Prisons chief alleges fraud
Wednesday, May 2, 2012 - Posted by Rich Miller
* It’s hard to argue with the guy…
The head of the Illinois prison system told a legislative subcommittee that he believes millions of dollars paid out in workers’ compensation claims to Menard guards who claimed injury from turning keys involved “fraud.”
Tony Godinez, director of the Illinois Department of Corrections, alleged fraud in response to a question from Rep. Dwight Kay, R-Glen Carbon, during an April 18 session of the Appropriations-Public Safety Committee.
“I am not surprised nor am I taken aback too often in this job, but that was one time I was,” said Kay.
That was Kay’s reaction when Godinez, drawing on his long experience working in the state’s prison system, told the committee, “I think there’s fraud.” This was in reference to more than $10 million paid to guards and Menard Correctional Center employees for repetitive trauma injuries, usually carpal tunnel syndrome of the wrist or cubital tunnel syndrome of the elbow. […]
“I think there’s fraud. I’m sorry to say that but I’ve been working in this business a long time and was (warden) at Stateville for 12 years, some 12 very hard years, and I never saw claims like I’ve seen since I’ve been back,” Godinez said.
In answer to another question from Kay as to why the maximum security Menard prison, and to a lesser extent the medium security Pinckneyville Correctional Center, would be the only two prisons to have numerous repetitive trauma claims, Godinez said, “In my professional opinion, on a personal side, if you’re running a maximum security facility and your claim is using the keys too much, you’re not using them much in a maximum security facility. They’re not coming out a lot. So, I don’t understand why (Menard) as opposed to other facilities where the inmates in minimum and medium are coming out more and the keys are turned more.”
* Part of the problem here is that state agencies no longer have to pay workers’ comp claims. CMS now does that. So the agencies, like Corrections, have no incentive to either stop the fraud (since the cost is coming out of somebody else’s pocket) or fix the problem that’s causing the injuries (since that would cost the agency money and not fixing it would be somebody else’s problem).
Attorney General Lisa Madigan explained this situation in a recent letter to legislative leaders…
Prior to the Blagojevich Administration, some of the largest State agencies – IDOT, IDOC, DHS and ISP – each administered their own workers’ compensation claims, using their own funds. As a result, those agencies had a direct financial interest in improving the workplace to avoid or minimize workers’ compensation claims, defending against workers’ compensation claims and ensuring that injured workers could return to work as soon as possible to reduce the cost of TDD [Temporary Total Disability] payments.
Under the consolidated system for workers’ compensation claims, however, the employing agencies do not experience any impact to their budgets when their employees file claims or remain off of work and on TTD for an extended period of time, providing those agencies with no financial incentive to determine the cause of the increase in claims and take steps to eliminate it. The agencies also have little incentive to accommodate employees whenever possible (including with light duty work) to allow them to return to work quickly.
* Madigan also related this workers’ comp horror story from the private sector…
In 2009, the Second District Appellate Court reinstated benefits to an employee who was injured when he threw himself up against a vending machine in an attempt to dislodge a bag of Fritos that had become stuck after a co-worker attempted to purchase them. Circuit City Stores, Inc. v. IIC, 391 Ill. App. 3d 913 (2d Dist. 2009). The IWCC had awarded benefits to the employee by finding that the personal comfort doctrine applied and that because the employee’s use of physical force to shake the machine to dislodge a bag of chips was neither unusual nor outrageous, the employer was liable for workers’ compensation benefits.2 The Circuit Court reversed, finding that the personal comfort doctrine did not apply. The Appellate Court then reversed and reinstated the benefits.
Some doofus flings himself at a vending machine and that’s covered under workers’ comp? How the heck is that possible? From Madigan…
While acknowledging that the personal comfort doctrine did not apply, the Appellate Court found the claim was nevertheless compensable under the “Good Samaritan” doctrine. The Appellate Court noted that prior cases applying the Good Samaritan doctrine involved an employee providing aide to someone in urgent need (such as rescuing someone who fell into a lake, protecting a young child from physical harm or providing transportation to a stranded motorist and her children). The Appellate Court, however, extended the doctrine to cover an injured worker’s attempt to rescue a co-worker’s stranded bag of chips because the Court found that it was reasonably foreseeable to the employer that this may occur. In addressing the “arising out of’” employment analysis, the Appellate Court concluded that a reasonable trier of fact could find that the “injury originated in a risk incidental to [the employee’s] employment” because (1) the employer provided the vending machine for the convenience of its employees, (2) the machine was defective and (3) the defect “creat[ed] a need for action to dislodge the bag of Fritos.” Circuit City Stores, Inc. 391 Ill. App. 3d at 990-91.
The Illinois Supreme Court has made it clear that Illinois employers are not liable for accidents or injuries solely because they occur at work. The IWCC and the lower courts, however, have increasingly applied an expansive approach to determining whether an accident or injury arose out of and in the course of employment. These decisions have created significant challenges for employers in defending claims on the issue of compensability.
Sheesh.
- Captain Illini - Wednesday, May 2, 12 @ 9:18 am:
Okay…I’m just going to say it even though its contrary to the article’s point. The common denominator for most agency grief is CMS. The skim that’s occurring from ghost management of state buildings and consolidation of various tasks is just short of criminal. If I could wave a magic wand, it would eliminate CMS and allow procurment and other functions by either the agencies again, or through contracts…(frankly I haven’t figured that part out yet, though I would be celebrating for at least two weeks if it happened…)
- titan - Wednesday, May 2, 12 @ 9:21 am:
I seem to recall seeing workman’s comp granted to a (private sector) worker who, while on a business trip, had a heart attack while getting frisky with a paid companion. It would seem that a fair bit of the workman’s comp system might be ripe for revision.
- one day at a time - Wednesday, May 2, 12 @ 9:22 am:
Next DOC workers will claim disability due to a diagnosis of “Situational Claustrophobia”. Fear of going into small enclosed spaces i.e. cells. lol
- Leave a Light on George - Wednesday, May 2, 12 @ 9:30 am:
What Captain Illini said!
- John Galt - Wednesday, May 2, 12 @ 9:33 am:
The “workman’s comp reform” that was passed a short while back was weak sauce. It only reduced reimbursement rates for physicians–zero anti-fraud provisions.
They need to get a second bite at the apple here.
- Ahoy - Wednesday, May 2, 12 @ 9:41 am:
– Illinois Supreme Court has made it clear that Illinois employers are not liable for accidents or injuries solely because they occur at work. The IWCC and the lower courts, however, have increasingly applied an expansive approach to determining whether an accident or injury arose out of and in the course of employment.–
Maybe it’s time to finally address causation? I’m sure there will be people on this board who disagree, but I think the facts speak for themselves. The Courts are having a hard time deciphering when Workers Compensation should be applied; I believe this is due to bad laws that need to be fixed.
This is a two pronged budget issue:
1. Our Workers Comp laws are costing the State a lot of money.
2. Our Workers Comp laws are hurting our business climate which creates jobs which creates more taxpayers.
- Fed up - Wednesday, May 2, 12 @ 9:41 am:
Sounds like Lisa is making excuses for her offices ineptness. Her office represents the tax payers in these claims and has done a terrible job. I wonder if union campaign donations keep her from cracking down on fraudulent workers comp claims.
- Downstate - Wednesday, May 2, 12 @ 9:44 am:
One of my firms was forced to pay a work comp claim for an individual who claimed a back injury - even though we were able to prove that he was participating in TWO summer golf leagues.
We appealed the ruling to no avail.
The work comp system is corrupt from top to bottom.
- wordslinger - Wednesday, May 2, 12 @ 9:45 am:
–the agencies, like Corrections, have no incentive to either stop the fraud (since the cost is coming out of somebody else’s pocket) or fix the problem that’s causing the injuries (since that would cost the agency money and not fixing it would be somebody else’s problem).–
If that’s what’s happening, it’s a terrible case of “not-my-job” parochialism.
Fortunately, the real chief of both CMS and Corrections is the governor. It’s clearly within his powers and duties to straighten this mess out.
As appropriator, the GA also has an oversight role. Hearings would seem to be in order. Many GA members have a lot of time on their hands as they wait for leadership to tell them what to do.
From my understanding of the law, a statewide grand jury wouldn’t apply here, but the Illinois State Police and AG should still be all over it. The state’s attorneys with jurisdiction over Menard and Pickneyville could convene grand juries as well.
The head of IDOC has alleged widespread fraud costing taxpayers millions. You can’t un-ring that bell.
Time to get to work.
- Colossus - Wednesday, May 2, 12 @ 9:52 am:
Ah, I see The Unions Boogeyman has already been brought into play. I’ll be sure to check my closet and under my bed before I go to sleep tonight, lest they come and snatch my children away for indoctrination.
- Honestly - Wednesday, May 2, 12 @ 10:09 am:
I have also witnessed the State go to the other extreme and simply fired workers after they file a workers comp claim. This type of mischief, in addition to harming workers, also shifts costs to the AG’s office.
- Robert - Wednesday, May 2, 12 @ 10:16 am:
==Sounds like Lisa is making excuses for her offices ineptness. Her office represents the tax payers in these claims and has done a terrible job. I wonder if union campaign donations keep her from cracking down on fraudulent workers comp claims.==
You are very possibly correct. However, did you read the link? AG Madigan is smart enough to know that when some stink is thrown her way, she better clean it up, and her detailed proposals, if adopted, would seem to go a long way to cleaning it up.
- Foxfire - Wednesday, May 2, 12 @ 10:19 am:
I’m not sure why anyone is surprised by these reports. Businesses and the Illinois Chamber have been pushing reforms for years only to be stymied. We all know who opposes those efforts, we know why they oppose them, and we know who they empower.
The work comp system is a real problem that requires real reform. Causation is common sense and should be done.
As an employer, I’ve been told by legal counsel more than once to cut a deal because arbitrators won’t fairly consider both sides. So, it’s not just the decisions that the arbitrators make, it’s the decisions that they don’t get to make because it’s easier and less costly to settle.
- mark walker - Wednesday, May 2, 12 @ 10:24 am:
Unions are a red herring here. Abuses of workers comp occur as much or more in non-union private companies, as in unionized government offices.
- Bitterman - Wednesday, May 2, 12 @ 10:26 am:
Talk about coming to the party late! The AG is finally acting on a problem that is been with us a long time. As has been posted above, the private sector employers have for years been crying out for changes but to no avial. Last year’s worker’s comp reform did not come close to fixing the problem as Ahoy 9:41 pointed out.
And yes, the labor unions, along with the trial lawyers, need to take credit for preventing meaningful changes.
- wordslinger - Wednesday, May 2, 12 @ 10:32 am:
–Unions are a red herring here. –
Ah, Mark, don’t take the boogie-man away.
Given what’s happening to public employee pensions, retirement age and healthcare contributions, those who don’t want to get it never will.
- Returning Dog - Wednesday, May 2, 12 @ 10:41 am:
“So the agencies, like Corrections, have no incentive to either stop the fraud….or fix the problem that’s causing the injuries”
The problem here isn’t incentives - if agencies were paying it directly, that doesn’t mean there would be funds available to fix problems or fight fraud.
- Just Observing - Wednesday, May 2, 12 @ 11:24 am:
=== Some doofus flings himself at a vending machine and that’s covered under workers’ comp? ===
Uh Rich, evidently you have never been hungry and had a bag or Fritos stuck in a vending machine after you paid for it. Where’s the empathy?
- Anon - Wednesday, May 2, 12 @ 11:45 am:
And we wonder why there is not sufficient money to pay for vital Medicaid services?
- Louis Howe - Wednesday, May 2, 12 @ 11:50 am:
Actually, DOC’s HR personal were never even aware or processed the Worker’s Comp. claims as all employee claims were filed direcly through CMS.
- Yellow Dog Democrat - Wednesday, May 2, 12 @ 11:55 am:
=== Part of the problem here is that state agencies no longer have to pay workers’ comp claims. CMS now does that. So the agencies, like Corrections, have no incentive to either stop the fraud (since the cost is coming out of somebody else’s pocket) or fix the problem that’s causing the injuries (since that would cost the agency money and not fixing it would be somebody else’s problem). ===
Thanks for pointing this out Rich. As I’ve been saying all long, one of the core principles of performance-based budgeting and Illinois’ Budgeting for Results law is “budgeting with hard constraints,” which is another way of saying “no cost shifting to someone else’s budget.”
Private sector companies like Caterpillar dramatically increased employee safety and reduced worker compensation claims once individual plants and managers were held accountable for reducing workplace injuries as part of their overall budget.
This, btw, negates the argument that worker’s compensation requires a statutory fix. What it requires is a change in management mentality.
As for those who claim that the problems in Menard require a statutory solution…let me say out loud what everyone else is afraid to.
Contesting worker’s comp claims on behalf of the state and preventing fraud is the job of the Attorney General. Maybe the AG’s office needs additional resources, maybe there needs to be better coordination between CMS, agencies, and the AG, but I seriously doubt we need another law.
The law ALREADY provides for criminal prosecution and civil liabilities of three times actual damages for anyone who files a fraudulent claim. The AG’s Office with the cooperation of CMS and Corrections ought to pursue any fraud it suspects.
- Louis G. Atsaves - Wednesday, May 2, 12 @ 12:02 pm:
The audit showed only 2% of the funds CMS paid out were from awards of Arbitrators. The other 98% came from settlements arranged with CMS, the AG and the plaintiffs attorneys.
Time the State fix internally the 98% problem. The private sector would have zealously defended all of those carpal tunnel claims.
The bottom line is the State can save millions of dollars in claims just by using common sense and dedicating itself to appropriately defending itself. Those so-called phony claims will dry up once those who want to game the system realize that they won’t see anything out of it.
- Fed up - Wednesday, May 2, 12 @ 12:35 pm:
Wordslinger, Contesting worker’s comp claims on behalf of the state and preventing fraud is the job of the Attorney General. Maybe the AG’s office needs additional resources, maybe there needs to be better coordination between CMS, agencies, and the AG, but I seriously doubt we need another law.
Maybe we just need an Attorney General that actually looks out for the tax payers of the state of Illinois. I’m sure we will see a nice photo op of Lisa going after easy scap goats like a check cashing place or a bad nursing home while ignoring massive fraud in workers comp.
- Yellow Dog Democrat - Wednesday, May 2, 12 @ 1:37 pm:
@Fed up:
I don’t believe its helpful or necessary to politicize the debate over solutions by either ignoring the role of the AG’s office or taking cheap shots at it.
Let’s keep in mind that as part of his budget proposal, Governor Quinn proposed yet another round of funding cuts for the AG’s office, despite the fact — as you point out — that the AG plays a significant role in protecting taxpayer dollars and actually generates revenue for the state.
I’d also point out that last time I checked, public lawyers from the AG’s office down to your local state’s attorney’s are among the lowest if not the lowest paid attorneys in the state…if not the lowest paid among any professionals.
Right now, an Assistant Attorney General with three years prior legal experience starts out making $50K a year. These are the folks who deter Medicaid fraud, enforce environmental regulations, etc. That ain’t a lot of dough given the mountain of debt folks have coming out of law school and the complexity of the legal cases handled.
If we’re serious about law enforcement, we need to compensate the lawyers who enforce the law better so that we can attract and retain the highest calibre attorneys.
- Fed up - Wednesday, May 2, 12 @ 1:56 pm:
Ydd,
Yes her funding was cut this year. Maybe if she could point to the good job she was doing saving taxpayers money from workers comp abuse, we could justify her budget. But considering she has basically ignored this fraud along with all other corruption it makes it difficult to say she deserves more.
- Yellow Dog Democrat - Wednesday, May 2, 12 @ 2:37 pm:
@Fed Up:
LOL. She’s pointed to the “good job” she’s done saving Illinoisans tens of millions each year and that didn’t stop budget cuts. You think one more press release is going to make a difference?
BTW, I’m not sure, but I believe that while the AG represents the state in cases before the Workers’ Compensation Commission, technically the prosecution of workers’ compensation fraud is the jurisdiction of local state’s attorneys. If that’s the case, then maybe that’s one thing that ought to change.
On the other hand, maybe having the AG responsible for representing the state and prosecuting fraud is a conflict-of-interest? I could go either way.
- Michelle Flaherty - Wednesday, May 2, 12 @ 2:41 pm:
all that and a bag of chips
- Demoralized - Wednesday, May 2, 12 @ 5:31 pm:
Fed Up:
Stop making such ridiculous comments. Your partisan bashing is pathetic. To suggest that the AG has any interest in letting something like this happen is baloney. Try making a coherent argument or providing evidence and then maybe I’ll listen to you. Until then your comments are just worthless partisan ranting.
- Fed Up - Wednesday, May 2, 12 @ 6:21 pm:
Demoralized,
Yes suggesting that something like campaign contributions from unions would affect policy is just crazy. Oh didnt Pat Quinn get 50k and an endoresment from AFSCME after promising no job cuts. Im sure thats just ridiculous to you.
- Wilson Pickett - Wednesday, May 2, 12 @ 9:27 pm:
I can’t help but visualize Pat Quinn reading this article and pondering: “But, did the guy ever get his bag of Fritos? I better check with Lisa tomorrow.”
- Demoralized - Wednesday, May 2, 12 @ 11:10 pm:
Fed Up:
Grasping at straws aren’t you. Your comments on here are always pathetically slanted. You offer nothing of substance so you attack. A simple “I hate Lisa Madigan” would have done. That’s the gist of your argument. The rest is just nonsense.
- Fed Up - Wednesday, May 2, 12 @ 11:37 pm:
sorry I dont follow lock step with you Democrat love. You should be demoralized about the corruption, incompetance, nepotism and insider deals that are common place in illinois politics. But the status quo is working for you I guess.