Court Said IME Doctor Lied

New York State Supreme Court Judge Duane Hart concluded that an “independent medical expert” (“IME”) named Michael Katz, who insurance companies regularly employed to undercut workers' compensation claims, lied about how extensive his exams were. 

Dr. Katz claimed that he performed various tests during his 20 minute examination. However, the claimant’s videotape of the exam showed that it lasted less than two minutes, and that the tests were not done. Judge Hart declared that Dr. Katz had lied, and stated that the matter should be referred to the District Attorney to prosecute for perjury. The judge also imposed $10,000 sanctions upon the attorneys representing the insurance company that hired Dr. Katz. 

Long Term Disability insurers are well known for their using IMEs to create evidence to contradict the supporting treating medical experts. However, it seems to me that Judge Hart’s conclusions can also be applied to the consultative examinations (“CEs”) that are done in connection with Social Security Disability (“SSD”) hearings. 

I have advised administrative law judges (“ALJs”) for years that the CEs are fraudulent because the reports contain exam finding that never took place. I have even advised some of my clients to videotape the exams, a practice that I will now universally endorse. 

It seems to me that if a fraudulent exam by an IME in the context of a State workers compensation case is perjury, then a fraudulent CE in the context of a federal SSD case would be a false or fictitious statement in violation of 18 U.S.C. § 1001. Since a doctor who seeks payment from the Social Security Administration under Medicare for tests that were not done can be prosecuted under 18 U.S.C. § 1001, then why can’t a doctor who seeks payment from the Social Security Administration under the SSD program for tests that were not done be prosecuted under 18 U.S.C. § 1001?