is standing on “The Price is Right” stage, approaching the giant wheel, reaching with both arms, grasping the handles and throwing her body into a couple of serious spins. And grinning like a fool.

Cathy Cashwell, c’mon down! You’re busted.

As she should be.

These spectacles are great fun to watch – unless you’re one of the millions of workers with legitimate on-the-job injuries. In addition to suffering physical pain, you’re stigmatized as a malingerer and painkiller addict by insurance companies, doctors, pharmacies, bosses, co-workers and maybe even your own family.

I know. In my work as a physician, I’ve treated thousands of these workers and am extremely concerned about the erosion of their rights. No one can defend fraud, but for the sake of context, you should know that the stereotype of the malingering worker is way overblown. Claimant fraud is just a fraction of the workers’ compensation fraud. The big money is in fraud perpetrated by employers, providers and carriers.

What really frustrates me, though, is the institutional resistance I get as I try to heal my worker patients as quickly and effectively as possible. I’m trying to get them back on the job, and I assure you that’s where the vast, vast majority of them want to be. (Studies have shown that only 1 to 2 percent of claims are fraudulent.)

Here’s a typical example. A steel worker has fallen and injured his lower back. He’s in excruciating pain. I have two routes. I can prescribe powerful, addictive opiate pills, or I can prescribe a topical cream, made to order by a pharmacy.

I choose the compound because it addresses the pain without the chance for addiction. Here’s where it goes off the rails. The workers’ compensation carrier denies the prescription saying the topical compound isn’t FDA approved. That’s a red herring. It’s not FDA approved because it’s a custom “compounded” mixture, and the FDA doesn’t approve them. That would be like the city health inspector reviewing every meal that goes out of every restaurant kitchen.

But the active ingredients are FDA approved and come from FDA approved manufacturers. The pharmacy that puts it together is, or should be, accredited by the Pharmacy Compounding Accreditation Board, the industry standards body. And the ointment carries the same ingredients, active and inactive, as FDA approved pre-packaged medications available only at a lesser concentration. FDA says compounding is only appropriate for special cases. I agree. And the injured worker is a special case.

I can fight the insurer on this, as I have many times, or I can accede to the pressure and prescribe the opiate pills, quite likely initiating an addiction process and prolonging my patient’s absence from work. Another twist: unlike ointments, opiate pills make you dizzy. A recovering worker doesn’t want to be dizzy walking eight inches of steel half a mile off the pavement in a crosswind.

It gets worse. Other measures that might get my patient back to work faster (and relieve his pain) – including physical therapy, manipulative therapy, psychological evaluation and cognitive behavioral therapy – will almost certainly be denied.

This is just one example of the uphill battle for physicians trying to do right by injured workers. We know better than the insurance companies what’s good for our patients, and dare I say we care more about the patient. We’re the ones who look them in the eye when they come to us for help getting back to work, or help just wading through the red tape of insurers, pharmacies, doctors, lawyers, employers and claims.

Insurance companies in particular have gained enormous power over the patient. In fact, in some states, they handpick the doctors who will manage the care of workers covered under their policies. Although I have many strong professional relationships with carriers, this is a clear conflict of interest. Trust me, you don’t want your herniated disc diagnosed as a garden variety back sprain.

If, however, you have a back sprain and try to pass it off as a herniated disc, I hope to see you on TV.