Wednesday, July 13, 2005

More Workers Comp Fraud In Ohio. Guess Who It Is This Time?

Oy, more workers comp fraud in Ohio.

Damn cheating workers again? Not even close.

This time it's Ohio hospitals bilking the state for a half billion dollars, according to a study conducted by the Service Employees International Union District 1199, representing 27,000 health-care workers in Ohio, Kentucky and West Virginia. This is on top of a $300 million the Bureau of Workers Compensation lost bureau may have lost investing in rare coin collections and other questionable items in recent years. The SEIU study showed that "Treating injured workers is good business for hospitals — they account for less than 1 percent of all patients but generate 12 percent of hospital revenue."

Here's how it worked, according to the Columbus Dispatch:
Say Joe Lunchbucket sprained his ankle and the actual cost to treat it was $100.

If he were on Medicare — the government insurance plan for the elderly, which compensates closest to actual cost — an Ohio hospital would be paid $95 for his treatment.

If he had private insurance, the hospital would get $122, on average.

But if he was injured on the job and covered by workers’ compensation, the hospital would have been paid $171 in 2003 and $159 last year.

Now, multiply Joe Lunchbucket’s bill by the hundreds of thousands paid each year by the bureau and discover why critics say the agency is shelling out millions too much for hospital care.

In 2004, the bureau paid hospitals $270 million for treating injured workers.

If the bureau had paid hospitals at the same rate as Medicare, the tab last year would have been about $161 million. If the rate was the same as for private insurers, the bureau would have paid hospitals about $207 million.
And how could the state have let this happen? Gosh, I can't imagine:
Since 1990, top hospital officials and board members have given more than $600,000 to state candidates, a Dispatch analysis shows. About a third of the total was poured into campaigns for governor, who oversees the Bureau of Workers’ Compensation. More than $100,000 went to Gov. Bob Taft, while almost that amount was given to Ohio Supreme Court candidates.

Separately, the Ohio Hospital Association’s political-action committee, Friends of Ohio Hospitals, said it contributed $132,330 to candidates for Congress and state government in 2004 — the biggest year ever for political donations. That money, mostly provided by member hospitals and health systems, went to "officials who understand the needs of Ohio hospitals and support OHA’s advocacy agenda."

A steering committee of top hospital executives establishes "guidelines" for contributions: $1,000 to join the Pacesetters Club, $500 to become part of the Chairman’s Circle, and so on down to a $25 membership in the Buckeye Club. The panel wants to raise $134,000 this year for campaign contributions.

The steering committee also suggests contribution amounts depending on the importance of the politician: $750 to $2,500 for "chairs of key committees," $0 to $2,500 for House and Senate leaders, $2,000 to the maximum $5,000 for majority Republican caucuses, all the way down to $0 to $150 for legislators who are neither in leadership nor on key committees.
Meanwhile, Gov. Bob Taft is demanding a "full explanation." Now word on whether he's planning on returning his $100,000 contribution from hospital officials.