- Drug Shortages Feared After Closure of Contaminated Irvine Planton May 24, 2022 at 11:32 AM
The Israel-based, multinational Teva, one of the world's largest generic drug producers, closed its pharmaceuticals manufacturing plant in Irvine, California, after receiving the latest in a string of warning letters from the US Food and Drug Administration (FDA) about observations of contamination, dirty changing rooms and scrubs, and a years-long lack of sterilization and testing of equipment.
In an October 2021 letter, the FDA detailed possible mold contamination of the company's injectable drugs from unaddressed water leaks. In response, Teva recalled more than 2.5 million vials of injectables used for indications such as cancer, arthritis, schizophrenia, and muscle relaxation for intubation. It also halted production at the facility.
Teva’s violations appear related to a gradual relaxing of standards at the factory as opposed to deliberate wrongdoing, said John Gray, a professor of operations at the Ohio State University Fisher College of Business after reviewing the documents obtained by Bloomberg.
In its first analysis, the newly formed End Drug Shortages Alliance (EDSA) warns that the recent shuttering of a troubled Teva Pharmaceuticals manufacturing plant could affect the availability of 24 generic sterile injectable drugs, including 5 essential medications for which the company had an over 15% market share.
EDSA, is a collaboration of more than 70 health systems and supply chain and pharmaceutical industry experts formed in November 2021, and it aims to end drug shortages by boosting transparency, communication, quality, redundancy, and production.
The EDSA report, released last week, involved a market analysis of the potentially affected drugs, which include those used to treat cancer, adult and pediatric diabetes, and pancreatic neuroendocrine tumors.
The injectables produced at the closed plant most vulnerable to shortages were the vasodilator alprostadil; the antibiotic amikacin; the chemotherapy drugs bleomycin, dacarbazine, idarubicin, ifosfamide, mitoxantrone, streptozocin, and topotecan; and the hormone octreotide.
Those less likely to be affected are injectable adenosine, daunorubicin, desmopressin, epoprostenol, epoprostenol diluent, etoposide, haloperidol decanoate, leucovorin, medroxyprogesterone, methylprednisolone acetate, metoclopramide, norepinephrine, vecuronium, and vincristine.
The report lists suppliers that may step up production of the drugs to meet needs, estimates the potential impact for each drug, and details strategies to help surmount supply challenges.
Specifically, it advises drug manufacturers to assess their ability to boost production of the affected drugs and pivot or increase capacity, and it recommends that wholesalers keep enough supplies on hand to ensure the medications are available.
The FDA, the EDSA said, should expedite approval of any applications for drugs affected by the plant closure or mull their importation, particularly for those without alternatives (eg, streptozocin). Group purchasing organizations should formulate strategies to provide more redundancy for essential medications, and providers and clinicians should practice good stewardship when ordering, prescribing, and administering the affected drugs, EDSA added.
"Information shared in this report highlights the level of transparency that is required across the supply chain to successfully navigate drug shortages," Terri Lyle Wilson RPh, EDSA vice-chair and director of pharmacy supply chain services at the Children's Hospital Association, said in a news release.
While onshoring of drug production will shorten the supply chain and make it easier for the FDA to inspect facilities, onshoring is not always a failsafe solution. Many other US drug manufacturing plants have had serious FDA compliance issues in recent years, including Eli Lilly & Co.'s New Jersey facility, Pfizer's Kansas operation, and Emergent BioSolutions in Baltimore, which led to the disposal of as many as 400 million doses of COVID-19 vaccine in the past 2 years.
"The proximity of making medications in America can be an important factor in strengthening the resilience of our drug supply chain," he said. "However, where a drug is made is not a guarantee of its quality. Quality assurance is essential to a robust drug supply no matter where the drug is made."
- Tustin Podiatrist Sentenced After Conviction for Treatment Fraudon May 24, 2022 at 11:32 AM
A podiatrist from Tustin, who in February was found guilty of billing insurance companies for medical services that were never actually performed, was sentenced to nearly a year in prison.
42 year old Renae Louise Witt is scheduled to report to the Orange County Jail on June 17, after being convicted of seven felony counts of filing a fraudulent claim for a health benefit. She was sentenced to 364 days in jail, two years formal probation and ordered to pay restitution to the insurance companies.
A judge has rejected her request to extend her jail surrender date.
Witt also faces a 10-year suspension of her medical license.
Between 2015 and 2017, while working as a doctor of podiatric medicine at the Tustin Place Medical Group, Witt billed two insurance companies for $174,395 for podiatrist appointments that never happened and for medical services that were never performed for six different patients. The insurance companies paid out $75,861.52 for these fraudulent claims.
One of the patients was not even in the country on some of the dates that Witt billed appointments on her behalf.
When Anthem Blue Cross began investigating patient complaints about the billings, Witt provided fabricated medical records to try to justify the fraudulent billings.
Prosecutors say she moved to Oregon on Nov. 6 2017 and was living in La Pine, Oregon, when she was was arrested on Jan. 19, 2018 by deputies from the Deschutes County (Oregon) Sheriff’s Department, and then.extradited after being charged on Jan. 16 2018 with seven felony counts of insurance fraud with sentencing enhancements for aggravated white collar crime over $100,000 and loss of over $65,000,
"Doctors are entrusted with the most serious of responsibilities to maintain and restore human health," said Orange County District Attorney Todd Spitzer.
"Instead this doctor violated that position of trust and used her unsuspecting patients as a revenue stream by bilking insurance companies out of tens of thousands of dollars for work she never performed. The Orange County District Attorney’s Office is committed to protecting patients from unscrupulous doctors and protecting insurance companies from being defrauded. Holding bad actors accountable prevents insurance rates from being increased and keeps costs down for patients."
Deputy District Attorney Steven Bunn of the Insurance Fraud Unit prosecuted this case.
- Apportionment Mandatory When Disability Caused by Two CT Periodson May 23, 2022 at 1:15 PM
Jeanette Chamorro filed two applications for injury she claimed to have sustained while working for Saputo Cheese U.S.A.. One was a specific injury on October 10, 2010 (ADJ10793276) to her upper extremities and multiple other body parts as a result of the "repetitive nature of her job duties." The second one was for a cumulative injury through March 1, 2017 to the same body parts (ADJ10870183).
In case The WCJ found that applicant sustained an injury in case ADJ10793276 from October 10, 2009 through October 10, 2010 to her arms, hand, fingers, upper extremities, and thumbs. And that applicant sustained an injury in case ADJ10870183 from August 31, 2016 through August 31, 2017 to her lumbar spine, right shoulder, bilateral wrists, cervical spine, and hands .
The WCJ found that her award of 41% permanent disability was caused by the injury in ADJ10870183. And awarded temporary disability indemnity as a result of the injury in ADJ10793276 and was entitled to future medical care for both injuries.
Stonington Insurance Company filed for reconsideration contending that the WCJ erred in finding that all permanent disability resulted from the second cumulative trauma injury. Reconsideration was granted in the panel decision of Chamorro v Saputo Cheese U.S.A., ADJ10793276-ADJ10870183 (May 2022).
In this case, the threshold issue was whether there were two cumulative trauma injuries or a single injury. If there were two injuries, the issue of apportionment of permanent disability between the two dates of injury must be addressed and requires medical evidence.
The date of injury for an industrial cumulative trauma injury is defined by Section 5412, as follows: "The date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment."
As used in Labor Code Section 5412, "disability" means either compensable temporary disability or permanent disability. (Chavira v. Worker’s Comp. Appeals Bd. (1991) 235 Cal.App.3d 463 [56 Cal.Comp.Cases 631]; State Compensation Insurance Fund v. Workers’ Comp. Appeals Bd. (Rodarte) (2004) 119 Cal.App.4th 998 [69 Cal.Comp.Cases 579].)
Separate cumulative trauma injuries occur where "periods of disability and/or need for medical treatment [are] interspersed within the course of the repetitive activities.- (Aetna Casualty & Surety Co. v. Workmen's Comp. Appeals Bd. (Coltharp) (1973) 35 Cal.App.3d 329 [38 Cal.Comp.Cases 720] and Ferguson v. City of Oxnard (1970) 35 Cal.Comp.Cases 452 (Appeals Board en banc).)
There is a single cumulative trauma with one date of injury (i.e., the first period of compensable temporary disability) where periods of temporary disability were linked by a continued need for medical treatment under Western Growers Ins. Co. v. Workers’ Comp. Appeals Bd. (Austin) (1993) 16 Cal.App.4th 227 [58 Cal.Comp.Cases 323].)
When Western Growers (Austin) is read in conjunction with the Labor Code section 3208.1 definition of "cumulative injury," the anti-merger provisions of Labor Code sections 3208.2 and 5303, and the holding of Aetna Casualty (Coltharp), the following principles apply:
- - (1) if, after returning to work from a period of temporary disability and a need for medical treatment, the employee’s repetitive work activities again result in injurious trauma (i.e., if the employee’s occupational activities after returning to work from a period of temporary disability cause or contribute to a new period of temporary disability, to a new or an increased level of permanent disability, or to a new or increased need for medical treatment), then there are two separate and distinct cumulative injuries that cannot be merged into a single injury (Lab. Code §§ 3208.1, 3208.2, 5303; Aetna Casualty (Coltharp), supra, 35 Cal.App.3d at p. 342); and
- - (2) if, however, the employee’s occupational activities after returning to work from a period of industrial temporary disability are not injurious (i.e., if any new period of temporary disability, new or increased level of permanent disability, or new or increased need for medical treatment result solely from an exacerbation of the original injury), then there is only a single cumulative injury and no impermissible merger occurs. (Lab. Code, §§ 3208.1, 3208.2, 5303; Western Growers (Austin), supra, 16 Cal.App.4th at p. 235.)
If applicant sustained two injuries, it is settled law that when two industrial injuries combine to cause permanent disability, the permanent disability caused by each must be separately awarded, unless the evaluating physician cannot parcel out, with reasonable medical probability, the approximate percentages to which each distinct industrial injury causally contributed to the employee’s overall permanent disability. (Benson v. The Permanente Medical Group (2007) 72 Cal.Comp.Cases 1620 (Appeals Board en banc), affirmed sub nom. Benson v. Workers’ Comp. Appeals Bd. (2009) 170 Cal.App.4th 1535 [74 Cal.Comp.Cases 113].)
The panel concluded the review of the law on apportionment and ruled that "Given that the record requires further development on the number and nature of injuries and apportionment between injuries pursuant to Benson, supra, we must return this matter to the trial level."
- City of San Diego Comp Claims 17% Higher Than Similar Agencieson May 23, 2022 at 1:15 PM
A new audit shows that the city of San Diego worker's compensation spending is rising annually, but is not taking the necessary steps to curb the cost.
The audit, released this week, says last fiscal year the city spent $40.7 million in employee medical expenses and industrial leave. But when accounting for indirect costs such as lost productivity, that amount skyrockets to $224 million, an amount higher than the library and parks and recreation annual budgets combined.
The audit says the amounts spent on workers comp have increased each fiscal year for the past five years, and the city's workers comp claim rates are 17 percent higher than similar agencies.
According to the City’s Injury and Illness Prevention Program (IIPP), individual departments are responsible for developing and implementing their own safety programs.
While departments have different safety needs based on the type of work conducted, auditors found that some departments’ safety programs do not address core elements of the Citywide IIPP. In addition, it found that the City’s Occupational Safety and Health program (OSH) had not, until recently, started reviewing and verifying whether departments have implemented and continue to maintain their required safety programs.
Finally, interviews with City staff indicated that some departments may not have enough resources dedicated to developing, managing, and promoting an effective safety program. These issues have likely contributed to the City having workers’ compensation claims rates that are 17 percent higher than similar agencies, as well as increased workers’ compensation costs and work days lost. Further, many employees indicated a lack of confidence in the City’s safety programs.
Auditors say it is imperative for the City to leverage data analytics to take a closer look at its existing safety programs and develop effective incident prevention strategies. Auditors found a lack of Citywide requirements on root cause analysis and corrective actions, coupled with insufficient incident investigation trainings provided to supervisors, has contributed to inconsistent and ineffective incident investigation practices. In addition, they found that, while the City performs some analyses with workers’ compensation claims data, it does not systematically collect and track injury, illness, and near-miss data to identify and prioritize safety issues
The Workers’ Compensation Division’s Claims Adjusters are trained to identify red flags for potential fraud in workers’ compensation claims. Additionally, fraud tips can come to Workers’ Compensation through either the City’s Fraud Hotline or directly to Workers’ Compensation. Although Workers’ Compensation has a process for reviewing and documenting investigations into red flags and tips, it does not centrally track all allegations of fraud or red flags and the outcome of investigations into the red flags or tips. As a result, Workers’ Compensation is missing potential information on the pervasiveness of workers’ compensation claims fraud or potential trends across the City.
Recommendations to improve Citywide safety management and the monitoring of controls over potential workers’ compensation fraud, and management agreed to implement all 10.
- Cal/OSHA Fines Companies $1.75M for Confined Space Fatalityon May 20, 2022 at 11:34 AM
Cal/OSHA fined a San Francisco Bay Area refinery and three contractor companies more than $1.75 million for safety violations following the November 12, 2021 death of a 35 year old worker, Luis Gutierrez, who suffocated while trying to clean a well.
Three of the four employers were cited with willful and serious violations after determining that they failed to follow confined space guidelines, including the failure to determine acceptable entry conditions for the employee, which resulted in exposure to an oxygen-deficient atmosphere.
A willful violation is cited when evidence shows the employer either knowingly violated the law or took no reasonable steps to address a known hazard. A serious violation is cited where there is a realistic possibility that death or serious physical harm could result from the actual hazard created by the violation.
San Antonio-based Valero bought the refinery in 2000, which processes crude oil into gasoline, diesel fuel, jet fuel and asphalt.
Shortly before midnight on November 12, 2021, the worker lost consciousness after descending into a regenerator overflow well at the Valerio Benicia refinery to evaluate the condition of the well interior and perform cleaning operations in advance of a welding crew.
He was found inside the regenerator suspended by fall protection equipment. A refinery emergency rescue team retrieved him. Benicia Fire Department and Valero Fire Department performed medical treatment on-site but were unable to resuscitate him.
Valero spokesperson Paul Adler confirmed the death and described the victim as a worker for a contractor. Cal/OSHA later confirmed that the contractor was JT Thorpe, a Richmond-based company.
Inspectors determined that a welding torch was left in the well that was leaking argon, an odorless gas that displaced oxygen inside the confined space.
"Working in confined spaces is extremely dangerous, as is working with argon," said Cal/OSHA Chief Jeff Killip. "The employers involved had a responsibility to keep their workers safe. The first step to preventing a completely avoidable fatality is to identify hazards before a worker enters a confined space."
Confined space hazards exist in many workplaces. Employers must identify and label confined spaces, establish and maintain onsite emergency response plans, and provide training for workers and supervisors. Common types of confined spaces include tanks, silos, pipelines, sewers, storage bins, drain tunnels and vaults.
The fines given to the Valero Refinery totalled $528,750, Total Safety Specialty was fined $988,000, JT. Thorpe & Son, Inc. fine was $135,500 and finally T.R.S.C., Inc. was fined $101,125.
Among the violations were failure to: evaluate the workplace to determine if any spaces are permit-required confined spaces, ensure employees use equipment and safety precautions during the rescue of an employee, and monitor unauthorized entrants into workspaces.
Cal/OSHA has extensive informational materials on its website, including a confined space guide for general industry to help employers provide safe workplaces and ensure workers know these hazards.
- Sedgwick Acquires Orchid Medical a National Care Service Provideron May 20, 2022 at 11:34 AM
Sedgwick announced it has acquired Orchid Medical, a nationwide provider of ancillary medical management solutions for the workers' compensation industry.
Orchid Medical was established in 2002 as a durable medical equipment (DME) and medical supplies provider. Subsequently it evolved into a national provider of integrated ancillary and surgical cost containment solutions specifically for the workers’ compensation industry.
Orchid Medical offers a broad range of services including Surgical Cost Containment Program® (SCCP), DME & supplies, prosthetics and orthotics, home health and complex care, modifications, diagnostic imaging, physical medicine, transportation and language, retrospective DME, long term care and urine drug testing. It is headquartered and fully operated in Orlando Florida.
Sedgwick says that this acquisition represents an investment in the continued growth of Sedgwick's ancillary care network, which ensures that employees of the company's workers' compensation clients receive prompt, high-value service for durable medical equipment (DME), transportation, translation, home health, diagnostic imaging and other aspects of care on the road to recovery.
"Together with Orchid, we will strengthen our holistic approach to caring for clients' injured and ill colleagues, helping them return to maximum health and productivity," said Andrea Buhl, Sedgwick's president of managed care.
"This acquisition enables us to provide employers with a single point of service for a broad range of ancillary care needs while strengthening our workers' compensation and managed care capabilities and our commitment to taking care of people when they need us most."
"By joining forces with Sedgwick, we'll create a combined network of unparalleled reach and scope that will truly transform ancillary care for workers' compensation," said Paul Taylor, CEO of Orchid Medical. "Bringing together the brilliant minds and outstanding solutions of our two organizations means we can deliver the very best care available to employees of our valued clients."
- Inflation Triggers Increase in California Minimum Wageson May 19, 2022 at 11:15 AM
The California minimum wage is currently $15 an hour for employers of 25 or more employees and $14 an hour for all employers of less than 25 employees. Federal law currently sets the minimum wage at $7.25 per hour. However, federal law allows states and cities to set a minimum wage that is higher than the federal rate.
There are some employees who are exempt from the California minimum wage law, such as outside salespersons, individuals who are the parent, spouse, or child of the employer, and apprentices regularly indentured under the State Division of Apprenticeship Standards.
Several local California jurisdictions have also passed minimum wage laws, such as San Francisco, San Jose, Los Angeles, San Diego, Oakland, and Berkeley, The University of California at Berkeley has compiled and maintains local city and county level minimum wage rates.
A 2016 statute signed into law by former Gov. Jerry Brown, Senate Bill 3, amended sections 245.5, 246, and 1182.12 of the Labor Code, and set forth a plan to gradually increase the statewide minimum wage to $15 per hour over the past six years. SB 3 also included a provision requiring an automatic increase in the minimum wage as determined by the Consumer Price Index..
The California state minimum wage law as amended - Labor Code 1182.12 - provides that the state minimum wage must increase to $15.50 per hour for everyone in 2023 if inflation increases by more than 7% between the 2021 and 2022 fiscal years. Thursday, the California Department of Finance said it projects inflation for the 2022 fiscal year - which ends June 30 - will be 7.6% higher than the year before, triggering the minimum wage increase.
Governor Newsom subsequently announced that all California employers will be required, regardless of size, to pay a new minimum wage of $15.50 per hour, effective January 1, 2023.
This development also increases the minimum salary for most exempt employees in California to $64,480 annually and $5,373.33 per month, effective January 1, 2023. This increase is most significant for smaller employers, who currently have a salary floor of $58,240 annually.
Finally, in other minimum wage developments, earlier last week supporters of California’s ballot initiative to raise California’s minimum wage to $18 per hour announced having submitted more than 1 million signatures - way beyond the 623,000 required to land it on the November ballot. If this ballot measure passes, and many expect that it will, the minimum wage in the Golden State would go to $16 per hour on January 1, 2023, and move up for all hourly employees annually until reaching $18 an hour on January 1, 2028.
"Increasing the minimum wage at this time of spiking prices is a just and urgently needed measure," said David Huerta, president of SEIU California and SEIU-United Services Workers West. But according to the report by Cal Matters, some small business owners said it could further impede California’s economic recovery.
John Kabateck, state director of the National Federation of Independent Business California said "We recognize this is the law but this has the opposite effect on the people they’re trying to help."
Ironically, Newsom on Thursday proclaimed May "Small Business Month" in California.
- Murderer Serving Life Sentence is Lead Defendant in $2M EDD Fraudon May 19, 2022 at 11:15 AM
Federal authorities just arrested five people linked to a ring that allegedly obtained at least $2 million in California unemployment insurance (UI) benefits - mostly pandemic-related relief - by using stolen identities, some of which belonged to California prison inmates.
The arrests were made following a 39-count indictment that charges 13 defendants in a scheme to use misappropriated personal identifying information (PII) to fraudulent apply for, and receive, unemployment benefits, mostly during the second half of 2020.
The lead defendant in the case is Natalie Le Demola, 37, who is currently serving a life prison sentence after she was convicted in 2005 of first-degree murder for killing her mother. The indictment also charges Carleisha Neosha Plummer, 32, of Los Angeles, who was a close associate of Demola in prison until she was paroled in July 2020.
DeMola has been serving a life sentence at the California Institution for Women since 2005 when she and her then-boyfriend, Terry Bell, were convicted of first-degree murder for beating her mother to death at their Corona, Calif., home in 2001. DeMola, who was 16 at the time, and Bell, who was 17, had plotted to kill her mother because she objected to them dating, according to news reports from their trial.
DeMola allegedly procured the personal details, including dates of birth and social security numbers, of other inmates and their visitors from a prison associate who had access to a database containing that info. She would then send the details on to her accomplices outside the prison who would use them to file for fraudulent unemployment benefits which they would have sent to mail boxes they controlled, prosecutors said.
Prison inmates are not eligible for unemployment benefits, but the gang would check boxes on the application stating they were not incarcerated, according to court documents.
The indictment charges all 13 defendants with conspiracy to commit wire fraud and bank fraud. The conspiracy count alleges 150 overt acts, including illegally obtaining PII, some of which was provided by an unnamed prison official employed by the California Department of Corrections and Rehabilitation.
The indictment names various defendants in 31 bank fraud counts and seven aggravated identity theft counts. The defendants named in the indictment are:
- - Demola, originally of Corona, who will be brought to federal court to face the charges in this case;
- - Plummer, 32, of Los Angeles, who was arrested today;
- - Khanshanda King, 31, of Los Angeles, who is still being sought;
- - Cleshay Johnson II, 28, of Los Angeles, who is still being sought;
- - James Antonio Johnson, who has several aliases including "Big Dawg Niddy," 31, of Los Angeles, who is currently in custody in a Los Angeles County jail;
- - Felicite Aleisha King, 41, of Los Angeles, who is still being sought;
- - Shafequah Lynete Mitchell, 33, of Los Angeles, who is currently traveling outside of California;
- - Loresha Shamone Davis, 31, of Moreno Valley, who was arrested today;
- - Porsha Latrice Johnson, 32, of Lynwood, who was arrested today;
- - Donisha Lashawn Pace, 38, of South Los Angeles, who was arrested today;
- - Dominique Charmone Martin, 37, of Yucaipa, who is still being sought;
- - Mykara Destiny Robertson, 23, of Los Angeles, who is still being sought; and
- - Amber Jane Wade, 34, of Palmdale, who was arrested today.
The conspiracy and bank fraud charges each carry a statutory maximum sentence of 30 years in federal prison. Aggravated identity theft carries a mandatory two-year consecutive sentence.
- WCRI Studies Chiropractic Care for Workers with Low Back Painon May 18, 2022 at 12:57 PM
The Workers Compensation Research Institute (WCRI) announced the release of a new study on chiropractic care for low back pain. The study reveals substantial variation in the use of chiropractic care across 28 states and offers insights into the patterns and outcomes of chiropractic care.
"Chiropractors often participate in the delivery of physical medicine services for low back pain, but few workers received chiropractic care in states where employers or insurers control the selection of providers," said John Ruser, WCRI’s president and CEO. "This study will be helpful for policymakers and stakeholders who are interested in re-evaluating the role of chiropractors, especially those who have been adopting evidence-based practices and contributing to cost-effective care."
This study, Chiropractic Care for Workers with Low Back Pain, describes the prevalence of chiropractic care and provider patterns of physical medicine treatment for workers with low back pain. It provides some evidence as to how different provider patterns of physical medicine treatment are associated with variations in overall medical and indemnity costs, and the duration of temporary disability. The study also looks at the utilization of medical services, including magnetic imaging studies, opioid prescriptions, and pain management injections.
The following is a sample of the study’s key findings:
- - The prevalence of chiropractic care varied substantially across the 28 study states. States that give employers control of selecting medical providers were among the states with the lowest prevalence of chiropractic care.
- - When chiropractors are involved in care, they alone may provide physical medicine care or deliver physical medicine care in conjunction with other non-chiropractic physical medicine providers.
- - Based on the experience of 16 states with prevalent chiropractic care, 12 percent of workers with low back pain received physical medicine care exclusively from chiropractors, and 17 percent received physical medicine treatment from chiropractors and other non-chiropractic providers, concurrently or sequentially.
- - Claims with care provided exclusively by chiropractors were associated with lower costs and shorter duration of temporary disability than a set of claims with similar characteristics where care was exclusively provided by non-chiropractic providers.
The data used for this study are from the WCRI Detailed Benchmark/Evaluation database, which includes more than 2 million open and closed claims from 28 states, with injuries from October 1, 2015, through September 30, 2017, and detailed medical transactions up through March 31, 2019.
The 28 states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.
To learn more about this study or to download a copy, visit WCRI’s website. Dongchun Wang, Kathryn L. Mueller, Donald R. Murphy, and Randall D. Lea authored the study.
- Three Face Charges for $128K State Fund Premium Fraudon May 18, 2022 at 12:57 PM
Three Sacramento Area residents face charges of worker's compensation premium fraud by allegedly manipulating their companies payroll resulting in a loss of nearly $128 thousand in State Compensation Insurance Fund premium.
Troy Williams, 49, of Angels Camp, Nanci Morman, 68, of Somerset, and John Allison, 63, of Rocklin, were arraigned on multiple felony counts of insurance fraud after a joint investigation with the California Department of Insurance and the El Dorado County District Attorney’s Office revealed the defendants allegedly conspired together to illegally lower their company’s workers’ compensation insurance premiums and defraud the State Compensation Insurance Fund.
Williams has owned and operated a framing business called Archer Building Company since 2001, which reported carpentry payroll between 2013 and 2016; however, in 2016 the company’s work-related claims costs increased, which would increase its worker’s compensation insurance rates.
The joint investigation found that Allison, an Archer Building Company employee, created Allison Development. Between 2016 and 2020, Archer Building Company diverted its carpentry payroll to Allison Development in order to avoid paying accurate workers’ compensation insurance premiums.
In 2020, Allison Development’s workers’ compensation policy was cancelled and the employees transferred back to Archer Building Company.
The investigation found Archer Building Company and Allison Development attempted to defraud State Fund of $127,795 by not paying the correct amount of premium. Also, it was revealed that Morman was the bookkeeper and point of contact for insurance audits for both companies.
On March 10, 2022, Williams and Morman self-surrendered to the El Dorado County Jail. Allison self-surrendered on March 14, 2022.
They are scheduled to return to court on May 26, 2022. The El Dorado County District Attorney’s Office is prosecuting this case.
- Drug Shortages Feared After Closure of Contaminated Irvine Planton May 24, 2022 at 11:32 AM
The Israel-based, multinational Teva, one of the world's largest generic drug producers, closed its pharmaceuticals manufacturing plant in Irvine, California, after receiving the latest in a string of warning letters from the US Food and Drug Administration (FDA) about observations of contamination, dirty changing rooms and scrubs, and a years-long lack of sterilization and testing of equipment.
In an October 2021 letter, the FDA detailed possible mold contamination of the company's injectable drugs from unaddressed water leaks. In response, Teva recalled more than 2.5 million vials of injectables used for indications such as cancer, arthritis, schizophrenia, and muscle relaxation for intubation. It also halted production at the facility.
Teva’s violations appear related to a gradual relaxing of standards at the factory as opposed to deliberate wrongdoing, said John Gray, a professor of operations at the Ohio State University Fisher College of Business after reviewing the documents obtained by Bloomberg.
In its first analysis, the newly formed End Drug Shortages Alliance (EDSA) warns that the recent shuttering of a troubled Teva Pharmaceuticals manufacturing plant could affect the availability of 24 generic sterile injectable drugs, including 5 essential medications for which the company had an over 15% market share.
EDSA, is a collaboration of more than 70 health systems and supply chain and pharmaceutical industry experts formed in November 2021, and it aims to end drug shortages by boosting transparency, communication, quality, redundancy, and production.
The EDSA report, released last week, involved a market analysis of the potentially affected drugs, which include those used to treat cancer, adult and pediatric diabetes, and pancreatic neuroendocrine tumors.
The injectables produced at the closed plant most vulnerable to shortages were the vasodilator alprostadil; the antibiotic amikacin; the chemotherapy drugs bleomycin, dacarbazine, idarubicin, ifosfamide, mitoxantrone, streptozocin, and topotecan; and the hormone octreotide.
Those less likely to be affected are injectable adenosine, daunorubicin, desmopressin, epoprostenol, epoprostenol diluent, etoposide, haloperidol decanoate, leucovorin, medroxyprogesterone, methylprednisolone acetate, metoclopramide, norepinephrine, vecuronium, and vincristine.
The report lists suppliers that may step up production of the drugs to meet needs, estimates the potential impact for each drug, and details strategies to help surmount supply challenges.
Specifically, it advises drug manufacturers to assess their ability to boost production of the affected drugs and pivot or increase capacity, and it recommends that wholesalers keep enough supplies on hand to ensure the medications are available.
The FDA, the EDSA said, should expedite approval of any applications for drugs affected by the plant closure or mull their importation, particularly for those without alternatives (eg, streptozocin). Group purchasing organizations should formulate strategies to provide more redundancy for essential medications, and providers and clinicians should practice good stewardship when ordering, prescribing, and administering the affected drugs, EDSA added.
"Information shared in this report highlights the level of transparency that is required across the supply chain to successfully navigate drug shortages," Terri Lyle Wilson RPh, EDSA vice-chair and director of pharmacy supply chain services at the Children's Hospital Association, said in a news release.
While onshoring of drug production will shorten the supply chain and make it easier for the FDA to inspect facilities, onshoring is not always a failsafe solution. Many other US drug manufacturing plants have had serious FDA compliance issues in recent years, including Eli Lilly & Co.'s New Jersey facility, Pfizer's Kansas operation, and Emergent BioSolutions in Baltimore, which led to the disposal of as many as 400 million doses of COVID-19 vaccine in the past 2 years.
"The proximity of making medications in America can be an important factor in strengthening the resilience of our drug supply chain," he said. "However, where a drug is made is not a guarantee of its quality. Quality assurance is essential to a robust drug supply no matter where the drug is made." - Tustin Podiatrist Sentenced After Conviction for Treatment Fraudon May 24, 2022 at 11:32 AM
A podiatrist from Tustin, who in February was found guilty of billing insurance companies for medical services that were never actually performed, was sentenced to nearly a year in prison.
42 year old Renae Louise Witt is scheduled to report to the Orange County Jail on June 17, after being convicted of seven felony counts of filing a fraudulent claim for a health benefit. She was sentenced to 364 days in jail, two years formal probation and ordered to pay restitution to the insurance companies.
A judge has rejected her request to extend her jail surrender date.
Witt also faces a 10-year suspension of her medical license.
Between 2015 and 2017, while working as a doctor of podiatric medicine at the Tustin Place Medical Group, Witt billed two insurance companies for $174,395 for podiatrist appointments that never happened and for medical services that were never performed for six different patients. The insurance companies paid out $75,861.52 for these fraudulent claims.
One of the patients was not even in the country on some of the dates that Witt billed appointments on her behalf.
When Anthem Blue Cross began investigating patient complaints about the billings, Witt provided fabricated medical records to try to justify the fraudulent billings.
Prosecutors say she moved to Oregon on Nov. 6 2017 and was living in La Pine, Oregon, when she was was arrested on Jan. 19, 2018 by deputies from the Deschutes County (Oregon) Sheriff’s Department, and then.extradited after being charged on Jan. 16 2018 with seven felony counts of insurance fraud with sentencing enhancements for aggravated white collar crime over $100,000 and loss of over $65,000,
"Doctors are entrusted with the most serious of responsibilities to maintain and restore human health," said Orange County District Attorney Todd Spitzer.
"Instead this doctor violated that position of trust and used her unsuspecting patients as a revenue stream by bilking insurance companies out of tens of thousands of dollars for work she never performed. The Orange County District Attorney’s Office is committed to protecting patients from unscrupulous doctors and protecting insurance companies from being defrauded. Holding bad actors accountable prevents insurance rates from being increased and keeps costs down for patients."
Deputy District Attorney Steven Bunn of the Insurance Fraud Unit prosecuted this case. - Apportionment Mandatory When Disability Caused by Two CT Periodson May 23, 2022 at 1:15 PM
Jeanette Chamorro filed two applications for injury she claimed to have sustained while working for Saputo Cheese U.S.A.. One was a specific injury on October 10, 2010 (ADJ10793276) to her upper extremities and multiple other body parts as a result of the "repetitive nature of her job duties." The second one was for a cumulative injury through March 1, 2017 to the same body parts (ADJ10870183).
In case The WCJ found that applicant sustained an injury in case ADJ10793276 from October 10, 2009 through October 10, 2010 to her arms, hand, fingers, upper extremities, and thumbs. And that applicant sustained an injury in case ADJ10870183 from August 31, 2016 through August 31, 2017 to her lumbar spine, right shoulder, bilateral wrists, cervical spine, and hands .
The WCJ found that her award of 41% permanent disability was caused by the injury in ADJ10870183. And awarded temporary disability indemnity as a result of the injury in ADJ10793276 and was entitled to future medical care for both injuries.
Stonington Insurance Company filed for reconsideration contending that the WCJ erred in finding that all permanent disability resulted from the second cumulative trauma injury. Reconsideration was granted in the panel decision of Chamorro v Saputo Cheese U.S.A., ADJ10793276-ADJ10870183 (May 2022).
In this case, the threshold issue was whether there were two cumulative trauma injuries or a single injury. If there were two injuries, the issue of apportionment of permanent disability between the two dates of injury must be addressed and requires medical evidence.
The date of injury for an industrial cumulative trauma injury is defined by Section 5412, as follows: "The date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment."
As used in Labor Code Section 5412, "disability" means either compensable temporary disability or permanent disability. (Chavira v. Worker’s Comp. Appeals Bd. (1991) 235 Cal.App.3d 463 [56 Cal.Comp.Cases 631]; State Compensation Insurance Fund v. Workers’ Comp. Appeals Bd. (Rodarte) (2004) 119 Cal.App.4th 998 [69 Cal.Comp.Cases 579].)
Separate cumulative trauma injuries occur where "periods of disability and/or need for medical treatment [are] interspersed within the course of the repetitive activities.- (Aetna Casualty & Surety Co. v. Workmen's Comp. Appeals Bd. (Coltharp) (1973) 35 Cal.App.3d 329 [38 Cal.Comp.Cases 720] and Ferguson v. City of Oxnard (1970) 35 Cal.Comp.Cases 452 (Appeals Board en banc).)
There is a single cumulative trauma with one date of injury (i.e., the first period of compensable temporary disability) where periods of temporary disability were linked by a continued need for medical treatment under Western Growers Ins. Co. v. Workers’ Comp. Appeals Bd. (Austin) (1993) 16 Cal.App.4th 227 [58 Cal.Comp.Cases 323].)
When Western Growers (Austin) is read in conjunction with the Labor Code section 3208.1 definition of "cumulative injury," the anti-merger provisions of Labor Code sections 3208.2 and 5303, and the holding of Aetna Casualty (Coltharp), the following principles apply:
- - (1) if, after returning to work from a period of temporary disability and a need for medical treatment, the employee’s repetitive work activities again result in injurious trauma (i.e., if the employee’s occupational activities after returning to work from a period of temporary disability cause or contribute to a new period of temporary disability, to a new or an increased level of permanent disability, or to a new or increased need for medical treatment), then there are two separate and distinct cumulative injuries that cannot be merged into a single injury (Lab. Code §§ 3208.1, 3208.2, 5303; Aetna Casualty (Coltharp), supra, 35 Cal.App.3d at p. 342); and
- - (2) if, however, the employee’s occupational activities after returning to work from a period of industrial temporary disability are not injurious (i.e., if any new period of temporary disability, new or increased level of permanent disability, or new or increased need for medical treatment result solely from an exacerbation of the original injury), then there is only a single cumulative injury and no impermissible merger occurs. (Lab. Code, §§ 3208.1, 3208.2, 5303; Western Growers (Austin), supra, 16 Cal.App.4th at p. 235.)
If applicant sustained two injuries, it is settled law that when two industrial injuries combine to cause permanent disability, the permanent disability caused by each must be separately awarded, unless the evaluating physician cannot parcel out, with reasonable medical probability, the approximate percentages to which each distinct industrial injury causally contributed to the employee’s overall permanent disability. (Benson v. The Permanente Medical Group (2007) 72 Cal.Comp.Cases 1620 (Appeals Board en banc), affirmed sub nom. Benson v. Workers’ Comp. Appeals Bd. (2009) 170 Cal.App.4th 1535 [74 Cal.Comp.Cases 113].)
The panel concluded the review of the law on apportionment and ruled that "Given that the record requires further development on the number and nature of injuries and apportionment between injuries pursuant to Benson, supra, we must return this matter to the trial level." - City of San Diego Comp Claims 17% Higher Than Similar Agencieson May 23, 2022 at 1:15 PM
A new audit shows that the city of San Diego worker's compensation spending is rising annually, but is not taking the necessary steps to curb the cost.
The audit, released this week, says last fiscal year the city spent $40.7 million in employee medical expenses and industrial leave. But when accounting for indirect costs such as lost productivity, that amount skyrockets to $224 million, an amount higher than the library and parks and recreation annual budgets combined.
The audit says the amounts spent on workers comp have increased each fiscal year for the past five years, and the city's workers comp claim rates are 17 percent higher than similar agencies.
According to the City’s Injury and Illness Prevention Program (IIPP), individual departments are responsible for developing and implementing their own safety programs.
While departments have different safety needs based on the type of work conducted, auditors found that some departments’ safety programs do not address core elements of the Citywide IIPP. In addition, it found that the City’s Occupational Safety and Health program (OSH) had not, until recently, started reviewing and verifying whether departments have implemented and continue to maintain their required safety programs.
Finally, interviews with City staff indicated that some departments may not have enough resources dedicated to developing, managing, and promoting an effective safety program. These issues have likely contributed to the City having workers’ compensation claims rates that are 17 percent higher than similar agencies, as well as increased workers’ compensation costs and work days lost. Further, many employees indicated a lack of confidence in the City’s safety programs.
Auditors say it is imperative for the City to leverage data analytics to take a closer look at its existing safety programs and develop effective incident prevention strategies. Auditors found a lack of Citywide requirements on root cause analysis and corrective actions, coupled with insufficient incident investigation trainings provided to supervisors, has contributed to inconsistent and ineffective incident investigation practices. In addition, they found that, while the City performs some analyses with workers’ compensation claims data, it does not systematically collect and track injury, illness, and near-miss data to identify and prioritize safety issues
The Workers’ Compensation Division’s Claims Adjusters are trained to identify red flags for potential fraud in workers’ compensation claims. Additionally, fraud tips can come to Workers’ Compensation through either the City’s Fraud Hotline or directly to Workers’ Compensation. Although Workers’ Compensation has a process for reviewing and documenting investigations into red flags and tips, it does not centrally track all allegations of fraud or red flags and the outcome of investigations into the red flags or tips. As a result, Workers’ Compensation is missing potential information on the pervasiveness of workers’ compensation claims fraud or potential trends across the City.
Recommendations to improve Citywide safety management and the monitoring of controls over potential workers’ compensation fraud, and management agreed to implement all 10. - Cal/OSHA Fines Companies $1.75M for Confined Space Fatalityon May 20, 2022 at 11:34 AM
Cal/OSHA fined a San Francisco Bay Area refinery and three contractor companies more than $1.75 million for safety violations following the November 12, 2021 death of a 35 year old worker, Luis Gutierrez, who suffocated while trying to clean a well.
Three of the four employers were cited with willful and serious violations after determining that they failed to follow confined space guidelines, including the failure to determine acceptable entry conditions for the employee, which resulted in exposure to an oxygen-deficient atmosphere.
A willful violation is cited when evidence shows the employer either knowingly violated the law or took no reasonable steps to address a known hazard. A serious violation is cited where there is a realistic possibility that death or serious physical harm could result from the actual hazard created by the violation.
San Antonio-based Valero bought the refinery in 2000, which processes crude oil into gasoline, diesel fuel, jet fuel and asphalt.
Shortly before midnight on November 12, 2021, the worker lost consciousness after descending into a regenerator overflow well at the Valerio Benicia refinery to evaluate the condition of the well interior and perform cleaning operations in advance of a welding crew.
He was found inside the regenerator suspended by fall protection equipment. A refinery emergency rescue team retrieved him. Benicia Fire Department and Valero Fire Department performed medical treatment on-site but were unable to resuscitate him.
Valero spokesperson Paul Adler confirmed the death and described the victim as a worker for a contractor. Cal/OSHA later confirmed that the contractor was JT Thorpe, a Richmond-based company.
Inspectors determined that a welding torch was left in the well that was leaking argon, an odorless gas that displaced oxygen inside the confined space.
"Working in confined spaces is extremely dangerous, as is working with argon," said Cal/OSHA Chief Jeff Killip. "The employers involved had a responsibility to keep their workers safe. The first step to preventing a completely avoidable fatality is to identify hazards before a worker enters a confined space."
Confined space hazards exist in many workplaces. Employers must identify and label confined spaces, establish and maintain onsite emergency response plans, and provide training for workers and supervisors. Common types of confined spaces include tanks, silos, pipelines, sewers, storage bins, drain tunnels and vaults.
The fines given to the Valero Refinery totalled $528,750, Total Safety Specialty was fined $988,000, JT. Thorpe & Son, Inc. fine was $135,500 and finally T.R.S.C., Inc. was fined $101,125.
Among the violations were failure to: evaluate the workplace to determine if any spaces are permit-required confined spaces, ensure employees use equipment and safety precautions during the rescue of an employee, and monitor unauthorized entrants into workspaces.
Cal/OSHA has extensive informational materials on its website, including a confined space guide for general industry to help employers provide safe workplaces and ensure workers know these hazards. - Sedgwick Acquires Orchid Medical a National Care Service Provideron May 20, 2022 at 11:34 AM
Sedgwick announced it has acquired Orchid Medical, a nationwide provider of ancillary medical management solutions for the workers' compensation industry.
Orchid Medical was established in 2002 as a durable medical equipment (DME) and medical supplies provider. Subsequently it evolved into a national provider of integrated ancillary and surgical cost containment solutions specifically for the workers’ compensation industry.
Orchid Medical offers a broad range of services including Surgical Cost Containment Program® (SCCP), DME & supplies, prosthetics and orthotics, home health and complex care, modifications, diagnostic imaging, physical medicine, transportation and language, retrospective DME, long term care and urine drug testing. It is headquartered and fully operated in Orlando Florida.
Sedgwick says that this acquisition represents an investment in the continued growth of Sedgwick's ancillary care network, which ensures that employees of the company's workers' compensation clients receive prompt, high-value service for durable medical equipment (DME), transportation, translation, home health, diagnostic imaging and other aspects of care on the road to recovery.
"Together with Orchid, we will strengthen our holistic approach to caring for clients' injured and ill colleagues, helping them return to maximum health and productivity," said Andrea Buhl, Sedgwick's president of managed care.
"This acquisition enables us to provide employers with a single point of service for a broad range of ancillary care needs while strengthening our workers' compensation and managed care capabilities and our commitment to taking care of people when they need us most."
"By joining forces with Sedgwick, we'll create a combined network of unparalleled reach and scope that will truly transform ancillary care for workers' compensation," said Paul Taylor, CEO of Orchid Medical. "Bringing together the brilliant minds and outstanding solutions of our two organizations means we can deliver the very best care available to employees of our valued clients." - Inflation Triggers Increase in California Minimum Wageson May 19, 2022 at 11:15 AM
The California minimum wage is currently $15 an hour for employers of 25 or more employees and $14 an hour for all employers of less than 25 employees. Federal law currently sets the minimum wage at $7.25 per hour. However, federal law allows states and cities to set a minimum wage that is higher than the federal rate.
There are some employees who are exempt from the California minimum wage law, such as outside salespersons, individuals who are the parent, spouse, or child of the employer, and apprentices regularly indentured under the State Division of Apprenticeship Standards.
Several local California jurisdictions have also passed minimum wage laws, such as San Francisco, San Jose, Los Angeles, San Diego, Oakland, and Berkeley, The University of California at Berkeley has compiled and maintains local city and county level minimum wage rates.
A 2016 statute signed into law by former Gov. Jerry Brown, Senate Bill 3, amended sections 245.5, 246, and 1182.12 of the Labor Code, and set forth a plan to gradually increase the statewide minimum wage to $15 per hour over the past six years. SB 3 also included a provision requiring an automatic increase in the minimum wage as determined by the Consumer Price Index..
The California state minimum wage law as amended - Labor Code 1182.12 - provides that the state minimum wage must increase to $15.50 per hour for everyone in 2023 if inflation increases by more than 7% between the 2021 and 2022 fiscal years. Thursday, the California Department of Finance said it projects inflation for the 2022 fiscal year - which ends June 30 - will be 7.6% higher than the year before, triggering the minimum wage increase.
Governor Newsom subsequently announced that all California employers will be required, regardless of size, to pay a new minimum wage of $15.50 per hour, effective January 1, 2023.
This development also increases the minimum salary for most exempt employees in California to $64,480 annually and $5,373.33 per month, effective January 1, 2023. This increase is most significant for smaller employers, who currently have a salary floor of $58,240 annually.
Finally, in other minimum wage developments, earlier last week supporters of California’s ballot initiative to raise California’s minimum wage to $18 per hour announced having submitted more than 1 million signatures - way beyond the 623,000 required to land it on the November ballot. If this ballot measure passes, and many expect that it will, the minimum wage in the Golden State would go to $16 per hour on January 1, 2023, and move up for all hourly employees annually until reaching $18 an hour on January 1, 2028.
"Increasing the minimum wage at this time of spiking prices is a just and urgently needed measure," said David Huerta, president of SEIU California and SEIU-United Services Workers West. But according to the report by Cal Matters, some small business owners said it could further impede California’s economic recovery.
John Kabateck, state director of the National Federation of Independent Business California said "We recognize this is the law but this has the opposite effect on the people they’re trying to help."
Ironically, Newsom on Thursday proclaimed May "Small Business Month" in California. - Murderer Serving Life Sentence is Lead Defendant in $2M EDD Fraudon May 19, 2022 at 11:15 AM
Federal authorities just arrested five people linked to a ring that allegedly obtained at least $2 million in California unemployment insurance (UI) benefits - mostly pandemic-related relief - by using stolen identities, some of which belonged to California prison inmates.
The arrests were made following a 39-count indictment that charges 13 defendants in a scheme to use misappropriated personal identifying information (PII) to fraudulent apply for, and receive, unemployment benefits, mostly during the second half of 2020.
The lead defendant in the case is Natalie Le Demola, 37, who is currently serving a life prison sentence after she was convicted in 2005 of first-degree murder for killing her mother. The indictment also charges Carleisha Neosha Plummer, 32, of Los Angeles, who was a close associate of Demola in prison until she was paroled in July 2020.
DeMola has been serving a life sentence at the California Institution for Women since 2005 when she and her then-boyfriend, Terry Bell, were convicted of first-degree murder for beating her mother to death at their Corona, Calif., home in 2001. DeMola, who was 16 at the time, and Bell, who was 17, had plotted to kill her mother because she objected to them dating, according to news reports from their trial.
DeMola allegedly procured the personal details, including dates of birth and social security numbers, of other inmates and their visitors from a prison associate who had access to a database containing that info. She would then send the details on to her accomplices outside the prison who would use them to file for fraudulent unemployment benefits which they would have sent to mail boxes they controlled, prosecutors said.
Prison inmates are not eligible for unemployment benefits, but the gang would check boxes on the application stating they were not incarcerated, according to court documents.
The indictment charges all 13 defendants with conspiracy to commit wire fraud and bank fraud. The conspiracy count alleges 150 overt acts, including illegally obtaining PII, some of which was provided by an unnamed prison official employed by the California Department of Corrections and Rehabilitation.
The indictment names various defendants in 31 bank fraud counts and seven aggravated identity theft counts. The defendants named in the indictment are:
- - Demola, originally of Corona, who will be brought to federal court to face the charges in this case;
- - Plummer, 32, of Los Angeles, who was arrested today;
- - Khanshanda King, 31, of Los Angeles, who is still being sought;
- - Cleshay Johnson II, 28, of Los Angeles, who is still being sought;
- - James Antonio Johnson, who has several aliases including "Big Dawg Niddy," 31, of Los Angeles, who is currently in custody in a Los Angeles County jail;
- - Felicite Aleisha King, 41, of Los Angeles, who is still being sought;
- - Shafequah Lynete Mitchell, 33, of Los Angeles, who is currently traveling outside of California;
- - Loresha Shamone Davis, 31, of Moreno Valley, who was arrested today;
- - Porsha Latrice Johnson, 32, of Lynwood, who was arrested today;
- - Donisha Lashawn Pace, 38, of South Los Angeles, who was arrested today;
- - Dominique Charmone Martin, 37, of Yucaipa, who is still being sought;
- - Mykara Destiny Robertson, 23, of Los Angeles, who is still being sought; and
- - Amber Jane Wade, 34, of Palmdale, who was arrested today.
The conspiracy and bank fraud charges each carry a statutory maximum sentence of 30 years in federal prison. Aggravated identity theft carries a mandatory two-year consecutive sentence. - WCRI Studies Chiropractic Care for Workers with Low Back Painon May 18, 2022 at 12:57 PM
The Workers Compensation Research Institute (WCRI) announced the release of a new study on chiropractic care for low back pain. The study reveals substantial variation in the use of chiropractic care across 28 states and offers insights into the patterns and outcomes of chiropractic care.
"Chiropractors often participate in the delivery of physical medicine services for low back pain, but few workers received chiropractic care in states where employers or insurers control the selection of providers," said John Ruser, WCRI’s president and CEO. "This study will be helpful for policymakers and stakeholders who are interested in re-evaluating the role of chiropractors, especially those who have been adopting evidence-based practices and contributing to cost-effective care."
This study, Chiropractic Care for Workers with Low Back Pain, describes the prevalence of chiropractic care and provider patterns of physical medicine treatment for workers with low back pain. It provides some evidence as to how different provider patterns of physical medicine treatment are associated with variations in overall medical and indemnity costs, and the duration of temporary disability. The study also looks at the utilization of medical services, including magnetic imaging studies, opioid prescriptions, and pain management injections.
The following is a sample of the study’s key findings:
- - The prevalence of chiropractic care varied substantially across the 28 study states. States that give employers control of selecting medical providers were among the states with the lowest prevalence of chiropractic care.
- - When chiropractors are involved in care, they alone may provide physical medicine care or deliver physical medicine care in conjunction with other non-chiropractic physical medicine providers.
- - Based on the experience of 16 states with prevalent chiropractic care, 12 percent of workers with low back pain received physical medicine care exclusively from chiropractors, and 17 percent received physical medicine treatment from chiropractors and other non-chiropractic providers, concurrently or sequentially.
- - Claims with care provided exclusively by chiropractors were associated with lower costs and shorter duration of temporary disability than a set of claims with similar characteristics where care was exclusively provided by non-chiropractic providers.
The data used for this study are from the WCRI Detailed Benchmark/Evaluation database, which includes more than 2 million open and closed claims from 28 states, with injuries from October 1, 2015, through September 30, 2017, and detailed medical transactions up through March 31, 2019.
The 28 states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.
To learn more about this study or to download a copy, visit WCRI’s website. Dongchun Wang, Kathryn L. Mueller, Donald R. Murphy, and Randall D. Lea authored the study. - Three Face Charges for $128K State Fund Premium Fraudon May 18, 2022 at 12:57 PM
Three Sacramento Area residents face charges of worker's compensation premium fraud by allegedly manipulating their companies payroll resulting in a loss of nearly $128 thousand in State Compensation Insurance Fund premium.
Troy Williams, 49, of Angels Camp, Nanci Morman, 68, of Somerset, and John Allison, 63, of Rocklin, were arraigned on multiple felony counts of insurance fraud after a joint investigation with the California Department of Insurance and the El Dorado County District Attorney’s Office revealed the defendants allegedly conspired together to illegally lower their company’s workers’ compensation insurance premiums and defraud the State Compensation Insurance Fund.
Williams has owned and operated a framing business called Archer Building Company since 2001, which reported carpentry payroll between 2013 and 2016; however, in 2016 the company’s work-related claims costs increased, which would increase its worker’s compensation insurance rates.
The joint investigation found that Allison, an Archer Building Company employee, created Allison Development. Between 2016 and 2020, Archer Building Company diverted its carpentry payroll to Allison Development in order to avoid paying accurate workers’ compensation insurance premiums.
In 2020, Allison Development’s workers’ compensation policy was cancelled and the employees transferred back to Archer Building Company.
The investigation found Archer Building Company and Allison Development attempted to defraud State Fund of $127,795 by not paying the correct amount of premium. Also, it was revealed that Morman was the bookkeeper and point of contact for insurance audits for both companies.
On March 10, 2022, Williams and Morman self-surrendered to the El Dorado County Jail. Allison self-surrendered on March 14, 2022.
They are scheduled to return to court on May 26, 2022. The El Dorado County District Attorney’s Office is prosecuting this case.