State News : Pennsylvania

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Pennsylvania

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“RIPE FOR CORRUPTION”

By Kevin L. Connors, Esquire

 

Not our words!

It is a direct quote from the front page banner headline of the Philadelphia Inquirer on September 24, 2017, with the headline being (Inquirer Investigation/Workers’ Comp, Pharmacies’ alliance:  “Ripe for Corruption.”)

For those who did not pick up a copy of the Sunday Philadelphia Inquirer, the hyperlink can be found by googling “Ripe for Corruption.”

For anyone involved in the administration or defense of Pennsylvania workers’ compensation claims, this article is a “must read,” as it investigates the ethical boundaries surrounding Attorney ownership and investment in pharmacies prescribing medications for workers’ compensation Claimants, as the Inquire investigated pharmacies owned by Pond Lehocky, a Philadelphia law firm almost exclusively representing Claimants either receiving or seeking workers’ compensation benefits, with the firm having written referral “arrangements” with physicians prescribing medications for persons receiving or seeking workers’ compensation benefits, to utilize Pond Lehocky-owned pharmacies to fill doctor-prescribed prescriptions.

Yes, the article accurately sets forth that Pond Lehocky secured approval from the Pennsylvania State Licensing Administration, to establish the pharmacy, also having sought legal Counsel as to the ethics of pharmacy ownership, with the question left unanswered as to whether ethical boundaries limit Attorneys profiting from the medical outcomes of Clients through this type of arrangement without full disclosure to either Patient/Client, and/or Party responsible for paying.

However certain that Pond Lehocky and his Partners might be that their “arrangement” was ethically and legally sound, the “arrangement” was apparently outlined by Sam Pond, a legend unto himself, which Sam had emailed referral doctors:  “For all Patients that you may see with a workers’ compensation claim, referred to you from our office or elsewhere, we ask that you have our pharmacy, Workers First Pharmacy Services, fill these scripts.”

Apparently, Workers First Pharmacy received State approval to open its pharmacy in October of 2016, with the application submitted by Pond Lehocky indicating that no medical practitioners had a proprietary interest in the pharmacy, although, in fact, several doctors are part-owners, as evidenced by the Inquirer’s investigation into the pharmacy.

The “arrangement” has been questioned by legal and medical ethicists, on grounds that it may potentially lead to conflicts of interest, and to create a financial incentive to prescribe the costliest drugs, whether or not medically appropriate, in order to prolong workers’ compensation legal disputes, to boost legal fees and legal recoveries.

Citing to Pond Lehocky’s website, it makes a vague reference to its relationship with Workers First, noting that the firm is “partnering” with the pharmacy to help Clients get the best pharmaceutical care.

However, Clients can click right through Pond Lehocky’s website, to the pharmacies’ website, without being apprised of the law firm’s financial interest in the pharmacy and any medication scripts that it might fill.

The Inquirer article cites to numerous references of Workers First charging what some are calling “inflated” prices for medications, particularly for high-cost compounded pain cream.

Of course, Pond Lehocky takes the position that Workers First Pharmacy is an attempt to “stand up” to “diabolical people” and insurance companies, who frequently deny medications to Pond Lehocky’s Clients, in order to boost insurance company profits.

Pond’s quote is:  “You ever have an insurance claim?  You ever go up against these bastards?”

Pond Lehocky apparently denies that the email/letter that it sent to doctors, asking doctors to use Workers First for their workers’ compensation Patients, does not constitute aquid pro quo, nor does the firm believe that doctors might feel pressured to use the firm’s pharmacy, in order to continue receiving Patient referrals from Pond Lehocky, noted in theInquirer as a major pipeline for new Patients.

Conveniently, Pond says “I would be outraged--if I heard that.”

According to Workers First Board of Pharmacy application, 65% of the firm is owned by Sam Pond, and his two law Partners, Jerry Lehocky and David Stern, as well as law firm CFO, Bryan Riley.

The remaining 35% of the pharmacy is owned by six other doctors.

No less interesting is the fact that Pond Lehocky has been a strong advocate in opposition to House Bill 18, which was introduced in February of 2017 in an attempt to address the over-prescription of opioids and other painkillers, attempting to create a list of approved drugs, a set duration for treatment, and established dosage amounts for workers injured on the job.

In essence, House Bill 18 would create a pre-approved list, or “formulary” of opioids and other drugs for injured Employees requiring medical care and financial assistance for lost wages under the Workers’ Compensation Act.

With Pennsylvania ranking third in a recent 25 State study of the amount of opioids prescribed to injured workers, Bill supporters advocate that House Bill 18 is necessary to protect workers from the effects of being over-prescribed opioids, potentially resulting in other health conditions and extending recovery phases.

In response, Pond Lehocky, in advertisements that it had raised in response to House Bill 18 criticized the proposed legislation as catering to the insurance company, potentially leaving injured workers without proper treatment, as well as being a wedge between Patients and their doctors.  Pond claims that Workers First is a “mail delivery pharmacy” serving as a “counter to insurance companies warranting capricious denial of medical care to people who are recovering from injuries sustained while on the job.”

The opposition to House Bill 18 has been intensive, and no less expensive with close to $4,000,000.00 being spent by “legal professional” lobbyists, opposing the legislation.

True, more dollars were spent by “liability reform” lobbyists, although it is unclear how much of the “liability reform” dollars were spent on workers’ compensation issues.

The September 24, 2017 article by The Philadelphia Inquirer raises very serious issues with respect to conflicts of issue, as well as the potential for abuse and overreach, while, no doubt, advocates, like Pond Lehocky, will claim that their efforts are geared towards reducing worker suffering, as opposed to prolonging the shelf life of workers’ compensation claims, and eventual recoveries predicated on the length and duration of claims remaining open.

However you might look at this issue and whatever your orientation might be, there would still seem to be an unholy alliance in “investing” in the medical outcomes of Clients.

In the final analysis, the Inquirer’s banner headline poses the essential question, being whether this “arrangement” is, in fact, “ripe for corruption?”

 

ConnorsO’Dell LLP

Trust us, we just get it!  It is trust well spent!

We defend Employers, Self-Insureds, Insurance Carriers, and Third Party Administrators in Workers’ Compensation matters throughout  Pennsylvania.  We have over 100 years of cumulative experience defending our clients against compensation-related liabilities, with no attorney in our firm having less than ten (10) years of specialized experience, empowering our Workers’ Compensation practice group attorneys to be more than mere claim denials, enabling us to create the factual and legal leverage to expeditiously resolve claims, in the course of limiting/reducing/extinguishing our clients’ liabilities under the Pennsylvania Workers’ Compensation Act.

Every member of our Workers’ Compensation practice group is AV rated.  Our partnership with the NWCDN magnifies the lens for which our professional expertise imperiously demands that we always be dynamic and exacting advocates for our clients, navigating the frustrating and form-intensive minefield pervasive throughout Pennsylvania Workers’ Compensation practice and procedure.