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Paterson schools workers comp. medical billing spiked 78-percent under risk manager Samir Goow | Paterson Times

Paterson schools workers comp. medical billing spiked 78-percent under risk manager Samir Goow

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The school district’s workers’ compensation medical billing skyrocketed by 78-percent under suspended risk manager Samir Goow, according to an internal investigation report provided to the school board last week.

Under Goow, the district’s medical billings for workers compensation cases went from $1.27 in 2016 to $2.31 million in 2017, according to the report. Number of bills from medical providers jumped from 492 to 1,389 – a 182-percent increase – during that same period.

Goow on Wednesday said he did not see the report.

“My goal has always been to provide quality medical care to the employees. It’s unfortunate the medical costs got to where they did,” said Goow. He said he was in the process of negotiating to reduce medical expenses before he was removed in Feb. 2018 following allegations of “irregularities” with the City of Paterson’s medical billings.

Questions about billing increases ought to be asked to the district’s third-party administrator, Cannon Cochran Management Services, which approves the payments, said Goow.

The third-party administrator’s review of billings led to a 45.68-percent or almost $1.1 million reduction. After reduction, the increase was 58-percent from 2016 to 2017 or 4-percent above the billing levels of 2015.

In 2015, charges stood at 1.9 million. There was a $759,369 reduction or 38.6-percent. The third-party administrator is responsible adjustments for such things as duplicate billings, and fee schedule repricing for in-network providers.

The report says Goow added three new providers that benefited from the increase. He added orthopedic doctor Robert Kayal, Patient Care Associates of Englewood, and Totowa Center for Pain Management and Physical Medicine.

Patient Care Associates is the surgical facility used by Kayal.

690 bills worth $319,821 came from Totowa Center for Pain Management and Physical Medicine. 125 worth $385,7000 from Kayal. 8 worth $187,202 from Patient Care Associates.

The total payments to the three entities represented 49-percent of all provider payments in 2017, according to the report.

Neither the two providers nor Kayal responded to calls for comment on Wednesday.

“I don’t have a relationship with them,” said Goow of the three providers. He said he picked the three providers because they were “top quality.” Employees were returning to duty quicker with the providers and there were fewer medical complications, he said. His company’s office is in the same building as Totowa Center for Pain Management and Physical Medicine, according to the report.

Goow was contracted by the district in Jan. 2017 through his firm Investigations Unlimited to serve as risk manager following the retirement of in-house risk manager Laurie Moloney to save money on salary and benefits. His firm was hired for $70,000 from Jan. 1 through Jun. 30, 2017. His contract was renewed for the next school year for the same amount. Just days before his firm was suspended, Goow’s contract was increased by 20-percent for a total of $84,000 for 2017-18 school year.

Moloney retired from the district in Sept. 2016. In Oct. 2016, the district put out a request for qualification. Three companies submitted proposals — Brown and Brown for $5,550 per month; Acrisure LLC for 7,500 per month; and Investigations Unlimited for $115 per hour.

The district’s attorney Robert Murray and assistant superintendent for human capital and labor Luis Rojas reviewed the proposals. Murray did not think the other two firms were a good fit for the district and selected Goow’s company.

The district could not produce signed contracts with Investigations Unlimited, according to the report.

“The auditors cannot conclude that there was any direct evidence of any impropriety,” reads the report.

Three corrective actions were taken following the investigation. Murray said the company’s contract will not be renewed and the risk manager will no longer have the authority to add healthcare providers without written consent of general counsel.

2 of the 3 providers Goow added were out-of-network and the other was added to in-network. The third-party administrator was advised to only assign cases in-network and seek approval for out-of-network.

The district suspended Goow’s firm when the City of Paterson began investigating big increases in medical payments in workers compensation cases. The probe was focused on $2 million increase in medical payments, according to a city official at the time.

The city’s chief attorney Domenick Stampone on Wednesday said Goow remains suspended pending a hearing. A departmental hearing was scheduled, but had to be adjourned at Goow’s request.

Stampone said the city referred the matter involving Goow to the New Jersey Attorney General’s Office when he was suspended for possible prosecution.

Goow is the brother of former councilman Aslon Goow.

Email: jay@patersontimes.com

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