Report: #1388226

Complaint Review: California Medical Evaluators

  • Submitted: Tue, July 25, 2017
  • Updated: Thu, July 27, 2017
  • Reported By: QME Physician — Pasadena California USA
  • California Medical Evaluators

    Nationwide
    USA

California Medical Evaluators CMEGabor VariCalifornia Psychiatric Evaluators Workers Compensation Billing Fraud Insurance Fraud Los Angeles Nationwide

*UPDATE Employee ..inside information: Response from CME

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Psych QME - Thank you for posting this and providing the public with truthful information about California Medical Evaluators and its owner Gabor Vari!! I'm so sorry to hear that you lost your certification as a result of the company's actions. 

I used to be a QME with California Medical Evaluators (aka CME) and fortunately caught on to what they were doing in terms of unlawful biling pretty quickly - I left before they were able to cause too much damage so I still have my QME certification. I am aware of many of the CME doctors losing their QME license and being audited because of billing issues. I don't know exactly what the DWC's concern was with respect to those doctors but I can speak about my experience with the company:

I have been a QME for over 10 years. About 2 years ago, I met a recruiter who worked with CME who I really liked (he is no longer with the company). After speaking with him, it seemed to make sense to increase my workers' compensation evaluations by going with a management company who could handle more volume. The recruiter explained that CME would handle all of the administrative tasks relating to the evaluations (including the billing). After I started up with the company, I no longer had any interaction with the recruiter (who I really liked) and unfortunately only had interactions with the owner Gabor Vari. I learned very quickly that this guy (an ex-psychiatrist) was a person I did not want to be associated with AT ALL.

After QME doctors perform an evaluation, they write a report and send it to California Medical Evaluators to be sent off to the insurance companies with a bill. Under the state medical-legal fee schedule, ML105s are billed out hourly (whereas the lower codes are billed at flat rates). Also, QMEs are billed out less than AMEs (agreed medical evaluators). I freqently asked Gabor Vari for copies of my final reports before they were sent out. I was always met with defiance and would have to go to the billers or the accounting people for a copy of my reports. Unfortunately, they'd be sent to me AFTER they billed the insurance company. More than 1/2 the time I noticed that the company billed me out incorrectly - and it wasn't done by accident. For example, they would bill me out as an AME when I clearly was a QME chosen to do an evaluation through the panel system. On at least 4 different ocassions, they had upcoded my services. I also saw times where the company double and even triple billed the insurance company under my name and kept the overpayments for themselves!!!!

I frantically called Gabor Vari asking him to immediatley inform the insurers of the errors and to reimburse overpayments. He refused to do so claiming that "if it was the insurance company's fault, he was going to keep the money." He tried to convice me that I shouldn't be concerned about the upcoding or the "errors" in billing because I would ultimately get paid more if I just stayed quiet and didn't tell the payors about the errors. He tried to convince me that if the DWC caught on, that he'd be able to argue that the higher billing codes were proper or would hire an attorney to do so. 

At least twice while I was with the company, Gabor Vari performed internal "audits" of the doctors and would inform us if we weren't billing enough ML105s...threatening to fire us if we only billed lower billing codes. 

Nothing about that company felt right and I refused to stay quiet knowing that my license (medical and QME) was on the line. I informed the DWC of what was going on at CME and promptly left the company.  

What's frightening is that CME takes 50% of everything it bills the doctors for. So it's not surprising that Gabor Vari would not fix bills submitted in my name. He makes a lot of money off of the QMEs - unfortunately though - he has no consideration for the doctors and is even less concerned of the damage he is causing by fraudulently billing the insurance companies. It's also unfortunate because California Medical Evaluators and Gabor Vari have approval from the division of Workers Compensation to provide training to QMEs - yet here they are fraudulently billing and their doctors are losing their licenses.

I am one of the lucky ones who left the company when my gut was telling me to do so. Now there are a lot of doctors who are stuck in a really bad place, being audited by the DWC and being denied renewal of their certification (or losing it) becasue of CME's fraudulent billing in the doctors' names. 

Please be careful QMEs!!! These guys don't care who they hurt to make a buck. If you lose your QME certification, the Division of Workers Compensation can report this to the medical board and you could lose your license to practice! I spoke with an attorney when I left CME last year and he told me that a company's fraudulent billing under your name is not a defense!!

 

 

 

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This report was posted on Ripoff Report on 07/25/2017 07:38 PM and is a permanent record located here: http://www.ripoffreport.com/reports/california-medical-evaluators/nationwide/california-medical-evaluators-cmegabor-varicalifornia-psychiatric-evaluators-workers-comp-1388226. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content

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#1 UPDATE Employee ..inside information

Response from CME

AUTHOR: CME - (USA)

Thank you for voicing your concern about our company and services.  Although I would prefer the opportunity to discuss any matters with you, I feel I can clarify some of your concerns here.

I would like to start by saying that we, at California Medical Evaluators, strictly adhere to the procedures and laws that govern the California Department of Workers compensation. As stated in the previous post you are responding to, California Medical Evaluators is not being investigated for fraud.  We provide a valuable service to providers looking to work in the Medical-Legal industry.  We have a long-standing reputation of helping providers more effectively manage their medical-legal practice, which can be very time consuming and perplexing. We have well over 100 providers currently in our network and according to our recent provider satisfaction ratings, we are highly rated amongst them.

Although I understand that you are not a current member of our network, I would encourage the opportunity to reach out to me directly so that I may alleviate any of your concerns.

I would like to discuss in detail the overall procedures we strictly adhere to and help alleviate any concerns.

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