I received a call today from an officer in the W.C. fraud unit in responsedto the claim I filed against the Ins. companies Q.M.E. who claimed to have spent 2 hours in face to face time doing my Q.M.E. when in fact he only spent 30 minutes, total.

I am fortunate to have a number of items that back my claim including a signed parking ticket in the garage at the medical building. The Officer is going to subpoena the Dr.'s records and interview other patients regarding the time he spent with them.

If you request a copy of the Q.M.E., you can look and see how much time he claims to have spent with you, you can see if he is billing honestly. I noticed it on the 1st Q.M.E. and filed a claim with a tape recording as evidence. The officer I spoke with said at that time that a tape recording wasn't good evidence as it could be tampered with. Also, having a witness is also only a limited plus as it is still your word against the Dr. and his staff's. It's best to create a paper trail.

I also intend to send this information to the Governor's office, so that he knows that the corruption is also taking place on the Dr's end. (Not that he doesn't know, but it's just one more thing to complain to him about since he really screwed up our states system!)

Hopefully, others here can keep an eye on whether or not things are above board in their case as well!

Thanks all for reading,

Cala

PM ME...
I'm investigating and slamming a QME
he needs to be removed from the system and his license stripped

I have not actively practiced w/c since 9/03. But I recall these "time" issues used to come up occasionally on both sides of the fence. (Remember I represented insurance co.s, and that's why I try to share my experience so much with everyone, because I share sort of "insider" stuff.) Anyways, I think, and don't want to look it up, that when they take your history, etc., if it is a designated physican's aide in that regard, that the time is included. I vaguely remember that it doesn't have to be ALL by the doc himself or herself, but staff who are properly designated can be included in that.

I can't remember if reading your history and med reports adds to that 2 hour face time, if the doc reads them personally or has an aide.

I vaguely recall that 1/2 hour was required as face-to-face with the actual doctor. Again, it's in those Codes, and I just don't have the ability to go search right now.

It should be in the Labor Code itself having to do with QMEs. The Labor Code spells out specifically what is required of them in that regard, as I recall.

Whenever anyone I've known has seen a psych, the time there adds up to almost a full day, with testing. Are you saying you spent less than 2 hours for the total exam, as by your parking ticket - including testing, history, etc.? That would be outrageous.

I believe, but don't have the Criminal Code on hand, that taping in CA is illegal unless you had permission, or, you are out in public, (which a doc office I do not believe would justify a public place for the purpose of that statute - again, just my personal opinion and not a legal absoulte), just for those who are thinking of hiding a recording device.

Please keep the board posted on this, and if you want, I would like to know more about what happened as far as how long you were there, etc. It is useful for everyone to share, but bear in mind, Cal, as you already said, other jurisdictions may not be the same as what you've experienced, and the taping, etc., might be legal and useful in another state. They may use it for investigative purposes and not for "evidence admissable to court", which was our entirely different post.

Best of luck on your fraud complaint about the QME - I'm assuming it was that psych..

I found my four-year old notes on "time" issues with the doctor.

If anyone wants to look them up, I've copied them here. Just FYI for whoever wants them.

Med Rpt. Rqmts. LC 139 and Indust. Med. Council any QME must spend 30 mins face to fact time w/ P

Med Rpt. Rqmts. LC 4628 Dr.s’ declaration & rqmts. re: staff involvement, inadmissible if violated

Otherwise, Med Rpt. Rqmts. CCR10606 Affects weight not admissibility if lacking 15 points req'd.

P&S Rpt. Rqmts. CCR 9785(g) Doctor only shall perform all tasks of exam, any diagnostic techs, etc. must be identified & setforth qualifications in report Scheffield Medical Group (3/1999), LC 4628 Sanctions: bar of all reports, bar of liens & fines.

And remember Employer can’t have med. info., such as medical (whole) reports - limited to "need to know" to fix work restrictions per caselaw and LC 3762

I know I had a QME with a neurologist that spent less than five minutes with me, left the room for 15 minutes and came back and spent another 5 minutes with me. An exam was not even done. Then he wrote that I refused to let him examine me - or check my reflexes. Because someone is in pain and jumps when you go to touch them does not constitute refusal to let them examine you. I even offered for him to try again but HE refused. He also ignored the TOS diagnosis and didn't check pulses, ask me to raise my arms, etc.
So, I wish I'd known about the 30 minute rule back then. This forum is so useful in helping educate us and the newly diagnosed people about the system.
Hope