Here Comes the Sun

The state Division of Workers' Compensation has uncovered "tens of millions of dollars in unnecessary medical care" in the last several years, but its commissioner failed to sanction the doctors involved, a key former division employee told lawmakers Tuesday night.

Dr. Ken Ford, who served for six years as assistant medical advisor at the division, is one of six employees who have exited their positions since January, alleging fraud probes have been buried by their boss, Commissioner Rod Bordelon. Public scrutiny of the division — following a May 12 Texas Tribune story — began in earnest Tuesday night, as members of the Sunset Advisory Commission questioned Bordelon and former workers' comp investigators about cases against doctors accused of overtreating or overbilling patients during the last half decade. The commission’s recommendations, which won't be voted on for several months, are typically used to guide changes during the legislative session.

More hearings are planned for this summer as lawmakers scrutinize the roiling controversy, which includes allegations that Bordelon may have bent to political pressure in spiking at least one case in January and closed the books on eight others that had already moved into the enforcement stage.

“The [division’s] Office of Medical Advisor has discovered tens of millions of dollars in unnecessary medical care, and it’s all been swept under the rug,” Ford told the commission. 

Under questioning from lawmakers, Bordelon defended his decision to dismiss the nine cases, blaming his former employees — including Ford — for tainting the selection of the doctors for review. He said those employees “targeted” the physicians selectively, creating a potential roadblock to prosecuting them. “The defendants bring up as a defense that they have been targeted,” Bordelon told the panel.

Ford, in his testimony, called Bordelon’s assertions “a lie,” saying that the doctors were selected based on complaints from their patients. The doctors enjoy ample safeguards, he said. "Where it seems to bog down is, once they go to enforcement, they just seem to disappear,” Ford said.

Bordelon also defended himself against questions about political influence in his decision to close one particular case. State Rep. Leo Berman, R-Tyler, told the Tribune that he had called Bordelon on behalf of his constituent Dr. Aaron Calodney, whose practices were under division review. Bordelon said he responded to Berman's intervention by taking a closer look at the allegations against Calodney, ultimating deciding to end the review without enforcement action.

Lawmakers say they're seeking to address that very issue: whether the commissioner should have the singular authority to shut down enforcement actions. They also plan to examine structural issues that may slow down the enforcement process. “What is the best practice, and how do we move forward?" asked state Sen. Glenn Hegar, R-Katy, who chairs the Sunset commission.

A State Auditor’s review of the enforcement questions is forthcoming. An initial audit was performed this spring, but Ken Levine, the interim director of the Sunset commission, said Bordelon has agreed to a follow-up audit on the specific matters raised in the Tribune story. However, Levine said, "I can't tell you whether or not they are looking at whether there was political influence." 

The second audit is expected to start in June, the same month state Rep. Joe Deshotel, D-Beaumont, who heads the House Business and Commerce Committee, has pledged to hold a hearing to address why doctors who face abuse and fraud allegations are not being sanctioned or removed from the system. Deshotel's committee oversees workers' comp legislation.

In their testimony last night, Levine and Sunset commission staff member Kelle Kennedy testified that their review confirmed a “slowdown” in enforcement but did not take a closer look at explanations for the stalls.

"The process that they had in place was not resulting in a lot of enforcement," Levine said.