Tuesday, October 22, 2013

Lynn Carter of MCMC is not a real person

Remember when I posted about those trials where it came out that Lynn Carter of MCMC does not exist and said that the transcript will probably bear this out.  Well, we have the transcript.  It does.


Mischievous and deceitful. Chicanerous and deplorable

Friday, October 11, 2013

The New Normal

Over at New York Personal Injury Law Blog as part of his series of posts about insurance company medical exams, Eric Turkewitz has a great posts on how insurance companies and not insurance company doctors decide what a normal range of motion is.

He provides part of a transcript evidencing this sad fact, which we now quote to a lesser extent (the emphasis is his):

Q:  So there should be no difference in the normal range of motion for an individual who’s 26 and  another one  who’s 34?

 A:  Actually, that’s not true.  This examination was done for a company that uses a different standard for range  of  motion  testing.

Q: Don’t you use your own opinions as to what normal range of motion  is?

 A:  I do, but if I’m employed by them to do an examination, I have  to  use  their  standards.

Q:  So you then will take a standard that you know isn’t accurate, and use it in a medical-legal context?

 A:  No.

Q:  Is that your testimony?

A:     No.     That’s not my testimony.   At   the end of my report, all of these   reports, I  state clearly that the range of motion testing is based on the American Academy of Orthopedic  Surgeon’s   standards,   but  there  are differences  with  body  habitus,  with  age, with activities. I state that clearly, so it’s a very subjective exam, and the 60 degrees here conforms to what this carrier says is normal. That’s not what I think is normal.

Q:    And you used it anyway?

A:   I   did.

Wednesday, October 9, 2013

Who actually creates these reports?


In this instance, the examinations performed by Drs. Miller and Ferrante are not persuasive. The range of motion findings from the two examining doctors differ. Dr. Miller found cervical flexion was 45 degrees; while Dr. Ferrante found it to be 55 degrees. Both doctors noted these findings were normal although Dr. Ferrante acknowledged limited range of motion and mild tenderness over C5-C6 and T1-T2. Dr. Miller found a normal neurological exam, but straight leg raising was negative to 60 degrees.

Further, a review of the similarity of the reports of Drs. Miller and Ferrante detracts from their weight and persuasiveness. 

A portion of Dr. Miller’s report reads as follows: 

Medication:  
The claimant takes Procardia and HCTZ at the present time;
however, the claimant did not elaborate as to the dosage
 or frequency of the medication. 
Employment History:  
The claimant was unemployed at the time of the accident.
She is currently not working. 

The same portion of Dr. Ferrante’s report reads as follows: 

Medication: 
The claimant takes Procardia and HCTZ at the present time;
however, the claimant did not elaborate as to the dosage
or frequency of the medication.  
Employment History:  
The claimant was unemployed at the time of the accident.
She is currently not working.

In sum, the question is how can reports from two examining experts in different specialties can have the exact same wording. The exact same language may indicate that the examinations followed a particular format and the resulting reports were not dictated by the individual doctors. At the very least, the form of these reports detracts from the weight and credibility of the findings.

MCMC

UPDATE 10/22/13 [We have the transcript]

From a reliable source:

Yesterday, a witness from MCMC testified that Lynn Carter does not exist.   In that case, and in many others, MCMC's IME scheduling letters say to contact Lynn Carter to reschedule.  Hopefully we will receive the transcript soon, which should bear this out [Kings County Civil Court, Index No. 109169/10.

UPDATE:  It happened again in 81798/10 and 81799/10 [Kings County Civil Court].

Below is an example of a letter saying to contact Lynn Carter.


IME instructions

"IF THE PROGNOSIS APPEARS GOOD, THEN STATE THAT.  OTHERWISE BE SILENT."





Thursday, September 19, 2013

More signatures

Compare these two signatures from Andrew M. Elmore, Ph.D.



Wednesday, August 7, 2013

Through the looking glass

"it seemed like I had just read it"

 Following receipt of the billing, the Respondent carrier arranged through Transcion Medical Service, a peer review with Dorothy Scarpinato, M.D. whose report of April 4, 2012 is contained in the ECF. Dr. Scarpinato’s peer review contains on page 2 a brief discussion session which is identical (word for word) with a peer review arranged with the same service Transcion Medical and Pierce Ferriter, M.D. which peer review is contained in AAA Case #412013029199. Consequently, I cannot give any credit or credibility to the peer review as it is not only non-persuasive but it is canned, deceitful and potentially fraudulent that this Transcion Medical Service would slap together a discussion and conclusion on a variety of peer review reports discussing durable medical equipment with various providers that are in their stable of providers and consequently this peer report has no credibility with me whatsoever. It is more than a mild coincidence and only the luck of the draw of the cases that they happen to be back to back on my hearing schedule so that having reviewed the earlier one, when I reviewed Dr. Scarpinato’s opinion here it seemed like I had just read it and in fact I just had read it.
Now you may be thinking "What has the Department of Financial Services (Superintendent Benjamin M. Lawsky) done about this obvious and reoccurring practice by IME/Peer doctors and the vendors that pay them Not a damn thing.  Ok, maybe you are thinking "well, if Mr. Lawsky is willing to let this practice slide, surely the Attorney General (Eric Schneiderman) has done something."  Nope, not a damn thing.  Now you might think "well, the OPMC is always there, just in case everyone else is willing to let this slide."  

You are sadly mistaken.


Monday, August 5, 2013

Identical reports, again.

This time we have Paul J. MIller, MD an orthopedic surgeon and Tatyana Gimmelberg a chiropractor submitting virtually word for word identical reports.  Normally one would call this an oddity but you will notice that both reports are addressed to Support Claim Services, so it is pretty much par for the courts [see what i did there].

Now you might be saying, "how bad could it be?" We'll tell you.

Tatyana Gimmelberg, the chiropractor listed her "prior orthopedic evaluation report."








Tuvia got crossed

details HERE.

Like the Katz story: Did This Medical Witness Defraud Thousands of Worker's Compensation Claims?, the Villiage Voice picked this one up in its article: Do Four Different Signatures Make This Radiologist a Perjurer?

The Katz story was also picked up in the blogosphere, Where Criminal Meets Civil Law.

Thursday, August 1, 2013

About that electronic signature that was notarized years after it was put on the document.

It gets better.

Before we get there, this is to catch up those who are too lazy to look down two posts.
Well, at trial Dr. Amidror said he did not know who the notary was and he said that he did not go before a notary on November 25th 2011.


Look all the way at the bottom.  Notice that Support Claim Services is mentioned.  You've seen that name before.  It's in most of those arbitration decisions we posted.

Wednesday, July 31, 2013

Not related

But everyone should check out Humans of New York, otherwise known as HONY.

We will put up some more posts soon

In the meantime Turkewitz posted about insurance company doctors whose signatures vary from report to report and he opines that people other than the doctors are signing the doctors' names.  As an example he offers a few signatures from Dr. Joseph Tuvia which appear to differ vastly from report to report.

Reports such as these generally go through many hands before making into litigation or a motion.  More often than not an insurance company will ask another company to have a peer review done.  The insurance company will send over whatever documents it feels like to the other company who will then forward all that (and sometimes less that it received) to a doctor who reviews the records.  Upon reviewing the record the doctor dictates the report which is transcribed by someone other than the doctor and put into a template or the doctor checks off a few boxes and sends it back to the company to create the report, which it will occasionally sign on the doctor's behalf.  If the doctors cannot utilize CPLR 2106, the report will have to be notarized, which will usually be performed by someone employed by the other company.  Rarely will the doctor appear before the notary and rarely will the document be notarized when it was signed.

Confusing, aint it.  And we are only going over one of the many variations.

We will post some examples of the amazing transforming signatures soon.

Edit.  found some stuff.

Here is some testimony from Dr. Stanley Ross.:

Note that this is the same Stanley Ross that an Arbitrator found to have misrepresented evidence and to have submitted a nearly identical report as to another peer reviewer.

Here is the signature page of report dated November 3, 2009 containing an electronic signature.  The report was not notarized until November 25, 2011

Tuesday, July 16, 2013

This never happens to me

In Part 4 of the Turkewitz Report gives a thorough report on the exam times of a few popular IME doctors.  
  • Dr. Toriello averages under five minutes.
  • Dr. Lisa averages under five minutes.
  • Dr. Jean-Ropert Desrouleaux averages under five minutes.
Common to all IME doctors is the claim that IMEs only make up a small percentage of the their practice.  Mr. Turkewitz pointed out that Dr. Desrouleaux testified that IMEs are only 1-2% of his practice but also testified that he does "20-30 per week (1,000 – 1,500/yr.), taking a total of four to six hours each week. I’ll help you with the math: if he is doing medical-legal exams five hours per week and this is 2% of his practice he is working 250-hour weeks, which is mighty impressive considering the week has just 168 hours in it."  

And it isn't just him, virtually every IME doctor will testify similarly.  The problem is that nobody has held the doctor's (or the insurance companies and the intermediaries) accountable.  Why would a IME doctor testify differently if there is no consequence?  Why would an insurance company not turn a blind eye to this or actively encourage this if they suffer no negative impact?  Up until someone involves OMPC or the Attorney General starts asking questions, I fear that this will continue unabated.

Friday, July 12, 2013

Picking up steam

The Turkewitz report (for lack of a better term) is picking up steam.  As he noted, Above the Law called the revelations in it a "blockbuster."  The Village Voice picked up the story: "Did This Medical Witness Defraud Thousands of Worker's Compensation Claims?"  In the story you'll see that the Village Voice interviewed Dr. Katz who..............wait for it....

wait for it...









"When the Voice contacted Katz regarding his role in the case, he vehemently denied being a 'shill' for insurance companies, and insisted he was siding with the city hospital 'for the children.'"

He was doing it all for the kids.

Wait?

Wut?

Who hires these guys

Reynolds v Ferrante, 2013 NY Slip Op 04154 (3rd Dept. 2013)

Defendant Geico General Insurance Company (Geico) appeals from an order denying its motion to dismiss the amended complaint pursuant to CPLR 3211 (a) (1) and (7). Plaintiff Robert A. Reynolds (plaintiff) had an insurance policy with Geico and sustained injuries to his neck, back and left shoulder in a motor vehicle accident. Geico scheduled a no-fault examination for plaintiff with a chiropractor through defendant SCS Support Claim Services, Inc. (SCS), an independent contractor for Geico. During the course of that examination, plaintiff's left knee was injured allegedly as a result of the chiropractor's manipulation of the knee. Plaintiffs commenced this action alleging, inter alia, that Geico was negligent in the selection, instruction and supervision of SCS and the chiropractor. 
Geico contends that Supreme Court erred in denying its motion because it cannot be held liable for the acts of an independent contractor. We reject that contention. It is well settled that a person who hires an independent contractor may be held liable for negligence in selecting, instructing or supervising that independent contractor(see Brothers v New York State Elec. & Gas Corp., 11 NY3d 251, 258). 
We further reject Geico's contention that the allegations in the amended complaint are insufficient to state a cause of action for negligent selection, instruction and supervision against it. On a motion to dismiss pursuant to CPLR 3211, pleadings are to be liberally construed (see [*2]Leon v Martinez, 84 NY2d 83, 87; see also CPLR 3026). The court is to "accept the facts as alleged in the complaint as true, accord plaintiffs the benefit of every possible favorable inference, and determine only whether the facts as alleged fit within any cognizable legal theory" (Leon, 84 NY2d at 87-88). It is well settled that "the primary function of a pleading is to apprise an adverse party of the pleaders claim . . . and to prevent surprise" (Cole v Mandell Food Stores, 93 NY2d 34, 40; see CPLR 3013). "Absent such notice, a defendant is prejudiced by its inability to prepare a defense to the plaintiff's allegations" (Cole, 93 NY2d at 40). We conclude that the amended complaint is sufficient to advise the court and Geico of the transactions and occurrences on which plaintiffs based their claim and plaintiffs have sufficiently pleaded a cause of action against Geico based upon the alleged negligent selection, instruction and supervision of SCS and the chiropractor (see generally CPLR 3013; Preston v APCH, Inc., 89 AD3d 65, 74). 

Thursday, July 11, 2013

This is totally improper and unacceptable

Yup.

Thus, with the exception of Dr. Ehrlich’s brief review of the patient’s history and Dr. Bleicher’s records in the introductory portion of these reviews, the body of the discussion section of the reviews totally ignores the clinical findings by Dr. Bleicher and all other health care providers, or any other diagnostic testing results, and he must simply use a boilerplate word processing summary to serve as his “discussion” of why the services in question were not medically necessary. In theory, Dr. Ehrlich’s use of a template form of a peer review “discussion” for the services claimed in this case, could serve in each and every other case in which he is requested to prepare a peer review report when the claim involves electrodiagnostic testing. This is totally improper and unacceptable.

Nine in one

Shazam.
Furthermore, the Applicant has submitted nine other peer review prepared by Dr. Cohen with respect to other Eligible Injured Parties. The wording of the discussion section of each of those nine peer reviews is almost word for word identical with the discussion in the peer review prepared in connection with this Injured Party.
Kapow.
Dr. Cohen was asked to comment about the medical necessity of the lower V-sNCT testing of December 9, 2009. He wrote a minimal and inadequate synopsis of the facts, which did not show any meaningful analysis. His conclusion is in the “discussion” portion of his peer. This “discussion” section does not relate the unique medical findings and symptoms of this individual injured person to the testing or to the medical rationales for the testing. Instead, Dr. Cohen inserted his formulaic boilerplate statement against the testing. His “discussion” and conclusion 4 is identical, word for word, to peers he wrote in other cases involving this testing (see AAA Case Nos. 412009026060, 412009026219, 412009026219, 412009026191, 412009026375). No matter the unique clinical findings, complaints and test results for the injured person, the conclusion and discussion is the same in every single case. The use of such a boilerplate statement, without analyzing the facts unique to the specific injured person, indicates that a button was pushed to accomplish a pre determined result. The peer review does not show that the relevant medical facts were analysed fully and in relation to applicable medical rationales. At a minimum his factual analysis should be as detailed as the above factual analysis written by this layperson.

Double your freshness

Conjoined doctors.
Dr. Russ found minimal tenderness to palpation over the posterior aspect with limited range of motion with forward abduction to 120° (180 normal,), forward flexion to 120° (180 normal) internal rotation to 80° (90 normal), and external rotation to 80° (90 normal). Impingement sign was negative. Dr. Russ suggests that the range of motion losses were due to the affirmative acts of the assignor and not due to injury. In doing so, his language in his report is word for word the same as the language of Dr. Emanuel.
 *** 
 In examining all the proof, the proof of the applicant outweighs that of the respondent. The respondent puts forth two independent medical examinations, both of which demonstrate substantial loss of range of motion in the shoulder but both independent medical examiners conclude that those losses are not the result of injury or pain, but the result of the assignor failing to conduct those tests in an honest fashion. Curiously, the language used by both examiners is identical and works to diminish its persuasive value.

Minimal evidentiary weight

AAOS said take a year off.

Applicant’s attorney argues that Dr. Winell’s peer review report should be afforded minimal evidentiary weight because the documentation from the American Academy of Orthopaedic Surgeons Committee on Professionalism demonstrates that he was found guilty ofviolating mandatory standards of condemning the performance of a provider that falls withingenerally accepted practice standards and/or endorsing or condoning performance falling outsidethose standards and/or lacking the knowledge and experience about the standard of care andavailable scientific evidence for the condition that led to the proceeding. She notes that the Committee on Professionalism and the Judiciary Committee conducting the appeal hearing voted to suspend his fellowship for one full year on November 2007. She further argues that Dr. Winell has demonstrated a pattern of ignoring standards or care and/or failing to accurately represent the facts of the case he performed a peer review on. To support her argument, she submitted a number of arbitration awards in which the arbitrators raised such issues. See New York Spine Specialists LLP and State Farm Mutual Automobile Ins. Co., AAA Case No. 412011067028, AAA Assessment No. 17 991 39362 11 ( Arbitrator Martin Schulman, Esq. 05/25/12), Elvina Surgical Supplies, Inc. and Allstate Ins. Co, AAA Case No. 412011022139, AAA Assessment No. 17 991 21936 11 (Arbitrator Andrew Horn, Esq., 04/13/12) and Day-Op Center of Long Island Inc. and Fiduciary Insurance Company of America, AAA Case No. 412010021134, AAA Assessment No. 17 991 15427 10 ( Arbitrator Lucille S. DiGirolomo, Esq., 08/10/10). She notes that in this case, the right shoulder arthroscopy showed a full tear of the right shoulder rotator cuff. Thus, she argues that Dr. Winell completely ignored the above findings of the arthroscopic surgery and therefore did not set forth a sufficient factual basis or medical rationale. Consequently, she contends that for the above reasons, it should be determined that Dr. Winell’s peer review was legally insufficient. Thus, she argues that Applicant should be fully reimbursed its claim.  
 ***  
In light of Dr. Winell’s history of ignoring pertinent facts in a case and offering inappropriate expert testimony [ as discussed in the documentation from the American Academy of Orthopaedic Surgeons], I am very reluctant to rely upon facts discussed by Dr. Winell without the supporting documentation. Moreover, Dr. Winell failed to cite any medical authority to support his conclusion that the Injured Party would have had severe pain immediately after the trauma or that the full tear would have happened immediately and not progressively. Therefore, I find unpersuasive Dr. Winell’s conclusion that the condition requiring the surgery was unrelated to the accident. Also, I find that the peer reviewer also failed to demonstrate that the disputed water circulating unit was prescribed inconsistent with the standard of care since he failed to cite the standard of care for post operative treatment of a full rotator cuff tear.

There were no symptoms


Respondent timely denied the claim based on lack of medical necessity predicated upon the peer review of Dr. Stanley Ross dated 6/13/12. In opining that the underlying surgery was not medically necessary, Dr. Ross stated:  
There are no symptoms or clinical findings related to the left knee until 4/3/12 evaluation where knee joint line tenderness and limited range of motion was noted.  
I find this to be a misrepresentation of the evidence. The report of Orlin & Cohen Orthopedic Associates LLP dated 12/20/11 indicates that the patient had left knee problems and difficulty squatting, kneeling, and climbing stairs. The physical examination of the left knee on that date also revealed an antalgic gate. Is this not a clinical finding? If not, it minimally required some explanation by the peer reviewer. The EIP's entire left leg was afflicted with pain, and he was diagnosed with a crush injury. How can the peer reviewer in good faith state that there were "no symptoms" related to the left knee? This was a serious accident wherein the car flipped over pinning the EIP's left leg. The MRI revealed a tear which was confirmed by the postoperative diagnosis. I find the peer review to be conclusory (not supported by the actual evidence) and completely lacking in credibility (his claim that there were no symptoms or clinical findings associated with the left knee).

Wednesday, July 10, 2013

They could be twins

The claim for payment of the EMG/NCV studies of the patient’s upper extremities conducted on July 18, 2008 was denied timely based on the peer review by Dr. Joseph C. Cole dated September 21, 2008. Dr. Cole reviewed some medical records and opined that the testing was not medically necessary. He stated that the “...documentation did not substantiate how the results of EMG/NCV testing of the upper extremities would have been incorporated into the claimant’s overall medical care...The documentation therefore does not reflect how the results of EMG/NCV testing would have been correlated with the history and physical examination findings...” He cited the findings of an article published in the American Association of Electrodiagnostic Medicine; minimonograph #32 Muscle Nerve 1998 December which stated that electrodiagnostic testing could not be used to exclude a radiculopathy. He concluded that the testing was excessive and not medically necessary. 
Applicant’s counsel argued that Dr. Cole’s peer review is not credible. I take judicial notice that in the case of Cambridge Medical, P.C. v. GEICO, 18 Misc.3d 1144A, 859 NYS2d 893, Dr. Cole testified under oath that the mimimonograph #32 was superceeded by the AANEM one year later. Dr. Cole admitted that the findings he cited were not valid since they were contradicted by different findings a year later. The Court noted: “In fact, an AAEM publication issued one year after the AAEM minimonograph #32 cited by Dr. Cole is dramatically opposed to Cole’s position that the electrodiagnostic test is not medically necessary since it stated that a ‘needle EMG is widely regarded as the technique of choice in the diagnostic evaluation of cervical radiculopathy.’”  
The denial of payment of the EMG/NCV studies conducted on the patient’s lower extremities was denied timely based on the peer review by Dr. Mitchell Ehrlich dated August 27, 2008. Dr. Ehrlich reviewed some medical records and opined that the testing was not medically necessary. He stated that a “...sound medical rationale for performing this testing was not presented in the records...” He added that the patient did not exhibit any signs or symptoms of neuromuscular diseases to differentiate with the testing and the necessity to provide conservative management did not depend on the testing since it was already being performed. He also cited the same article that Dr. Cole cited in his peer review in order to support the proposition that “...electrodiagnostic testing is actually technically limited in correlating segmental neuropathic findings with the exact spinal anatomy...” He concluded that medical justification was not established to warrant the conduction of the EMG/NCV studies of the patient’s lower extremities. I find based on evidence that the Respondent failed to show that the EMG/NCV testing of the patient’s upper and lower extremities conducted on December 16, 2008 were not medically necessary. The denials were based on peer reviews by Dr. Cole and Dr. Ehrlich where they cite and rely on a medical journal article that is not valid. They both supported their claim that the testing was not valid on a publication which was contradicted. Dr. Cole stated under 3 oath that he knew or should have known that the minimonograph #32 was reversed. I find that both of these doctors have an obligation to verify what it stated in their peer reviews.  
I find based on the evidence that the Respondent’s denials were not substantiated and the Applicant is entitled to payment for the electrodiagnostic testing of the patient’s upper and lower extremities conducted on July 18, 2008.

Literature LIterature Everywhere, without a stop to think


Based on a review of all the evidence and the arguments of the parties at the hearing, Respondent has failed to establish the lack of medical necessity for the disputed testing by a fair preponderance of the credible evidence. While Respondent did submit the specific pages from the articles referenced in the peer review report, it did not submit the entire article, and this makes the peer review physician’s reliance on this material less than persuasive. In addition, the peer review physician appears to have selectively referenced these articles, choosing to refer to a specific sentence or two, which is taken out of context, while ignoring statements in these articles that contradict the recommendation against reimbursement and which may actually support the medical necessity of this testing.
I am struck
Dr. Ehrlich’s addendums repeated the conclusions of his peer reviews and, although there was no indication that he actually viewed the MRI films or reports, he stated that “the MRI scan failed to reveal any lateralizing disc herniations.” His addendums are virtually identical. After reviewing the proof I am struck by how Dr. Ehrlich can claim that “strength, sensation and reflexes were unremarkable” at the physical exam of 7/8/10 yet can also claim that radiculopathy could have been diagnosed at that exam in view of the “unremarkable findings.” I am also disturbed by the dismissal of MRI findings by Dr. Ehrlich without his having reviewed the MRI reports or MRI films. All in all, I find that Dr. Ehrlich’s peer reviews are conclusive, inadequately supported by the medical facts and entirely unpersuasive. I have the same opinion about his addendums. Neither his peer reviews nor his addendums sufficiently showed that the disputed testing was a deviation from generally accepted standards of care.
Wut?
On August 21, 2006, Dr Ehrlich submitted an addendum report for which he reviewed a letter of necessity dated July 14, 2006. This letter was not submitted for the arbitration. 2 Dr Ehrlich noted that “the testing was done to determine the extent of radiculopathy which would help in determination of injection and surgical intervention; that ‘a vague diagnosis of radiculopathy lacks the rigor to be expected from a specialist in physical medicine and rehabilitation. A specific diagnosis of radiculopathy would describe the particular nerve root. Such a diagnosis of specific radiculopathy would be made based upon clinical findings of neurological deficits along the distribution of a given nerve root. Invasive management considerations such as injections and surgery are not dependent upon electrodiagnostic testing following the reported injuries. Such considerations would be based upon treatment course and radiologic findings. Providing acupuncture has nothing to do with electrodiagnostic testing at all.” As will be seen from the discussion below in reference to Applicant’s proofs, Dr Ehrlich has misrepresented what was stated in them in reference to acupuncture, and they show that, in fact, his criteria were major considerations in the decision to perform the subject testing.  
[As a side note of interest, on July 14, 2008, for another case with the same issue, Respondent’s office provided the Recommended Policy for Electrodiagnostic Medicine issued by the American Association of Neuromuscular & Electrodiagnostic Medicine. It states that “a minimum evaluation (for radiculopathy) includes motor and sensory nerve conduction studies with needle EMG, and these studies should be performed by one physician supervising and/or performing all aspects of the study. (Applicant testified he did all testing himself.) Page 3 gives an interesting insight in reference to this, noting as follows:  
“Although a common problem such as tingling and numbness in the hand and arm (which could be due to lesions in the brain, spinal cord, cervical roots, brachial plexus, or nerves in the upper extremities) may be studied in a similar way, there is no universally accepted protocol...the EDX consultant must continually reassess the findings encountered during the performance of the testing...he does not ‘read’ needle EMGs, he is integrally involved in performing a detailed study.”]  
Dr Ehrlich informed that MRI results noted cervical disc herniation at C4-5 and lumbar herniation at l5-S1. These tests were performed March 1, 2006.  
Applicant provided an assignment, the bill, subject test finding, referral for the MRIs, initial evaluation report of December 7, 2005, and follow-up reports of February 24, March 29, and June 12, 2006. The initial complaints were of persistent neck, middle and lower back pain with referred pain, numbness/tingling into the right arm and leg, intermittent headache with dizziness, blurred vision in the right eye, numbness over the face.  
These symptoms continued on February 24, 2006. Dr Finkel’s initial neurological report of January 4, 2006, documented diagnostic impressions of cervical/lumbar radiculopathy, cerebral concussion and right trigeminal traumatic neuropathy, recommended electroencephalogram. Neurological examination had positive findings. The plan was for the studies to evaluate for disc pathology and radiculopathy. “The universal criteria for electrodiagnostic studies according to the Guidelines of the AAEM is radicular pain down the extremities lasting three weeks or more; a more definitive diagnosis will help determine if more invasive techniques such as epidural and/or nerve blocks or acupuncture are warranted. 
This was the exact course taken in this case.
A conclusion based on an inaccurate description.
In short, Respondent has apparently provided a conclusion based on an inaccurate description of what was contained in the medical citation relied on. Therefore, I find, as a matter of fact, that the lumbar support was medically necessary inasmuch as Respondent has failed to demonstrate a lack of medical necessity, as is their burden.

You did what when?

Timing is everything.
What is most troubling with this report is that the IME was conducted on May 28, 2010 and while the IME report appears to have been prepared by Dr. Gimmelberg, it is dated May 28, 2010 and was signed by Dr. Gimmelberg on the same date and sent with the timely denial of claim to the applicant. However, the notary public for this report was signed by Melissa Karen Shuivan, who is qualified in Suffolk County, on October 23, 2012, more than two years AFTER the IME report was allegedly signed. It goes without saying that Ms. Shuivan could be subject to losing her notary license for executing this jurat more than 2 1⁄2 years after the report was signed. Further, without having Dr. Gimmelberg in her presence when she signed the report prior to her placing her notary signature on it truly questions whether ANY of the notaries that are placed on any of the documents which are submitted by this respondent have any credibility to them. This is troubling and disturbing and subject to investigation by the appropriate authorities. Further, there appears to be an additional page submitted with the report, in which a notary public jurat is on the page, which is left blank.

The Buddy System

IME doctors have been known to misrepresent the amount of time, quality, and substance of their examinations.  This is no surprise to those that have been at the short end of that stick or watched someone poked with that very short end.

Sometimes the buddy system is used to prevent drowning or getting hit by a bus.  New companies (no idea how new, just new to me) have cropped up that use that same system to keep IME doctors from shoving your head underwater or throwing you in front of a bus.  It is sad that it has come to this, but alas, it has become seemingly necessary.  Turkewitz mentioned a few (see link above), which I will now list along with some other(s) I have found.


I'm sure that someone out there will run across this, sitting up at night worried about the stress of an IME that will last two minutes and determine how much pain they are forced to endure and they will be wondering "will the IME doctor completely screw me."  To that we say, "yeah, probably."

Note that we get nothing from any of these services.  As of now they don't even know we exist.

Show me the junk

Why?


Carrington v Truck-Rite Dist. Sys. Corp.03 AD3d 606 (2nd Dept. 2013)

Here, the fact that the defendants' examining physician was arrested and temporarily surrendered his medical license subsequent to his examination of the plaintiff and the filing of the note of issue did not justify an additional examination by another physician. The defendants' concern that the plaintiff may impeach the examining physician's credibility with this information was not a sufficient basis to compel a second examination (see Schissler v Brookdale Hosp. Ctr., 289 AD2d at 470; Futersak v Brinen, 265 AD2d 452 [1999]).

Verbatim, Word for Word

Have you seen my stapler?

Separately, Dr. Corso’s peer report is dated February 24, 2010. In another surgical supply case, heard before me on the same day, where GEICO is the Respondent (file#412010027471), Dr. Gutman rendered a peer report, dated January 18, 2010. Dr. Corso’s peer report is 95% verbatim, word for word, paragraph for paragraph with Dr. Gutman’s report. It appears that there was a cut and paste job and possible electronic signing. I question the credibility of Dr. Corso as it appears that he was not the author of his report.

Looks familiar


"The peer reviewer herein, Julio Westerband, M.D. is a board certified orthopedic surgeon with an office in New York, New York according to the New York State Education Department Website. The peer review submitted by Respondent does not list any address for Dr. Westerband. The peer reviewer in Staten Island Medical and Surgical Supply, Inc. was Stanley Ross M.D. who is also a board certified orthopedic surgeon but with offices in Queens County and Nassau County. Despite having no apparent affiliation and despite maintaining offices in different counties both physicians submitted nearly identical peer reviews in totally different matters. Both peer reviews were obtained through an entity known as Support Claims Services. Significantly and of utmost concern is the fact this has occurred before and has involved Respondent and Support Claims Services. See, Phata Medical Supply a/a/o AA v. Geico, AAA # 41200921738 and Pahta Medical Supply, Inc., a/a/o RM v. GEICO, AAA # 412009021726. Moreover, another arbitrator has also discovered similar findings. See, U & R City Supply, Inc. v. Geico, 412009047617 (Arb Lori Ehrlich 4/8/10)  
As I noted before, it is not known whether the doctors, Support Claims Services, or Respondent is behind this deception. I will leave that conclusion to the appropriate authorities and personnel to decide. However, it is abundantly clear the two virtually identical peer review reports submitted herein are not a coincidence and are not credible. It is also clear this is not an isolated occurrence."

Copy and Paste

Have we met?
Peer reviewer Tatiana Sharahy, M.D. is an internist with an office in Richmond Hill, New York. Peer reviewer William Ross M.D. is a physician with an office in Mineola, New York. According to the affidavits submitted by Dr. Sharahy and Dr. Ross they “have no business or professional relationship.” Despite having no affiliation and despite maintaining offices in different counties both physicians submitted nearly identical peer reviews in totally different matters. Both peer reviews were obtained through an entity known as Support Claims ServicesRespondent submitted affidavits from each doctor attempting to explain these remarkable “coincidences”. Shockingly both affidavits are virtually identical. They both contain the caption in exactly the same format and matching paragraphs including paragraph number 4 which reads:
As part of my regular duties and responsibilities, and in the regular course of business, I am assigned to review medical files assigned to be by SCS for the purpose of determining whether the medical services rendered were medically necessary. Following my review of the medical documentation assigned to me, I prepare a report known as a “peer review”, which sets forth my medical opinion as to whether the medical services rendered were medically necessary.
It is not known whether the doctors, the peer review company, or Respondent is behind this deception. I will leave that conclusion to the appropriate authorities and personnel to decide. However, it is clear the two virtually identical peer review reports submitted herein are not a coincidence and are not credible.
Hot on the heels of Turkewitz's recent posts on Dr. Michail J. Katz (HERE, HERE, and HERE) and Dr. Robert Israel (just HERE) comes Bad IME (url is badinsurancecompany because we don't want to buy another domain name).

I'm working on setting everything up now, but we hope to keep track of IME shenanigans in every state, starting with New York.