Los Angeles County buses will soon be large, rolling warnings against workers’ compensation fraud.
Related: Judge Upholds New York Workers’ Comp Board Ban Against Spinal Surgeon
“If you choose to falsify a claim, exaggerate an injury, or create false medical documentation, you are committing a felony, and my office will prosecute you,” Hochman stated. “In fact, the very buses that soon will carry this message are connected to a recent case in which a Metro bus driver is now charged with staging a fake workplace fall to fraudulently obtain benefits.”
For more than a decade, insurance companies and physician groups have battled it out over the true meaning of Florida statutes: Are doctors considered pharmacists, allowed to dispense medications to injured workers, often at a higher price?
A Florida appeals court this week may have finally answered that question, giving a multimillion-dollar win to employers and carriers that have spent years trying to undo state workers’ compensation regulations that have allowed physician dispensing.
“This is huge. It’s not often you see a complete vindication like this,” said Jerry Fogel, a consultant with Imagine Clinical who has been at the center of the dispensing debate for years.
The 1st District Court of Appeals on Wednesday overturned a Florida Division of Administrative Hearings decision that had upheld a state Division of Workers’ Compensation regulation issued in 2023. That regulation, initially contemplated in 2020, reversed years of regulatory sentiment that the wording of Florida law does, in fact, allow insurers to deny reimbursement when physicians dispense medications to injured workers.
That 2023 rule has now been struck down. It’s unclear if the appellees in the case, including the Florida Department of Financial Services, the Florida Medical Association, and Prescription Partners LLC, will try to appeal to the state Supreme Court, or if the rule will now be revamped.
Those organizations and their lawyers could not be reached for comment Thursday. Rumors quickly circulated that efforts already were underway to change the law before the Florida legislative session is set to end March 13.
The place where injured workers obtain their prescriptions may not seem like a big deal. After all, workers’ compensation rates for most employers have fallen dramatically in Florida and nationwide over the last two decades. But insurers involved in the case said medical costs could be lower—and outcomes could be improved—if doctors stayed out of the medication-selling business. It’s a potential conflict of interest and physicians are not always trained on a wide range of medications like pharmacists are, insurance groups have said.
