View this article online: https://www.claimsjournal.com/news/southeast/2005/08/11/58251.htm
The West Virginia Workers’ Compensation Commission’s decision to terminate a Beckley physician from the workers’ compensation program was recently upheld by an administrative law judge, resulting in the right to reclaim more than $1.3 million in fraudulently obtained payments.
Earlier this year, the Commission terminated the rights of Michael Kostenko, DO, of Beckley, for reportedly abusing the system by providing health care that is excessive, medically unreasonable and unethical. Kostenko is an osteopathic general practitioner who operates the Coal Country Clinic in Beckley, W. Va.
The Commission’s decision to terminate Kostenko as a physician in the workers’ compensation system was based on the following: • Kostenko routinely performed exams and labs which were unrelated to a work-related injury; • Kostenko allowed the administration of tendon sheath injections by unqualified staff to injured workers that were in excess of treatment guidelines; and, • Kostenko engaged in fraudulent billing practices.
Under West Virginia Code, the Commission may permanently terminate the right of any health care provider to receive payment for services rendered to injured workers. Before the termination decision is final, a provider has the opportunity to provide evidence as to why the right to receive payment from the Workers’ Compensation Commission should not be terminated.
Kostenko’s appeal hearing before Administrative Law Judge Jack McClung began April 5 and a decision was rendered on July 21. The decision states in part, “After careful and thorough review of the record and exhibits admitted into evidence, it is the finding of the undersigned hearing examiner that the evidence at hearing of this matter weighs heavily in the favor of the West Virginia Workers’ Compensation Commission.”
On Aug. 3, the Commission sent Kostenko a notice for reimbursement for payments made to his clinic where tendon sheath injections were administered without medical necessity or were submitted fraudulently as services rendered to injured workers.
Kostenko has 60 days to return $1,351,665.23.