NFL Alleges ‘Deep and Widespread’ Fraud in Concussion Settlement
The league calls for a special investigator to look into accusations of fraudulent claims potentially worth hundreds of millions of dollars
NFL commissioner Roger Goodell during a news conference at the NFL meetings in March. PHOTO: PHELAN M. EBENHACK/ASSOCIATED PRESS
The National Football League has asked a federal judge to appoint a special investigator to probe what it describes as a widespread fraud that has resulted in hundreds of millions of dollars in false claims to a fund meant to compensate former players for head injuries.
The motion alleges fraudulent schemes by doctors, lawyers and players to illicitly tap the uncapped fund, which is potentially valued around $1 billion. The league established the fund as part of a settlement agreement with players, and the NFL has so far funded more than $227 million in claims.
The motion—filed in the U.S. District Court for Eastern Pennsylvania, where the settlement is overseen—says that an independent administrator in the case has recommended that more than 400 claims be rejected because of fraud. That amounts to 23% of the total claims submitted and has a potential value of hundreds of millions of dollars based on the claims already awarded.
Among the allegations: At least one player was advised to show up to a neuropsychological evaluation hungover and on Valium, to ensure that he failed cognitive tests required to qualify for a settlement. Medical reports submitted by one neurologist included identical vital signs for more than 20 different players. One doctor claimed to have spent 130 hours evaluating players in a single day—on two separate occasions.
The 2017 concussion settlement between the league and retired players established a 65-year, uncapped fund for players with qualifying diagnoses, such as CTE, ALS, Alzheimer’s disease, Parkinson’s and other neurocognitive impairments.
But the NFL has faced accusations that it has dragged its feet in paying players. A March filing from lawyers representing the players said the agreement is “failing to provide a fraction of what the NFL promised.” That filing accuses the league of shirking its responsibility to pay players and, in other instances, taking too long to review claims.
The NFL’s new motion fires back with a different explanation: Deserving players are facing delays because of “deep and widespread” fraud in the case perpetrated by other players, their lawyers and doctors. The league argues that the long wait time for reviewing claims is the result of the growing need to closely evaluate all of the cases because of the crooked ones.
“Ironically,” the motion says, “some of the lawyers who are complaining most vociferously and publicly about the slow pace of claims administration are themselves associated with the submission of questionable claims and the true cause of the delay.”
The motion calls for a special investigator to “identify all culpable parties, fashion appropriate remedies, provide effective deterrence and protect against payment of fraudulent claims.”
Additionally, the NFL asks that the special investigator be given subpoena power and be allowed to assist with recommendations about which doctors and lawyers should be referred to disciplinary boards and federal authorities.
“We want to ensure that players and their families receive the benefits they deserve. Fraud threatens the integrity of the settlement and the prompt payment of legitimate claims,” said Brad Karp, chairman of Paul, Weiss, Rifkind, Wharton & Garrison, which is representing the NFL. “There is significant evidence of fraudulent claims being advanced by unscrupulous doctors, lawyers and even players.”
According to the settlement agreement, the NFL does not play a role in approving the claims. That is done by an independent firm. The league has the right to appeal claims, which it has done in 10% of cases.
Gene Locks, a lawyer representing a large number of players who wrote the March motion criticizing the league, did not respond immediately to requests for comment.
“We have previously expressed concerns about potentially fraudulent claims and agree the appointment of a special investigator is appropriate,” said Christopher Seeger, co-lead counsel representing the players. “However, we will not allow this small number of claims to be used as an excuse by the NFL to deny payment to legitimately injured former players.”
Approximately 46% of the submitted claims have warranted audit by the independent claims administrator because of “red flags or other signs of potential fraud,” according to the league’s motion.
The filing details allegations of systematic fraud perpetrated by doctors, lawyers and players who sought to cheat the testing process in order to qualify for a settlement.
In some instances, law firms are accused of organizing the fraud. One law firm, representing more than 100 former players, is alleged to have “coached” players on how to answer questions during their evaluations and was “willing to pay doctors directly out of their pocket” for a qualifying diagnosis.
Another law firm allegedly charged players more to obtain an Alzheimer’s diagnosis, the motion says, and many of those players’ evaluations were done by a pediatric neurologist. The motion states that 75% of the players seen by the pediatric neurologist received an Alzheimer’s diagnosis even though they were as young as 29 years old.
That same pediatric doctor, identified as “Doctor-A,” is accused of submitting reports with identical vital signs for 21 different claimants. “When questioned about that medical impossibility,” the filing says, “Doctor-A was unable to provide an explanation.”
The league also accuses players of being active participants in the fraud. In one instance, a player diagnosed with Alzheimer’s in 2015 is later alleged to have denied any problems with speech, memory or concentration in a 2017 medical history questionnaire.
Some of the alleged occurrences happened when the players worked with a claims service entity to beat the tests. According to the motion, one text message from a claims representative to a retired player reads: “We found some things that we think we can take advantage of so you can pass the test the second go around.”
The league is seeking the special investigator to help recommend appropriate action against the doctors and lawyers. That could include their disqualification as eligible physicians in the settlement program or potential criminal charges.
It is unclear if players ultimately found to have made fraudulent claims would be allowed to get reevaluated and submit their claims again.
No comments:
Post a Comment