Dionne steps aside in BIW battle; court refuses to take hospital fee issue from Workers’ Comp Board
By Lindsay Tice, Staff Writer
Jun 22, 2010 12:00 am Lewiston Sun Journal
Saying that recent publicity made him look biased, Paul Dionne, chairman of the seven-member Maine Workers’ Compensation Board, has decided he will no longer be involved in a long-running battle over how much hospitals may charge employers that pay medical bills for injured workers.
Dionne is also board chairman of Central Maine Healthcare Corp., which includes Central Maine Medical Center in Lewiston. In March, Bath Iron Works filed a court motion seeking to have Dionne removed from the decision-making process, claiming that since Dionne was compensated as a member of that hospital group board, he cannot be — and has not been — impartial when helping the Workers’ Compensation Board decide how much hospitals can charge.
Dionne disagreed that he had a conflict, but said he recused himself because the publicity surrounding the issue gave the appearance of a conflict.
“It’s a hard decision because this is a very important issue for the workers’ compensation system,” he said. “But I’ve got a lot of confidence in the board members.”
Dionne officially recused himself at a Workers’ Compensation Board meeting last month. This month a judge denied BIW’s request to remove both Dionne and the Workers’ Compensation Board from the decision-making process, saying such a move was not yet warranted and there may yet be less intrusive ways to resolve the situation.
It appears the judge was unaware that Dionne had already stepped aside, since she made reference to Dionne’s “continuing participation” and did not mention his recusal in her decision.
At issue is the fee hospitals charge for the use of operating rooms, hospital beds and other facilities, services and equipment. BIW claims that in the early 1990s, as part of the state’s reform of Workers’ Comp, the board was required to create a list of allowable hospital fees — capping charges for workers’ compensation patients in a way similar to Medicaid and Medicare patients.
BIW said such a cap is important to businesses that self-insure for workers’ compensation because those businesses pay their own hospital bills and cannot negotiate charges, as insurance companies do. Without a list of allowable fees, BIW said, hospitals charge whatever they deem “usual and customary,” resulting in bills that are sometimes tens of thousands of dollars higher than what businesses think they should be.
In 2006, BIW filed suit against the Maine Workers’ Compensation Board, saying it had failed for 14 years to do its job. In 2008, a judge sided with BIW and ordered the board to create a fee list.
A year-and-a-half later there was still no list, though the board said it was working on it. BIW’s motion, filed this spring in Kennebec County Superior Court, asked the court to intervene, saying “The inescapable fact is that the Board has not fulfilled its statutory obligation for no reason other than that it truly does not want to do so.” It asked the judge to remove both Dionne and the Workers’ Compensation Board from the process and to appoint an independent person, called a receiver, to create the list.
In her denial, the judge said it was not yet time to take such a drastic step, though she said “… the court recognizes the difficult issues presented by Mr. Dionne’s continuing participation” and agreed with BIW that “It raises a serious question as to whether Dionne, as the holder of this critical vote and also Chairman of the Board for CMH, should participate.” The judge’s order allows BIW to bring the issue back to court at a later time if the company still isn’t satisfied with the board’s progress.
Jon Fitzgerald, a lawyer for BIW, said the court’s decision boils down to one thing: “We haven’t been frustrated enough.”
“She essentially said ‘You’ve got to continue to struggle through rule making,’” he said.
The judge also ordered the board to look at allowable doctors’ fees, saying state law requires it to annually review and adjust those fees and it has not done so.
Dionne said he had not seen the court’s rulings and could not comment on them. John Rohde, a lawyer for the Workers’ Compensation Board, said the court’s decision means the board can continue its work.
“We never really thought the request for a receiver had any merit to it at all anyway. So it’s not going to change what we’re doing here in terms of the facilities fee rule, which we’re still working very hard at,” he said.
Fitzgerald said he has found working with the board easier since Dionne recused himself. He remains hopeful the battle will end.
“Justice is coming, but it’s been slow,” he said.
Lewiston Sun Journal
AUGUSTA
Apr 14, 2010 12:00 am Lewiston Sun Journal
AUGUSTA — Gov. John Baldacci said Tuesday he has directed his chief legal counsel to investigate a longtime member of the state Workers’ Compensation Board who pleaded guilty to an assault charge in 12th District Court in Farmington last week.
The case stems from a bar fight last October at a conference where Anthony Monfiletto, 54, of Portland, was representing the state. According to Carrabassett Valley police, Monfiletto attacked Scott Spencer, 43, at the Widowmaker Lounge at Sugarloaf Mountain Resort on the second night of a three-day summit on workers’ compensation.
It was the second assault case against Monfiletto in his 14 years on the board, on which he represents organized labor. He was convicted and fined $500 for assault in a West Bath court in 1998, a year after he was appointed to the board.
Under the Workers’ Compensation Act, the governor’s office has the power to remove board members for “willful neglect of duty or malfeasance in office.” Such action would have to be approved by the Legislature’s Joint Standing Committee on Labor.
Gov. John Baldacci “has asked his chief legal counsel to investigate the circumstances of the incident in October and the plea agreement to determine what action, if any, is appropriate,” said David Farmer, the governor’s deputy chief of staff.
The Workers’ Compensation Board administers and resolves disputes between employers and victims of workplace injuries. In 2009, the board and its staff handled nearly 8,000 disputed claims for workers’ compensation, according to the most recent annual report.
After pleading guilty at a hearing in Farmington last Thursday, Monfiletto was placed on deferred disposition — essentially a form of probation — as part of an agreement with the District Attorney’s Office. If Monfiletto does not engage in any criminal conduct in the next year, and if he has no contact with Spencer, the case will be dismissed. Breaking those rules would result in automatic, retroactive conviction.
The day after the hearing — last Friday — the Maine Center for Public Interest Reporting began asking the governor’s office and the executive director of the Workers’ Compensation Board about Monfiletto. The statement from the governor’s office about the investigation was given to the center on Tuesday afternoon.
Workers’ Comp Insider is Lynch Ryan’s weblog about workers’ compensation, risk management, business insurance, workplace health & safety, occupational medicine, injured workers, insurance webtools & technology and related topics. For more articles by them, go to www.workerscompinsider.com.
Maine’s Fee Schedule: Down the Rabbit Hole Written by By Jon Coppelman on March 23, 2010
Three months ago we blogged the ongoing agony of Bath Iron Works (BIW), the people who build destroyers for the navy. You may recall that BIW self insures for workers comp, and as such must pay the “usual and customary” fees for medical services provided to injured workers. There are only two categories of payers who are stuck with usual and customary fees: self insureds and uninsureds. BIW has been waiting 18 years for Maine to come up with a fee schedule. Eighteen years! The Board in charge of developing the fee schedule is asking for…a little more time.
So what’s the problem? Paul Dionne, the Chairman of the Maine Workers Comp Board – the board responsible for developing the fee schedule – is also board chairman of Central Maine Healthcare Corporation – which stands to lose a lot of money once the fee schedule is implemented. Dionne is compensated by the comp board and by Central Maine Healthcare. If he were really candid, he might admit that his idea of a fee schedule is “usual and customary” fees. Dionne claims they are really getting close to the point where they will be able to issue a draft fee schedule for public comment.
Timely Remedies?
As reported by Lindsay Tice in the Lewiston Sun Journal, BIW has filed suit, claiming that Dionne has a conflict of interest. This is their second lawsuit. Back in 2006 they sued the board for its (then) 14 year failure to implement a fee schedule. The judge sided with BIW and ordered the board to create the fee schedule. Four years later…well, you get the drift (and I do mean drift!).
Dionne has consulted with an attorney, who advised him that there was a “potential” for a conflict of interest. (Brilliant work, counsel!) Dionne is seeking a second opinion from the board’s general counsel. Here’s a second opinion: it’s a conflict of interest!!!
Dionne claims that, if necessary, he will fully disclose his personal interests, as he has done in the past. Sure, Paul. The foxes are promising better management of the chicken coop. Foxes love chickens. They are very committed to raising the “usual and customary” chickens, fat and healthy.
Start Over?
The sheer passage of time, now approaching two full decades, has compromised the Maine fee schedule beyond recognition. It has become an embarrassment. It’s unlikely that any fee schedule issued by this board will be credible. Perhaps it’s time to create a truly independent body to develop the fee schedule. The bad news for BIW is that this would further delay the regulatory relief they have long sought. The good news is that the fee schedule might actually lower the fees.
During this prolonged process, BIW has tumbled down the rabbit hole, Maine version, into a world where nothing is quite what it seems. BIW – in the unlikely role of Alice, meets a Cheshire cat, with a grin like Paul Dionne’s:
`Cheshire Puss, …Would you tell me, please, which way I ought to go from here?’
`That depends a good deal on where you want to get to,’ said the Cat.
`I don’t much care where–’ said Alice.
`Then it doesn’t matter which way you go,’ said the Cat.
`–so long as I get SOMEWHERE,’ Alice added as an explanation.
`Oh, you’re sure to do that,’ said the Cat, `if you only walk long enough.’
Workers Comp Board gets back to business
By Kathryn Skelton
Staff Writer
In a 12-pen signing, Gov. John Baldacci inked into law Thursday changes to the workers compensation system in Maine that he said would put behind bitterness and acrimony that’s lingered for years.
“We’re able to reform the operation and make sure both injured workers and business are being better served for the future,” Baldacci said, writing a few letters of his name with each pen and later handing the pens to the people who helped with the bill’s passage.
The law, which took effect immediately, changed the Workers Compensation Board from eight members to six and named the board’s executive director — former Lewiston Mayor Paul Dionne — as chairman and the board’s seventh, tie-breaking, member.
It should mean faster results for injured workers in Maine and a more stable environment for businesses.
Three members will continue to represent management, picked by the Maine Chamber of Commerce, and three will continue to represent labor, picked by the Maine AFL-CIO.
Paring down the board shouldn’t be hard. One labor member from Lewiston quit last month and one management member’s four-year term expired two years ago.
“This is really a historic moment,” said Baldacci. “Maine is going to be an inviting state. It’s not going to be one mired by controversy and shutdown.”
Workers compensation insurance has been mandatory here since 1974. All businesses pay for it, with a few exceptions for agriculture and one-person shops.
Among other things, the board controls how long financial benefits are given to injured workers and how many people get lifetime benefits, both of which affect premium rates to businesses.
Since 2001, the board has been divided over whether to extend benefits, over budget issues, over the appointment of hearing officers and over who to elect as chair.
A Portland attorney last year tried to have the entire board declared incompetent because of its divisions and the delays it has caused.
“I can assure all of you that the board will be striving for reconciliation, for common ground,” said Dionne, the executive director since 1996. He predicted: “I will probably never have to break a tie.”
Dionne, an attorney, served as Lewiston mayor from 1980 to 1984. Along with his new role, he’s been invited to Baldacci’s weekly cabinet meeting with commissioners and department heads, a seat at the table that the Workers’ Compensation Board has never had.
He has a number of issues to work on when board meetings resume April 20, among them how to approach five hearing officer appointments at the end of the year.
Hearing officers act as judges in disputes between insurance companies and injured workers over money, bills or getting an old job back.
In December 2002, the board split on whether to reappoint or fire two hearing officers, and they lingered on with pay until last October. Meanwhile the system slowed down.
The caseload at the end of 2002 was 1,324 and the average formal dispute took 7.2 months to resolve, Dionne said. The caseload has increased by 400 and resolution is now taking two months longer.
Buddy Murray, commissioner of the Department of Professional and Financial Regulation, said new board members and an executive director picked by Baldacci should be in place by fall.
kskelton@sunjournal.com
Lewiston Sun Journal March 5, 2003
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