Heigo Kubar, 84, of Fresno, was arraigned on three felony counts of workers’ compensation fraud, after a Central Valley Workers’ Compensation Fraud Task Force investigation discovered he allegedly underreported over $2 million in payroll to illegally save on workers’ compensation insurance for his trucking company. The investigation began after an employee was found deceased in a company owned semi-truck. Kubar is the former owner of TKJ Trucking. Following an unfortunate incident where a TKJ Trucking employee was found deceased in company owned semi-truck, Kubar’s insurance company became suspicious and began an investigation. The insurance company found that leading up to the death of this employee, Kubar had classified the employee as a company salesperson, not a truck driver. Twenty-five days after the death, TKJ Trucking amended the employee’s job classification to truck driver. An investigation, led by the Fresno County District Attorney’s Office, found the deceased employee had been working for TKJ Trucking as a truck driver for approximately 15 years. At the time of their death, the cost to insure a sales person was approximately $1 for every $100 in payroll, but the cost to insure a truck driver was approximately $20 for every $100 in payroll. An audit by the California Department of Insurance, as part of the task force investigation, revealed that between December 1, 2018 to December 1, 2021, TKJ Trucking had workers’ compensation insurance coverage and reported $875,591 in employee payroll, however, the company actually had $3,233,899 in payroll. Kubar underreported payroll by $2,358,307, resulting in insurance premiums of $480,093 owed to Kubar’s insurance company. The Central Valley Workers’ Compensation Fraud Task Force is an inter-agency anti-fraud partnership with members from the California Department of Insurance, the Fresno County District Attorney’s Office, the Tulare County District Attorney’s Office, the Kings County District Attorney’s Office, the Kern County District Attorney’s Office, the Merced County District Attorney’s Office, the Madera County District Attorney’s Office, the San Luis Obispo County District Attorney’s Office, the California Employment Development Department, and the California Franchise Tax Board. This case is being prosecuted by the Fresno County District Attorney’s Office. Kubar is scheduled to appear in court next on August 14, 2024 ...

Silicosis is a form of occupational lung disease caused by inhalation of crystalline silica dust. It is marked by inflammation and scarring in the form of nodular lesions in the upper lobes of the lungs. It is a type of pneumoconiosis. Silicosis, particularly the acute form, is characterized by shortness of breath, cough, fever, and cyanosis (bluish skin). It may often be misdiagnosed as pulmonary edema (fluid in the lungs), pneumonia, or tuberculosis. Silicosis resulted in at least 43,000 deaths globally in 2013, down from at least 50,000 deaths in 1990. Since 2019, over 100 workers in California have developed the deadly disease silicosis from cutting artificial, man-made stone. Artificial stone is commonly used for countertops in new construction projects. Early recognition of the potential for industrially related came from the granite cutters of Vermont in the early 1900s. Dr. Alice Hamilton, a pioneer in occupational medicine, documented their plight, and by the 1930s, granite workers had secured safety measures like ventilation. However, this progress wasn't universal. The Hawk's Nest Tunnel disaster near Gauley Bridge West Virginia, also in the 1930s, stands as a grim reminder. Workers, primarily immigrants, drilled through a mountain rich in silica with minimal protection. The horrific outcome: over 700 deaths from silicosis. Following such tragedies, regulations emerged. However, enforcement remained lax, and silicosis re-emerged in the 1970s among sandblasters and oil field workers. More recently, engineered stone countertops have become a new source of concern. Workers fabricating these materials develop silicosis at alarming rates, often young and unaware of the risks. California’s Division of Occupational Safety and Health (Cal/OSHA) is increasing awareness of the dangers of being exposed to silica dust while working with man-made and natural stone. Sacramento California’s Division of Occupational Safety and Health (Cal/OSHA) is increasing efforts to address the growing number of silicosis cases among stone workers in California. Man-made stone that is frequently used contains higher concentrations of crystalline silica that can severely scar lung tissue when inhaled. With cases of silicosis increasing in California, Cal/OSHA has further intensified its enforcement and education efforts. On December 14, 2023, an emergency temporary standard was adopted to enhance existing guidelines for respirable crystalline silica hazards. Since then, Cal/OSHA has closed several stone cutting shops in the state that were not providing proper safety protections for their employees. A public meeting is scheduled on May 16 to consider a revised proposal for readoption of the emergency temporary standard for an additional 90 days in to protect workers from the hazards of silica dust. DIR and Cal/OSHA recently launched a bilingual public awareness and education campaign that offers employers and workers resources and information about the proper use of safety equipment and safe worksite practices. The campaign website, worksafewithsilica.org also provides vital information for workers on workplace safety rights and how to report safety violations. Cal/OSHA’s workplace safety laws and emergency temporary standard are key components to ensure that workers are safe. Increasing awareness to employers and employees of the dangerous effects of inhaling respirable crystalline silica dust from tasks like grinding, drilling and cutting, can help save lives and avoid incurable health conditions like silicosis, lung cancer and kidney diseases. According to DIR Director Katie Hagen "the startling uptick in deadly silicosis cases in our state underscores the necessity to protect workers from this fatal disease. Man-made stone products with high silica content, like countertops, can only be fabricated safely with proper safety equipment and practices, such as water systems, safe cleaning of dust and debris and the use of the best respiratory protection available. Failure to follow these life-saving practices can have grave consequences for some of California’s most vulnerable workers. Our department, through Cal/OSHA, is proactively working to educate employers on safe worksite practices, enforcing regulatory standards, and warning workers of its hazards." ...

The performance of the workers compensation system remains strong according to the 2023 metrics that the National Council on Compensation Insurance (NCCI) released today. Workers compensation premium increased 1% in 2023. Private carriers produced their 10th consecutive year of underwriting profitability with a Calendar Year 2023 combined ratio of 86. It is the 7th consecutive year with a combined ratio below 90 for the workers compensation insurance market. "The overall numbers for workers compensation show a financially healthy system," said Donna Glenn, Chief Actuary, NCCI. "To maintain the health of the system, NCCI continues to look beyond the headline numbers to understand the intricacies of the system and identify risks that may impact our future. We are relentless in our commitment to being The Source You Trust." "The workers compensation system has unique features that have differentiated us from other commercial lines in terms of overall performance during the past several years," said NCCI President and CEO Bill Donnell. "However, there are key questions ahead related to issues such as frequency change and medical cost inflation." Key Insights - - Workers compensation premium increased 1% in 2023. - - The Calendar Year 2023 combined ratio for workers compensation is 86%, a sign of underwriting profitability for the system. - - Workers compensation’s Accident Year 2023 combined ratio is 98% with prior years continuing to experience downward reserve development. - - The workers compensation reserve redundancy grew to $18 billion. - - Lost-time claim frequency declined by 8% in the past year, which is more than two times the size of the long-term average decline. - - Severity changes were considered moderate for 2023 with increases of 2% for medical claim severity and 5% for indemnity claim severity. Related may be downloaded using these links: - - 2024 State of the Line Report (PDF) - - 2024 State of the Line Guide (HTML) - - 2024 State of the Line Insights (PDF) ...

The Division of Workers’ Compensation (DWC) has announced its plans to address e-filing practices that result in repeated system errors in EAMS, DWC’s electronic case management system. These errors cause significant delays in document processing. DWC’s planned corrective actions will include, but are not limited to, suspension or removal of e-filing privileges and/or sanctions aimed at users who disregard regulations, e-filing instructions, and document discrepancy notifications. These corrective actions have become necessary because many users continue to e-file defective batches despite receiving error notifications and receiving ongoing problem-solving training in the system’s unprocessed document queue (UDQ). The most frequently encountered e-filing errors include: - - Using incorrect document titles for filing or submitting documents with incorrectly titled attachments. - - Making duplicate submissions of documents already in FileNet. - - Repeatedly submitting failed batches to the UDQ. - - Filing duplicate documents both electronically and by hard-copy (including emailing documents directly to a judge). DWC will evaluate users who continually violate the EAMS rules and guidelines over the next few months. Users who receive notification of impending suspension or removal of their e-filing privileges will be given an opportunity to first take corrective action. Information on how to properly file documents may be found on the DWC website ...

A San Joaquin County District Attorney’s Office investigator is on paid leave amid allegations of fraud. According to a news release from the district attorney’s office, potential fraud was flagged after an audit of the 2024 Auto Insurance Fraud Grant Application. The district attorney’s office says the audit found an investigator within the office was allegedly falsifying timesheet information to justify the office’s receipt of grant funds. The investigator told them they had done it at the ‘urging’ of the prior district attorney’s office administration. District Attorney Ron Freitas began auditing the Auto Insurance Fraud Grant Program in 2017 and asked the San Joaquin County Auditor’s Office to conduct its own audit, too. "We pledge to cooperate fully with the California Department of Insurance, the Office of the Attorney General and the San Joaquin County Auditor’s Office, to ascertain any wrongdoing, and return any monies that were fraudulently received by this Office via the Auto Insurance Fraud Grant Program," said Freitas. "As soon as the alleged fraud was uncovered, we notified the California Department of Insurance, along with the Office of the Attorney General, in order to help correct the wrong that was committed and ensure that our Office is run with the highest ethical standards." The Auto Insurance Fraud Grant Program would give money to district attorney’s offices across the state to cover attorney’s fees, investigators, paralegals and other costs as it related to investigating and prosecuting auto insurance fraud ...

Just a few days on a night shift schedule throws off protein rhythms related to blood glucose regulation, energy metabolism and inflammation, processes that can influence the development of chronic metabolic conditions. The finding, from a study led by scientists at Washington State University and the Pacific Northwest National Laboratory, provides new clues as to why night shift workers are more prone to diabetes, obesity and other metabolic disorders. "There are processes tied to the master biological clock in our brain that are saying that day is day and night is night and other processes that follow rhythms set elsewhere in the body that say night is day and day is night," said senior study author Hans Van Dongen, a professor in the Washington State University Elson S. Floyd College of Medicine. "When internal rhythms are dysregulated, you have this enduring stress in your system that we believe has long-term health consequences." Though more research is needed, Van Dongen said the study shows that these disrupted rhythms can be seen in as little as three days, which suggests early intervention to prevent diabetes and obesity is possible. Such intervention could also help lower the risk of heart disease and stroke, which is elevated in night shift workers as well. Published in the Journal of Proteome Research, the study involved a controlled laboratory experiment with volunteers who were put on simulated night or day shift schedules for three days. Following their last shift, participants were kept awake for 24 hours under constant conditions - lighting, temperature, posture and food intake - to measure their internal biological rhythms without interference from outside influences. Blood samples drawn at regular intervals throughout the 24-hour period were analyzed to identify proteins present in blood-based immune system cells. Some proteins had rhythms closely tied to the master biological clock, which keeps the body on a 24-hour rhythm. The master clock is resilient to altered shift schedules, so these protein rhythms didn’t change much in response to the night shift schedule. However, most other proteins had rhythms that changed substantially in night shift participants compared to the day shift participants. Looking more closely at proteins involved in glucose regulation, the researchers observed a nearly complete reversal of glucose rhythms in night shift participants. They also found that processes involved in insulin production and sensitivity, which normally work together to keep glucose levels within a healthy range, were no longer synchronized in night shift participants. The researchers said this effect could be caused by the regulation of insulin trying to undo the glucose changes triggered by the night shift schedule. They said this may be a healthy response in the moment, as altered glucose levels may damage cells and organs, but could be problematic in the long run. "What we showed is that we can really see a difference in molecular patterns between volunteers with normal schedules and those with schedules that are misaligned with their biological clock," said Jason McDermott, a computational scientist with PNNL’s Biological Sciences Division. "The effects of this misalignment had not yet been characterized at this molecular level and in this controlled manner before." The researchers’ next step will be to study real-world workers to determine whether night shifts cause similar protein changes in long-term shift workers ...

The Inland Empire Automobile Insurance Task Force arrested 12 Southern California residents after an investigation found they allegedly conspired together to create fraudulent insurance claims to illegally collect over $350,000. The investigation discovered the large-scale organized auto insurance fraud ring was engaged in multiple types of schemes including holding vehicles hostage and collusive collisions. Three additional residents have been charged for their alleged involvement in the organized ring. The Inland Empire Automobile Insurance Task Force began its investigation in November 2022 after they found out a California Highway Patrol (CHP) non-sworn employee, Rosa Isela Santistevan, 55, of Irvine, was unlawfully selling traffic collision report face pages, which contained personal information of people who had been involved in collisions throughout Southern California. After the task force served numerous search warrants they seized over 3,500 CHP traffic collision report face pages from the residence of Esmeralda Parga, 26, of Pomona, who the task force determined was connected to Santistevan through the organized ring’s ringleader, Andre Angelo Reyes, 36, of Corona. The conspiracy began after Reyes befriended Santistevan and other CHP employees by donating to various CHP events and parties. Santistevan printed and unlawfully sold thousands of traffic collision face pages to Reyes who would then provide the reports to E. Parga. E. Parga would then contact the parties involved in the collision, pretending to be from their insurance company and coordinate having their vehicle towed to a repair center that they misrepresented as approved by the insurance company. Unbeknownst to the victims, E. Parga did not represent the insurance company and was stealing the victims’ vehicles. Reyes and E. Parga would then dispatch tow trucks, whose drivers cooperated in the scheme and would pick up the vehicles and tow them to CA Collision, owned by Anthony Gomez, 35, of Jurupa Valley. Once the vehicles were at CA Collision, CA Collision would hold the vehicle hostage and demand cash payment from the insurance companies to have the vehicles released. During the numerous search warrants, additional evidence was obtained showing the alleged ring was engaged in other types of insurance fraud schemes, including collusive collisions. One of those collisions was recorded by a defendant and discovered on the defendant’s phone during a search warrant. The video depicts the defendants intentionally crashing a BMW sedan into a Polaris Slingshot. The defendants then claimed two separate crashes occurring on the freeway. Reyes was also involved in this scheme along with four other conspirators. This investigation resulted in 15 suspects being charged with insurance fraud, grand theft by trick, and false impersonation. The charges involved 19 fraudulent claims resulting in a loss of $353,035. Twelve of the 15 suspects were arrested over the weekend. Defendants include: - - Andre Angelo Reyes, 36, of Corona; booked into the Robert Presley Detention Center and bail is set at $700,000. - - Rosa Isela Santistevan, 55, of Irvine; booked into the Orange County Jail and bail is set at $700,000. - - Esmeralda Parga, 26, of Pomona; booked into the West Valley Detention Center and bail is set at $700,000. - - Anthony Gomez, 35, of Jurupa Valley; booked into the West Valley Detention Center and bail is set at $700,000. - - Ezequiel Baltazar Orozco, 30, of Los Angeles; charged but not yet in custody. - - Antonio Terrazas Perez Jr., 19, of Los Angeles; booked into the West Valley Detention Center and bail is set at $150,000. - - Erika Garcia, 31, of Los Angeles; charged but not yet in custody. - - Israel Avila Sandoval, 45, of Pomona; booked into the West Valley Detention Center and bail is set at $150,000. - - Luis Alberto Ramirez Jr., 32, of San Bernardino; booked into the West Valley Detention Center and bail is set at $100,000. - - Robert Arzac, 49, of West Covina; booked into the Orange County Jail and bail is set at $50,000. - - Antonio Ramirez Perez, 44, of Los Angeles; booked into the West Valley Detention Center and bail is set at $350,000. - - Brian Anthony Lopez, 25, of Anaheim - - Emily Marie Boatman, 26, of Ontario; booked into the West Valley Detention Center and bail is set at $700,000. - - Ricardo Parga Jr., 23, of Pomona; booked into the West Valley Detention Center and bail is set at $50,000. - - Steven Anthony Alfaro, 38, of Buena Park; charged but not yet in custody. The San Bernardino County District Attorney’s Office is prosecuting this case. The San Bernardino County Auto Theft Task Force assisted in obtaining evidence, and executing search and arrest warrants for this case. The investigating task force includes the California Department of Insurance, California Highway Patrol, San Bernardino County District Attorney’s Office, and the Riverside County District Attorney’s Office ...

The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released its Quarterly Experience Report. This report is an update on California statewide insurer experience valued as of December 31, 2023. Highlights of the report include: - - After five consecutive increases, the projected loss ratio, including the cost of COVID-19 claims, dropped 2 points in accident year 2022, driven by a significant increase in premium due to higher payrolls and very modest changes in claim frequency and severity. - - The accident year 2023 loss ratio is modestly higher than 2022, driven by the declining impact of COVID-19 claims and generally flat claim frequency and severity trends. - - The average charged rate for 2023 continues to decrease; it is 5% lower than 2022 and the lowest in decades. - - Indemnity claims had been settling more quickly through the first quarter of 2020, primarily driven by the reforms of Senate Bill No. 863 (SB 863) and Senate Bill No. 1160 (SB 1160). - - Average claim closing rates declined sharply beginning in the second quarter of 2020 due to the pandemic. - - Average claim closing rates have flattened in 2022 and 2023 and remain below the pre-pandemic level. - - Projected severity on indemnity claims for 2023 is 3% higher than 2022 and 22% above 2017. - - The average severity in 2023 is the highest it has been in more than a decade, since before the SB 863 reforms. - - Average Medical Cost Containment Program (MCCP) costs per claim have decreased by 14% since 2013, corresponding with the decline in average medical costs following the SB 863 reforms. Although MCCP costs increased modestly in 2023, MCCP cost levels have been generally declining over the last several years. - - Pharmaceutical costs per claim decreased by 88% from 2012 through 2023. After increasing during the early pandemic period in 2020, average pharmaceutical costs per claim reverted to the pre-pandemic trend in 2021 and declined another 12% in 2022 and 2023. - - Projected total statewide ultimate losses for 2005 through 2023 evaluations are below insurers’ reported amounts. Join WCIRB actuaries to discuss the highlights of the September 1, 2024 Pure Premium Rate Filing and December 31, 2023 experience. They will also discuss their research into the impact of economic changes on the California workers’ compensation system. Please submit your questions when you register so that we may answer them during the webinar on Thursday, May 16, 2024, 10:00 AM - 11:00 AM PT. Please register for the webinar ...

Alameda County District Attorney Pamela Price announced that her Consumer Justice Bureau has sued multiple automobile insurance companies and their affiliated software developers, alleging they worked together to create and use automobile valuation software to systematically undervalue "totaled" vehicles and pay California insurance consumers less than the actual value owed under the policies. The civil consumer protection Complaint alleges this automobile undervaluation scheme violates numerous California laws, including California’s Insurance Code, Unfair Competition Law, and False Advertising Law. The Complaint demands civil penalties, restitution for California consumers, injunctive relief, and associated fees and costs. "A vehicle is the lynchpin to life in California. Many residents live paycheck to paycheck and go deeply into debt just to buy a car. When an insurance company underpays its customers for a totaled vehicle, that can result in missed loan payments, damaged credit scores, impacted borrowing, and the inability to buy a replacement vehicle. That can lead to job losses and even homelessness. California residents and small businesses try their best to follow the law. They expect their insurance companies and affiliates to do the same," said District Attorney Pamela Price. The 69-page Complaint filed in Alameda Superior Court on April 26, 2024, amended on April 30, alleges that multiple automobile insurance companies - including The Progressive Corporation and its affiliates ("Progressive Insurance"), United Services Automobile Association and its affiliates ("USAA") - owed duties of good faith and fair dealing to "hundreds of thousands of California residents and businesses each year." Despite these legal duties, the Complaint alleges the insurance companies use specially designed automotive valuation software to undervalue totaled vehicles to pay vehicle owners less money than they are owed. The Complaint further alleges that the software developers (including CCC Information Systems and Mitchell International) worked with these automobile insurance companies to build into the software the means to manipulate and lower the reported "actual cash value" of the totaled vehicles and that the modified software is sold exclusively to automobile insurance companies. Specifically, the Complaint alleges that the software uses a deceptive set of so-called "comparable" vehicles and outcome-determinative adjustments to allow the insurance companies to lower the reported "actual cash value" of the totaled vehicles. The insurance companies then allegedly make "lowball" settlement offers to their customers and refuse to negotiate in good faith, relying on the purportedly "independent" software-generated deflated "actual cash value". The Complaint alleges that these insurance companies failed to disclose to their customers that they worked with the software developers to create exclusive versions of this software for their use or that they used the means built into that software to lower the "actual cash value" on which they base their settlement offers. The Complaint further alleges that once the insured accepts the lowball offer, the insurance companies can resell the same vehicle at auction to minimize its losses further: "Inherent to the Scheme is this loss recoupment opportunity: the [insurance company] would rather total a vehicle than repair it because of the opportunity to recoup ... If [it] pays to repair the vehicle, it has no ability to recoup any of that loss." The Complaint alleges this scheme harms all Californians paying insurance companies for what they expect to be a fair deal but is especially impactful on "disadvantaged Californians, including senior citizens, economically disadvantaged persons, and persons of color." Under California’s Unfair Competition Law and False Advertising Law increased civil penalties are imposed for unlawful acts that target specially protected California citizens like seniors and veterans. The Complaint alleges the scheme impacts California businesses as well, including (1) car manufacturers and dealers (by systematically lowering the market value of their vehicles); (2) gap insurance providers (whose "gap insurance" policies must make up the difference between an outstanding loan amount and undervalued amount paid); (3) automobile loan institutions (i.e., when underpaid car owners can no longer pay their car loans); and (4) car repair facilities (that lose out on potential repair business when vehicles are systematically totaled instead of repaired). "Public safety includes protecting consumers from powerful companies that seek only to maximize profits," said District Attorney Pamela Price. "We are seeking to level the playing field for vehicle owners who face what looks like a rigged game when their car or truck is totaled because a loss of a vehicle can destabilize a person’s life." Alameda County residents who believe their insurance company may have undervalued their totaled vehicle may complete a Consumer Fraud Complaint Form with the Alameda County District Attorney’s Office Consumer Justice Bureau. A link to that complaint form is here: Alameda County District Attorney Consumer Complaint Form ...

When Andrew Reynosa was employed by Advanced Transportation Services on March 3, 2017, he signed the company’s Arbitration Agreement which provided in part that he would arbitrate disputes he had with his employer. On April 26, 2019, Reynosa filed a "complaint for damages" against ATS with the superior court of Tulare County. On July 8, 2019, the parties stipulated Reynosa would submit his claims to binding arbitration pursuant to the aforementioned agreement and the court proceeding would be stayed pending completion thereof. On September 9, 2019, Reynosa filed a demand for arbitration with arbitration provider Judicate West. Under the heading "WHAT RULES OF ARBITRATION DO YOU PREFER," he marked the checkbox for "CCP § 1280 et se[q]." Retired judge John L. Wagner would serve as the neutral arbitrator. Certain arbitration fees were paid by the parties, and in July 2019 the case proceeded to unsuccessful mediation, and then multiple arbitration hearings at various states of discovery. Interim invoices were prepared along the way by Judicate West, and payments were made and posted. On March 20, 2023, Reynosa filed a "motion to terminate arbitration and request for monetary and evidentiary sanctions" with the court. In the motion, Reynosa - citing section 1281.98 - asserted ATS materially breached the arbitration agreement because (1) it was given invoices on July 21, 2021, and December 12, 2022, respectively; (2) each payment was due within 30 days after the date of receipt; and (3) each payment was rendered after the grace period elapsed. Hence, Reynosa was "statutorily entitled to unilaterally withdraw his claims from arbitration and proceed in court . . . ." In an attached declaration, Reynosa's attorney, Deborah P. Gutierrez, averred that on March 17, 2023, she "inquired with [Judicate West’s case manager] if ATS had timely paid the arbitration fees in this matter" and the case manager "confirmed that Defendant had . . . paid the December 12, 202[2] [invoice] on February 22, 2023 . . . ." In a minute order, Retired Judge Wagner conceded ATS’s payments were late but noted Reynosa "did have the opportunity to request this relief before significant work was done and non-refundable arbitration fees were paid" and nonetheless "elected on numerous occasions to proceed with the arbitration process after the alleged tardy payments occurred." Wagner stated: (1) "[t]he first tardy payment was made on September [17], 2021, more than 18 months ago," but Reynosa "sat on his rights under § 1281.98 and did nothing"; and (2) "[t]he last tardy payment was on February 22, 2023"; during the March 7, 2023 case management conference, Reynosa "successfully resisted [ATS]’[s] request for a continuation of the present April 17, 2023, hearing date" and Wagner "shortened the refundable date for the arbitration hearing fees to March 20, 2023"; and Reynosa "waited until that very date to file [his] Motion to Terminate Arbitration and advised [Wagner] of the filing of that motion on March 24, 2023, after the shortened non-refundable period had ended," prejudicing ATS financially. Wagner vacated the hearing dates and stayed the arbitration proceeding "pending a decision on [Reynosa]’s Motion to Terminate Arbitration by the Tulare Superior Court." On April 18, 2023, the superior court held a hearing on Reynosa’s withdrawal motion and it was denied. The Court of Appeal reversed in the published case of Reynosa v. Superior Court -F086342 (May 2024). The opinion noted that the clear and unequivocal language of section 1281.98, subdivision (a)(1) "establishes a simple bright-line rule that a drafting party’s failure to pay outstanding arbitration fees within 30 days after the due date results in its material breach of the arbitration agreement." § 1281.97 "contains no exceptions for substantial compliance,unintentional nonpayment, or absence of prejudice" Nevertheless, the superior court concluded the parties "mutually agreed upon" the February 23, 2023 due date, emphasizing Reynosa "did not object to the extended payment deadline when proposed." Under section 1281.98, subdivision (a)(2), "[a]ny extension of time for the due date shall be agreed upon by all parties." The verb "agree" - of which "agreed" is the past participle - is essentially undefined by the statute. "In our view, the construction of 'agreed' in section 1281.98, subdivision (a)(2) advanced by ATS and adopted by the superior court undermines the legislative intent: by letting a claimant’s silence, failure to object, or other seemingly acquiescent conduct (not amounting to direct expression) constitute a sufficient manifestation of his or her agreement to an extension, the need for the arbitration provider or the business/employer to actively procure such consent - e.g., by having the claimant sign an acknowledgement form - is obviated." "Reynosa did not directly express agreement with the February 23, 2023 due date. Therefore, pursuant to section 1281.98, subdivision (a)(2), the December 12, 2022 invoice was due upon receipt. Pursuant to section 1281.98, subdivision (a)(1), ATS had until January 11, 2023, to pay the arbitration fees and costs. By submitting payment on February 22, 2023, the company materially breached the arbitration agreement ...

George and Sheila Byers filed a lawsuit against USAA, their homeowners insurer, as well as other defendants (Masters Distribution, Inc.; Clifton Michael Potter; and Crawford and Company). Among other causes of action in their operative complaint, the Byerses allege USAA is liable for breach of contract and breach of the covenant of good faith and fair dealing related to the installation of hardwood flooring at their Orinda home. The complaint’s prayer for relief includes a prayer: "For attorneys’ fees and costs." During discovery, the Plaintiffs responded to an interrogatory propounded by USAA, indicating that they were indeed pursuing attorney fees known as "Brandt" fees referring to Brandt v. Superior Court (1985) 37 Cal.3d 813, a California Supreme Court case that provides for attorney fees as damages caused by an insurer’s breach of the covenant of good faith and fair dealing. USAA then served document requests asking Plaintiffs for production of "each and every fee agreement with YOUR attorneys in the instant litigation" and "each and every billing record, fee statement, invoice, receipt and proof of payment from YOUR attorneys in the instant litigation." The Plaintiffs refused to produce any documents for various reasons including "attorney-client privilege and/or work product doctrine." Following a hearing on USAA’s motion to compel, the trial court granted USAA’s motion. The Court of Appeal affirmed the trial court in the published case of Byers v. Superior Court -A169321 (May 2024). On appeal Plaintiffs "assert several interrelated arguments. They contend that the trial court abused its discretion by forcing them to waive the attorney-client privilege during litigation as a condition of seeking Brandt fees." The Court of Appeal said that it "determined that writ review is warranted because the Byerses asserted that compliance with the order would violate a privilege or privacy rights and the petition raises 'questions of first impression that are of general importance to the trial courts and to the profession, and where general guidelines can be laid down for future cases. ' " And it went on to conclude "that the Byerses’ admission that they are seeking Brandt fees as an element of their damages is an implied waiver of the attorney-client privilege at least as to the attorney fees documents that the Byerses plan to rely upon to seek to prove the amount of fees they reasonably incurred to establish their right to benefits under USAA’s insurance policy." "The parties have not cited, nor are we aware of, any controlling authority specifically holding that a party claiming Brandt fees impliedly waives the attorney-client privilege as to documentation supporting the fees, including fees agreements and invoices." It "is well established in other contexts that '[w]here privileged information goes to the heart of the claim, fundamental fairness requires that it be disclosed for the litigation to proceed.' " "We agree with the trial court that USAA has a right to learn during discovery of the attorney fees aspect of the Byerses’ alleged damages and that by seeking such damages the Byerses have impliedly waived the attorney–client privilege. The Byerses have put at issue the attorney fees they incurred in an effort to seek coverage under their insurance policy, and disclosure of documents supporting their claim for such fees is necessary to fairly adjudicate the issue of damages." ...

With U.S. officials bracing for another summer of dangerous heat, a new study from the Workers Compensation Research Institute (WCRI) found important effects of excessive heat on the incidence of occupational injuries. "The study found the probability of work-related accidents increases by 5 to 6 percent when the maximum daily temperature rises above 90°F, relative to a day with temperatures in the 65–70°F range. The effect is stronger in the South and for construction workers. Also, the effect of excessive heat is greater on traumatic injuries, including fractures, dislocations, contusions, and lacerations," said Ramona Tanabe, President and CEO of WCRI. The main goal of the study, Impact of Excessive Heat on the Frequency of Work-Related Injuries, is to measure the extent to which excessive heat has increased the incidence of work-related injuries in recent years by considering injuries like heat exhaustion as well as accidents like falling off a ladder on a hot day. It also answers the following questions: - - Is there variation in how excessive heat increases the frequency of work-related accidents in various regions of the country? - - How does excessive heat affect worker populations in a more diverse set of climates than in just a specific state? - - Is the effect of excessive heat on the frequency of injuries greater in certain industries and on certain injury types? This study uses claims data and weather data from 2016 to 2021 across 24 states. The study’s findings can inform public policy debates on the importance of preventing the effects of excessive heat. For more information on this study or to download a copy, visit www.wcrinet.org. The study is authored by Sebastian Negrusa, Olesya Fomenko, and Vennela Thumula ...

The owner and sole physician at a Bellflower medical clinic has pleaded guilty to submitting millions of dollars’ worth of false claims to a Medi-Cal health care program that provides family planning services to low-income and uninsured patients, causing more than $2.5 million in losses, the Justice Department announced today. Robert Eyzaguirre, 77, of Torrance, pleaded guilty to one count of health care fraud, a felony that carries a statutory maximum sentence of 10 years in federal prison. According to his plea agreement, Eyzaguirre owned and operated Dr. Robert’s Medical Center, a Bellflower-based medical clinic enrolled as a Family Planning, Access, Care and Treatment (Family PACT) provider run through the Medi-Cal public health program that California administered under Medicaid. At this clinic, Eyzaguirre employed and supervised Gary Lee Didio, 54, of Huntington Beach, and Sandra Rios, 51, of South Los Angeles. From at least December 2013 through January 2020, Eyzaguirre conspired with Didio and Rios to submit more than $4.6 million in fraudulent claims to the Family PACT program for family planning services that were never provided. Specifically, Rios picked random names from an online phone-and-address directory and created fake patient files, including inserting fake vital signs and patient notes. Eyzaguirre signed the fake patient files, falsely representing that he had provided family planning services to those patients. Eyzaguirre sometimes signed blank patient forms before the false vital signs and notes had been added. The fake patient files were then submitted to the Family PACT program for reimbursement. The Medi-Cal program paid more than $2.5 million on the fraudulent claims submitted by Dr. Robert’s Medical Center. Eyzaguirre also falsely certified in the fake patient files that laboratory tests were medically necessary. Didio and Rios then referred the names of fake patients to a laboratory in Northern California, which then paid an illegal kickback of $30 cash for each referral. In total, the laboratory paid more than $372,000 in illegal kickbacks for the referrals of fake Family PACT patients from Dr. Robert’s Medical Center. The Medi-Cal program paid more than $1 million on the fraudulent claims submitted by the laboratory related to the scheme. When Eyzaguirre learned that law enforcement was investigating the fraudulent scheme, he attempted to conceal the criminal activity by instructing Didio to remove the fake patient files from Dr. Robert’s Medical Center and hide them offsite. Once the files had been moved, Eyzaguirre attempted to shred the fake patient files to prevent law enforcement from discovering them. Eyzaguirre admitted in his plea agreement to abusing his position of trust as a physician and obstructing justice. Rios and Didio have pleaded guilty to conspiring to receive illegal remunerations for healthcare referrals. They are expected to be sentenced in the coming months. United States District Judge Jesus G. Bernal scheduled a sentencing hearing for Eyzaguirre on October 28. The United States Department of Health and Human Services Office of Inspector General and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse investigated this matter. Assistant United States Attorney Jason C. Pang of the General Crimes Section is prosecuting this case ...

NCCI just announced the release of the third and final installment in its new Insights series, "The Future of Workplace Safety Technology Is Now," which explores employer viewpoints on the latest trends in safety technology. In the first installment of its series it shared insights from interviews with four workers compensation carriers in various stages of testing, introducing, and implementing safety technology. In its second installment, NCCI interviewed six technology innovators who are actively working with workers compensation stakeholders to create and provide various types of workplace safety technologies, For this third installment, NCCI interviewed three employers that have adopted innovative safety technology including wearables and video AI/Computer Vision. Key insights from this new report include the following: - - To effectively implement safety technology, an ongoing partnership between the employer, the technology provider, and the insurer is important. - - Knowing how to interpret and use the data collected from the safety technology was a potential obstacle for at least one employer. - - The cost of the product was not necessarily an obstacle to implementation. - - Manufacturing and warehousing are currently the primary industry focus. - - Employee buy-in and trust are critical for success and can be achieved through education and transparency. - - The employers’ use of safety technologies also resulted in increased productivity and efficiencies. - - Use of a single safety technology may not address all workplace hazards or unsafe practices but can be another tool in the toolbox for creating a culture of safety. - - Safety technologies can be an effective tool for monitoring multiple locations remotely and in real time. The employers interviewed discussed some of the obstacles to implementing safety technologies, including learning how to manage and act on the data collected and address employee privacy concerns. Interestingly, the cost of the safety technology was not necessarily the biggest obstacle noted by these employers. An open, honest employer culture is important. According to one employer, employees "buy-in" when there is transparency, management explains the "why," and wears the device themselves. While not every employee may want to wear the device, the employers believe it was now viewed like any other personal protective equipment such as a hard hat or safety glasses. As it did for the first two articles, NCCI asked the three employers if safety technology is a "game-changer." One employer believes that they are a "100% game-changer - especially for a department of one!" A second employer found the ability to monitor a worksite 24/7 to be a game-changer for their operations. Interested readers can read the full report on the NCCI website ...

The Best States rankings from U.S. News & World Report show how each of the 50 U.S. states ranks in 71 metrics across eight categories. The data behind the rankings aims to show how well states serve their residents in a variety of ways. In calculating the rankings, each of the eight categories was assigned weights based on the average of three years of data from recent national surveys that asked nearly 70,000 people total to prioritize each subject in their state. In the Health Care category, California ranked #6 in the nation this year. The top ten were 1. Hawaii, 2. Massachusetts, 3. Connecticut, 4. New Jersey, 5. Rhode Island, 6. California, 7. Maryland, 8. New York, 9. Delaware and 10. Washington. Out of the eight categories, the Health Care Category follows the following three metric areas: Health Care Access - - Population Without Health Insurance: The percentage of adults ages 19 to 64 who reported having no health insurance coverage. (U.S. Census Bureau American Community Survey 1-year estimates; 2022) - - Child Dental Visits: The percentage of children and young adults enrolled in Medicaid who received past-year preventive dental services among those eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for 90 continuous days. (Centers for Medicare & Medicaid Services; fiscal 2021) - - Child Wellness Visits: The percentage of children and young adults enrolled in Medicaid and eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit who received screening services among those who should have received such services. (Centers for Medicare & Medicaid Services; fiscal 2021) - - Adults Without Dental Visit: The age-adjusted percentage of adults who reported not visiting a dentist or dental clinic within the past year. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Adults Without Wellness Visit: The age-adjusted percentage of adults who reported they had not visited a doctor for a routine checkup within the past year. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Adults Deterred From Care Due to Costs: The age-adjusted percentage of adults who reported there was a time in the past 12 months when they needed to see a doctor but could not because they could not afford it. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) Health Care Quality - - Preventable Hospital Admissions: The number of preventable hospital admissions per 100,000 Medicare beneficiaries. (Centers for Medicare & Medicaid Services; 2022) - - Medicare Enrollees With Top-Quality Coverage: The percentage of Medicare Advantage enrollees with a health plan rated 4 stars or better, among plans with a published star rating and number of enrollees. (Centers for Medicare & Medicaid Services; enrollment data as of February 2024, performance data reflective of March-June 2023) - - Nursing Home Quality Rating: An average index score per state reflecting a proportional scale between nursing homes rated by U.S. News as "high-performing" and those rated as "below average." (U.S. News Best Nursing Homes; 2023-2024) - - Hospital Quality Rating: An average index score per state reflecting a proportional scale between hospitals rated by U.S. News as "high-performing" and those rated as "below average,” among hospitals that perform or treat specific procedures or conditions. (U.S. News Best Hospitals; 2023-2024) Public Health - - Infant Mortality Rate: The number of infants who died before turning 1 year old, per 1,000 live births. (Centers for Disease Control and Prevention; 2021) - - Mortality Rate: The number of age-adjusted deaths per 100,000 population. (Centers for Disease Control and Prevention; 2022 provisional data) - - Obesity Rate: The age-adjusted percentage of obese adults, based on self-reported height and weight. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Smoking Rate: The age-adjusted percentage of adults who are current smokers, based on self-reported tobacco usage. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Poor Mental Health: The age-adjusted percentage of adults who reported their mental health was not good for 14 days or more in the past 30 days. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Suicide Rate: The age-adjusted rate of suicides per 100,000 population. (Centers for Disease Control and Prevention; 2022 provisional data) Sadly, despite California's high ranking in health care, it ranked #37 in terms of "Best States Overall." This global category is based on ranking of the 8 sub-categories which includes health care. The California rankings in each of the 8 sub-categories was #34 Crime & Corrections, #34 Economy, #23 Education, #42 Fiscal Stability, #6 Health Care, #32 Infrastructure, #33 Natural Environment, and #50 Opportunity. And out of the 30 Worst Places to Live, San Francisco was 3rd worst. The City by the Bay is one of the most expensive places to live in the U.S. The median income is higher here, but so are the costs for gasoline and utilities, which fall well above the national average. Job growth hovers just above 1%. Renters pay an average of $4,030 per month for a place to live. About 10% of the population lives below the poverty level. As for crime, the city experienced more than 50 murders and nearly 4,000 assaults in 2021 ...

According to a report by The American Prospect, the big three Group Purchasing Organizations (GPOs) - Premier, Vizent and HealthTrust use sole-source contracts to require hospitals to purchase virtually the same amount from suppliers every year. If a supplier cannot snag one of these contracts, they cannot sell to nearly all hospitals, and they cannot go forward as a business. This dramatically shrinks the manufacturers available for particular sterile injectable drugs, any of which can be thrown offline by the slightest imperfection. The GPO structure therefore limits competition for these drugs, and exacerbates resiliency challenges. It also can increase prices, because the determining factor of getting a contract is often the highest fee a manufacturer can provide. These fees cut into supplier margins and induce them to take shortcuts to ramp up production, making the system even more vulnerable to supply shocks. Hospitals have favored the scheme because they get paid too, through "share-backs" from the GPOs. This secures their participation and keeps the system stuck with supply challenges. Ending the anti-kickback safe harbor would shift the GPO compensation model. They would be paid by hospitals as co-op purchasers, for finding the cheapest prices for medical supplies, rather than being paid by suppliers as for-profit operators, hunting the biggest fees for access. A market with suppliers competing for business rather than paying GPOs to get into hospitals would reduce what hospitals pay, studies have shown. The Senate Finance Committee is releasing a bipartisan discussion draft this month that aims to tackle the epidemic of drug shortages, mostly in low-margin generic injectables used in hospitals. It attempts to reckon with the broken market structure that has created the most drug shortages in America on record. The discussion draft uses Medicare and Medicaid payments to incentivize reform of contracting practices that put generic injectables and other drugs at heightened risk for shortages. In particular, Senate Finance Committee chair Ron Wyden (D-OR) has taken aim at group purchasing organizations (GPOs), three of which handle bulk purchasing for 90 percent of all hospitals. Sole-source contracts and profit-skimming by GPOs (and large wholesalers, which also have extreme concentration, with three controlling 90 percent of purchases) have been blamed for creating the conditions where low-margin drugs are no longer profitable to most manufacturers, thinning out the supply chain and opening it up to regular disruptions. Yet the bill does not take what some have identified as the easiest path to breaking the power of GPOs: removing the safe harbor from anti-kickback laws that allows the companies to maintain their dominance by taking fees from hospital suppliers in exchange for inclusion in their guaranteed sale contracts. Instead, it creates a new framework starting in 2027 called the Medicare Drug Shortage Prevention and Mitigation Program. Hospitals and other providers would be eligible for incentive payments under the program, but only if they commit to a variety of contracting reforms to ensure that certain generic drugs are no longer chronically in shortage. This includes injectables like saline, and chemotherapy drugs that have recently gone into short supply. Some critics see that as a missed opportunity. "This draft is a convoluted, unworkable, nonsensical, overly complex mess," said Phillip Zweig, co-founder and executive director of Physicians Against Drug Shortages, which has highlighted anti-competitive contracting practices and kickbacks as the source of the problem. That there’s a draft at all reflects renewed attention to the problematic function of middlemen in the health care system, both on prices and the timely dispensation of treatment. Pharmacy benefit managers (PBMs), which play a similar role for prescription drugs purchased at pharmacies, have also come under scrutiny in Washington. Federal regulators are currently examining both GPOs and PBMs. But solutions have been elusive, and while the committee is optimistic that they could really get something done, critics argue that there are much simpler alternatives available: in this case, making pay-to-play GPO schemes illegal again ...

The Malibu Times as well as a story in the Conejo Valley Acorn, reports that Malibu/Lost Hills Sheriff’s Capt. Jennifer Seetoo has won her lawsuit against Los Angeles County implicating former Sheriff Alex Villanueva. Villanueva was accused of discrediting Seetoo by spreading false rumors about her and denying her the opportunity to interview for a promotion. In just under two hours of deliberations, a jury awarded Seetoo just over $971,000 in damages. The trial unfolded over nine days of testimony from April 8 to 19 at the Stanley Mosk Courthouse in downtown L.A. Among the witnesses were Seetoo herself and former L.A. County Sheriff Alex Villanueva, under whose administration the alleged mistreatment occurred. Villanueva himself was not named as a defendant in the lawsuit. Seetoo started with LASD as a custody assistant in 1997 at age 20. She was first in her class at the academy and rose through the ranks, arriving at Malibu/Lost Hills sheriff station as operations lieutenant, or second-in-command, in November 2018. On her first day the captain, Josh Thai, suffered a medical emergency, making her acting captain. That same week saw the Borderline mass shooting and the Woolsey fire, with Seetoo leading the station’s response to that historic disaster. In early December Villanueva was sworn in as sheriff, having campaigned on a promise to let local communities choose their captains. According to Seetoo’s original complaint, filed in January 2020, she soon began to face accusations from higher-ups that she was jockeying for the absent captain’s job. These included false comments about an "inappropriate relationship" with the city manager in one of the municipalities in her jurisdiction, insinuations which Seetoo believed came from the office of the sheriff himself. Seetoo was removed as acting captain and told she owed additional time as watch commander to be eligible for promotion. But this policy of Villanueva’s was not consistently applied to male officers, her suit alleged. She was also prevented from transferring to the detective bureau for a similar reason. When the captain position at Lost Hills opened in June 2019, Seetoo applied but did not get an interview. The 10 candidates selected to interview were all male. City officials told Seetoo they had sent a letter to LASD demanding that she be considered, which made her concerned about the potential repercussions. After Agoura Hills honored her Woolsey fire work by asking her to ride in the Reyes Adobe Parade, new Lost Hills Capt. Matt Vander Horck was allegedly directed to remove Seetoo from the operations lieutenant position he had asked her to fill, as well as her role as Malibu liaison. At that point, in October, Seetoo complained about the unfounded rumors and retaliation in an email to a commander. Shortly thereafter Vander Horck told her the decision had been made to transfer her to West Hollywood. Sending employees to work at stations far from their homes as punishment is a familiar tactic in the sheriff’s department, known as "freeway therapy." Vander Horck himself was abruptly removed as captain and transferred in Feb. 2020. Although Villanueva was not named as a party in the lawsuit, he was accused of spreading an unfounded rumor that the married Seetoo, then the Malibu Sheriff’s liaison, was having an affair with a city manager in Agoura Hills, a city in her jurisdiction. Villanueva did testify at the trial, but so did a Villanueva colleague, an assistant sheriff who contradicted Villanueva’s testimony. That witness testified that he heard the rumor directly from Villanueva, who stated it as if it was a fact. The former Agoura Hills city official, who now works for another nearby municipality, testified in support of Seetoo, a mother of two, that the rumor was completely baseless and unsubstantiated. Seetoo did not allege discrimination by her direct superiors, but rather from the very top of the department. Her complaint mentioned "spies" planted by the sheriff to watch her work. It also spoke of a larger pattern of discrimination against female sworn officers in the LASD under Villanueva. In May 2022 Seetoo finally became the first female captain at Lost Hills. Jurors found in Seetoo’s favor after deliberating for just over one and a half hours. The bulk of the jury award - $750,000 - was for non-economic losses including harm to her reputation and emotional distress. An additional $221,369 was awarded for lost earnings and benefits, bringing the total to $971,369. Seetoo also won legal fees. Seetoo’s attorney, Kathleen Erskine, said, "It has been a highlight of my career to represent Jennifer Seetoo. She led the Malibu/Lost Hills Station with bravery and skill during the Woolsey Fire, one of the most devastating events in its history. Rather than allowing her to compete for the promotion she deserved, former Sheriff Alex Villanueva and his high-ranking executives discriminated and retaliated against her." The ongoing case is Jennifer Seetoo v County of Los Angeles et. al assigned to Hon. Rupert A. Byrdsong in Department 28 Stanley Mosk Courthouse ...

On March 13, 2020, President Trump declared a national state of for COVID- 19, initiating the expansion of Medicare’s telehealth benefits under the section 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act.4 The Centers for Medicare & Medicaid Services (CMS) worked with Congress to waive Medicare’s restrictions on telehealth utilization, such as geographic restrictions and provider reimbursement. Prior to the public health emergency (PHE), an average of 13,000 fee-for- service (FFS) Medicare beneficiaries received telehealth services per week. At the end of April 2020, the number of FFS beneficiaries receiving telehealth services per week reached 1.7 million. The flexibilities that Congress expanded in order to increase patient access to telehealth services during the COVID-19 Public Health Emergency were extended through the end of 2024 in the Consolidated Appropriations Act of 2023. Additionally, CMS has also continued certain telehealth regulatory flexibilities to align with the statutory extensions. Notable flexibilities that are set to expire at the end of 2024 include: - - The ability for Medicare patients to receive telehealth services in their home; - - Removal of geographic restrictions for originating site for non-behavioral/mental telehealth services; - - Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are permitted to serve as a distant site provider for non-behavioral/mental telehealth services; - - The ability to deliver certain non-behavioral/mental telehealth services using audio-only communication platforms; - - Removing the requirement for an in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter; and - - Allowing telehealth services to be provided by all eligible Medicare providers. During an hours-long House Energy and Commerce subcommittee hearing this week, lawmakers considered 15 different legislative proposals surrounding telehelath access, noting changes in Medicare will impact decisions of private insurers. "There’s an urgent need to extend these flexibilities because it’s going to run out," said Rep. Anna Eshoo, D-Calif. "We need to take action on this." Lawmakers lauded the benefits of telehealth during a hearing Wednesday, but House members also raised questions about cost, quality and access that still need to be answered as a year-end deadline looms. As a December deadline draws closer, legislators are working to hash out details about extending or making pandemic-era telehealth flexibilities in Medicare permanent. Telehealth offers promising support to providers struggling to keep pace with current workforce shortages. The Health Resources and Services Administration (HRSA) projects a shortage of 139,940 physicians by 2036. Currently, there are 39.8 primary care physicians per 100,000 people in rural areas, compared to 53.3 primary care physicians per 100,000 people in urban areas Telehealth and remote patient monitoring can help alleviate some of these workforce challenges. According to a 2022 survey, 8 in 10 practitioners reported that retaining telehealth for health care practitioners would make them more likely to continue working in a role that maintains flexibility. According to the testimony at Wednesday's hearing of Eve Cunningham, M.D., group vice president and chief of virtual care and digital health at Renton, Washington-based Providence health system said: "Telehealth has become an integrated part of Providence's care delivery system making up about 20% of ambulatory care visits. Telehealth services are deployed across 93 acute care hospitals, including 42 hospitals from other health systems, and two high schools, with more than 1.2 million telehealth visits annually," "Telehealth is no longer a nice to have, but a core function of our healthcare delivery," Cunningham said. She added, "Telehealth expands access to high-quality, coordinated care to more people in more places. Telehealth enables us to offer specialty services in remote and rural areas like Kodiak, Alaska, while also allowing us to care for underserved communities in urban areas like Los Angeles," she said ...

Palm Care Pharmacy, a San Diego County pharmacy chain with a storefront in El Cajon, has paid $350,000 to resolve allegations that it diverted controlled substances, failed to keep necessary accounting records for controlled substances, and improperly sold pseudoephedrine chemical products. The settlement arises from a U.S. Drug Enforcement Administration investigation into suspected illegal activity at Talimi International, Inc. d/b/a Palm Care Pharmacy. Based on an inventory audit conducted by the DEA and other investigative activities, the government concluded that Palm Care Pharmacy’s El Cajon location committed multiple violations of the Controlled Substances Act and the Combat Methamphetamine Epidemic Act from 2018 through 2022. The government alleged that Palm Care Pharmacy failed to control its inventory of controlled substances, failed to maintain a complete record of controlled substances and the transactions, and sold listed chemical products (e.g., pseudoephedrine) without the necessary training and certification. Palm Care Pharmacy’s failure to control inventory resulted in unaccounted-for pills, including: opioids (oxycodone, hydrocodone, and tramadol), benzodiazepines (Xanax), and muscle relaxants (Soma). In addition to paying $350,000 to resolve the government’s claims, Palm Care Pharmacy entered into a Memorandum of Agreement with the DEA requiring Palm Care Pharmacy to undertake additional measures to handle controlled substances properly and safely. "Accurate record keeping prevents controlled substances from ending up in the wrong hands," said DEA Diversion Program Manager Rostant Farfan. "DEA will continue to hold registrants accountable to ensure they are operating within the closed system of distribution." This settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Southern District of California and the Drug Enforcement Administration. This case was prosecuted by Assistant U.S. Attorney Dylan M. Aste. The claims resolved by the settlement are allegations only, and there has been no determination of liability ...

According to recent studies published by the National Council on Workers' Compensation (NCCI) workers’ compensation has experienced a long-term decline in overall claim frequency, thanks to automation, robotics and continued advances in workplace safety. However, for WC Motor Vehicle Accident (MVA) claims, the story is quite different, with frequency declining for many years and then suddenly turning upward. These accidents can be very severe and are responsible for a significant portion of fatal WC claims. MVA lost-time claims continue to cost over 80% more than the average lost-time claim, because MVA claims tend to involve severe injuries (e.g., head, neck, and spine). In its 2020 update, NCCI noted that according to the National Highway Traffic Safety Administration (NHTSA) "the installation of automatic emergency braking (AEB) was part of a voluntary commitment by 20 automakers to equip virtually all new passenger vehicles with low-speed AEB that includes forward collision warning by September 1, 2022. The NHTSA further noted that "manufacturers have made great strides in providing advanced safety to consumers compared to 2018, when only 30% of their new vehicles were equipped with AEB." The the Insurance Institute for Highway Safety maintains that autobraking is making driving safer, estimating that the technology could cut rear-end collisions in half. This month the voluntary efforts of these 20 automakers have become a mandatory requirement for all of them. The National Highway Traffic Safety Administration (NHTSA) finalized Monday a new Federal Motor Vehicle Safety Standard which makes automatic emergency braking (AEB), including pedestrian AEB, standard on all passenger cars and light trucks by September 2029. According to the agency, this safety standard is expected to significantly reduce rear-end and pedestrian crashes, saving at least 360 lives a year and preventing at least 24,000 injuries annually. AEB systems use sensors to detect when a vehicle is close to crashing into a vehicle or pedestrian in front and automatically applies the brakes if the driver has not. The new standard requires all cars be able to stop and avoid contact with a vehicle in front of them up to 62 miles per hour and that the systems must detect pedestrians in both daylight and darkness. In addition, the standard requires that the system apply the brakes automatically up to 90 mph when a collision with a lead vehicle is imminent and up to 45 mph when a pedestrian is detected. In June 2023, the National Safety Council (NSC) supported NHTSA’s notice of proposed rulemaking to require AEB and pedestrian AEB on new passenger cars and light trucks. The standard fulfills a provision in the Infrastructure Investment and Jobs Act to establish minimum performance standards requiring that all passenger vehicles be equipped with AEB and also aligns with the Department of Transportation’s National Roadway Safety Strategy, further embracing the Safe System Approach by directly taking a step toward making safer vehicles, a pillar of the holistic approach to roadway safety. NSC believes the development, design, and accessibility of vehicle technology are key components to addressing the tragic trend of roadway fatalities. Improvements in vehicle safety must take into account risks to both vehicle occupants and non-occupants, and ways to mitigate these risks must be clearly communicated to the public ...