Spinal Pass-Through Part of Calderon Corruption Charges
Bribery. Money laundering. Mail fraud. False tax returns. The list of indictments against State Senator Ronald Calderon and his brother, Thomas, a former state assembly member, are hard to keep track of. Allegedly, the brothers accepted more than $100,000 in bribes in exchange for pushing corrupt legislation. One instance of this concerns a provision in the California workers’ compensation program regarding spinal surgeries.
Legislators routinely tweak the workers’ compensation schedule in response to demands by healthcare providers, insurance companies and employee advocates. More than 10 years ago, a change was made that allowed hospitals to charge an extra fee for implantable medical devices that were not covered under the existing spinal surgery fees. This extra billing is called a “pass-through.” Administrators complained about the high costs of paying for expensive spinal implants, but labor union leaders argued that the costs were justified since they provided the best treatment for injured construction, formwork and factory workers.
As it turned out, one Long Beach hospital profited handsomely from the spinal pass-through provision — so much so that the owner, Michael Drohott, made fraudulent contributions to the Calderon family of more than $10,000. The Long Beach scam, which may be "the largest insurance fraud in California history," involved:
- Doing more spinal fusion operations than any other hospital in California
- Bribing Senator Calderon to protect the legal loophole that facilitated these insurance charges
- Pretending to give the Calderon son a paid position on the hospital staff
One question that has not been addressed yet is whether employees with back injuries ended up having complex spinal surgeries and implants that were not necessary. Under workers’ compensation, employees should have access to the best medical treatment available, but no one should face the risks and potential complications of an unnecessary procedure.
Finding the best medical treatment while you are navigating the rules and restrictions sent forth by the Workers’ comp Board is not easy. This is why it is important to get the advice of a knowledgeable workers’ comp lawyer who has experience dealing with spinal cord injuries and other workplace injuries.