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S.F. Contractor Faces Multiple Felony Charges for Premium Fraud

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The San Francisco District Attorney announced multiple felony charges against Gemma Maher, office administrator of Cullinane Plastering, for insurance and tax fraud. Her employers, Denis Cullinane, owner of Cullinane Plastering, and Jeremiah “Jerry” Cullinane, owner of Cullinane Construction, have warrants outstanding for charges related to insurance and tax fraud.

Maher and her employers are alleged to have engaged in a years long scheme to defraud their victims by concealing approximately $5.8 million in unreported payroll to avoid paying insurance premiums and payroll taxes. Denis and Jerry Cullinane remain at large.

The Court previously entered an order freezing all the defendants’ assets to prevent them from dissipating those assets and to preserve the funds for victim restitution. The three defendants are residents of San Francisco and operate the local construction company Cullinane Plastering which has been licensed by the CSLB since 1989.  

The alleged fraud was discovered after a Cullinane Plastering employee was seriously injured while working on a job site on May 8, 2019.

Instead of informing the injured worker that he was entitled to workers’ compensation benefits, Denis Cullinane, Jerry Cullinane, and Maher allegedly concealed the employee’s existence and injury from their workers’ compensation insurance carrier, State Compensation Insurance Fund (SCIF), for almost a year.

When Maher finally disclosed the injury to SCIF on March 12, 2020, she made multiple alleged misrepresentations about the worker’s employment history and injury to further the fraud.

The resulting investigation revealed that Denis Cullinane, Jerry Cullinane, and Maher utilized Jerry Cullinane’s Cullinane Construction company to conceal the injured worker’s wages from SCIF and the Employment Development Department (EDD) in violation of California law.

In addition, the investigation uncovered that Denis Cullinane, Jerry Cullinane, and Maher submitted allegedly fraudulent employee payroll information to SCIF from 2018 through 2020 and to EDD from 2017 through 2020. These fraudulent reports artificially lowered their workers’ compensation insurance premiums and tax contributions – both of which are determined in part by employee payroll.

This resulted in an estimated $270,000 loss to SCIF in unpaid premiums and an estimated loss to EDD of over $300,000 in unpaid payroll taxes (and over $1.5 million in unpaid taxes and penalties).

This case was developed through a multi-agency operation led by San Francisco District Attorney Senior Investigator Jennifer Kennedy and conducted in collaboration with investigators from the San Francisco District Attorney’s Office, the California Department of Insurance, and the Employment Development Department.

Assistant District Attorneys Stephanie Zudekoff and Rebecca Friedemann are the prosecutors assigned to the case.

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Prevailing in WCAB 132a Claim is Not Res Judicata in FEHA Case

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Gurdip Kaur started working at Foster Farms in 2001 and worked for nearly 15 years. From 2008 to 2016, Kaur worked as a yield monitor at Foster Farms’ Cherry Avenue plant, a chicken processing facility.

On April 24, 2013, Kaur slipped at work while wearing company-issued rubber boots; and she broke her left wrist. Prior to the injury, she had slipped because of these boots, and attempted to avoid slipping by requesting new boots. Kaur is originally from India, and believed that she and other Indian employees at the plant frequently encountered difficulties in obtaining work-related gear, because they were Indian.

After a surgery to her broken wrist, she was restricted in the use of her left hand and wrist for work. She went back to her regular position as a yield monitor, with no modification in her duties, and complained that she needed light duty given the restrictions on using her left hand. She claims her request was never appropriately addressed by Foster Farms.

In May 2016, Foster Farms announced it would undergo a restructuring that would affect its Cherry and Belgravia chicken processing plants. The Cherry plant would lose 500 positions, while the Belgravia plant would gain 300. July 22, 2016, Kaur was terminated after numerous efforts to identify and train her for a job she could do at Belgravia. The sole reason for Kaur’s termination was that she “chose not to take the [one] accommodation” offered by the company (i.e., the pallet jack driver position); it was not a performance-related termination.”

In October 2017, Kaur filed a lawsuit against Foster Poultry Farms. The first five causes of action arose under FEHA: (1) discrimination on the basis of race/nationality and disability; (2) failure to provide reasonable accommodation; (3) failure to engage in an interactive process; (4) failure to take all reasonable measures to prevent discrimination; and (5) retaliation for asserting FEHA rights. The sixth cause of action asserted in the complaint was retaliation in violation of Labor Code section 1102.5.

Prior to filing the civil action she filed a petition against Foster Farms with the WCAB, asserting claims under Labor Code section 132a, which was litigated over three days, spread over the course of a year, before WCAB ALJ Debra Sandoval. On July 9, 2019 ALJ Sandoval denied the 132a petition.

Foster Farms then amended its answer in the civil case to assert an affirmative defense that all of Kaur’s disability-related claims were barred by res judicata and collateral estoppel based on the workers’ compensation ALJ’s ruling. It then moved for summary judgment on the basis of this affirmative defense.

The trial court granted summary judgment in favor of Foster Farms, holding that the WCAB opinion barred Kaur’s disability-related and other claims under FEHA and Labor Code section 1102.5, and that Kaur’s race/nationality discrimination action was time barred. The Court of Appeal reversed in the published case of Kaur v. Foster Poultry Farms LLC F081786 (September 2022).

The primary issue on appeal is whether the decision by the WCAB denying Kaur’s 132a claim has a res judicata or collateral estoppel effect on the claims at issue in this civil FEHA action.

Kaur’s petition before the WCAB alleged that Foster Farms “[was] aware that [Kaur] had suffered a work place injury on April 24, 2013.” The petition further alleged that Foster Farms “did intentionally and by means of retribution [discriminate] against [her] and said discrimination was in response and in retribution for [her] claim of injury and her filing of her workers’ compensation claim for benefits.”

As to her disability discrimination claim the Court of Appeal noted that “Labor Code section 132a proscribes a relatively narrow range of discriminatory conduct by employers, while FEHA targets a much broader range of discriminatory conduct and imposes affirmative duties on employers as to disabled employees.”

And it went on to say that “Kaur’s FEHA claims for disability discrimination, failure to provide reasonable accommodation, and failure to engage in a good faith interactive process involve entirely different inquiries and issues than her claims under Labor Code section 132a and encompass a whole range of affirmative duties and other requirements applicable to the employer (e.g., continuing obligations to make reasonable accommodations and engage in an interactive process), as well as benefits that accrue to the employee (e.g., preferential treatment with regard to open positions), that have no relevance to a Labor Code section 132a proceeding.”

The Court of Appeal concluded that the WCAB’s decision on Kaur’s Labor Code section 132a claim does not have preclusive effect on Kaur’s disability related FEHA claims, and the trial court therefore erroneously granted summary adjudication in favor of Foster Farms.

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Newsome Signs Law Extending Time to Study UR

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Gavin Newsom signed AB 2848, which amended Labor Code Section 4610 to require a study of possible changes to the workers’ compensation utilization review process.

SB 1160 (Mendoza, Chapter 868, Statutes of 2016) created the existing period of study and report by the Director related to the provision of medical treatment. The law required the DWC Administrative Director to contract with an outside independent research organization to evaluate and report on the impact of the provision of medical treatment within the first 30 days after a claim is filed, for claims filed on or after January 1, 2017, until January 1, 2019. The report was to be completed by January 1, 2020.

According to the author of the new law, the “current period of evaluation for the impact of the provision of medical treatment report is not sufficient to capture the effect of workers’ compensation claims filed after January 1, 2019. This bill will help gather more information on the workers’ compensation system by extending the period of review to January 1, 2021, so that the State can better understand workers’ use of medical treatment in the workers compensation system.”

However according to information provided by the author as noted in the March 2022 legislative analysis, this bill was intended to “be amended in the Senate to be a larger workers’ compensation reform package. The amendments will have the goal of raising permanent disability benefits, minimizing delays associated with medical treatment requests, and reducing frictional costs within the workers’ compensation system.”

Those proposed amendments apparently did not take place.

The California Labor Federation, a co-sponsor of the bill, wrote in support of the proposed law that “as written, AB 2848 extends the period of study for a previously mandated report regarding medical treatment within the first 30 days following a workers’ compensation claim. The bill extends the period of evaluation from the existing period of January 1, 2017 – January 1, 2019, to January 1, 2017 – January 1, 2021. The bill will also require the report to be completed by July 1, 2023, as opposed to the previously required completion date of January 1, 2020.”

“By adding two years’ worth of data to what will be considered by this change, AB 2848 will help gather a more comprehensive understanding of the workers’ compensation system. The amended completion date will also better align the expanded data collection with the amount of time necessary to compile and analyze the data.”

There was no opposition to the proposed law in the legislative record.

In summary, a proposed law that was aimed at increasing benefits to injured workers, ended up simply extending the time limits for a study that was specified back in 2016. Otherwise, there are no substantive changes that require the attention of claims administrators.

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Employers Must Set “Date Certain” for Emergency Leave Ending

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Reena Johar, a home improvement salesperson for Success Water Systems, left work to care for a terminally ill relative, and while she was away her employer decided she had quit. She was gone about a week.

Upon her return, the employer told her business was slow and gave her no new sales appointments. Johar eventually made a claim for unemployment benefits with the Employment Development Department (EDD), telling the EDD she lost her job due to a “temporary layoff.”

The employer denied laying Johar off. While conceding that she left with her supervisor’s approval, the employer advised the EDD that Johar’s failure to provide a return date or otherwise communicate with her supervisor while she was away amounted to a voluntary quit.

According to Johar, she was hired with the understanding that she might need to take leaves from time to time to care for her grandmother. She had two approved leaves of absences for this purpose before this controversy.

EDD conducted an interview with the employer who conceded they approved her leave to go to Chicago, but stated that the approved leave was not indefinite. They said that Johar failed to respond to repeated requests for a return date, and was eventually deemed absent without leave.

The EDD accepted the employer’s position, found Johar ineligible for unemployment benefits, ordered reimbursement of benefits improperly paid, and imposed a penalty for willful misrepresentation in seeking benefits. An administrative law judge sustained the EDD’s ruling, and the California Unemployment Insurance Appeals Board (CUIAB) affirmed, finding that “Basically, [Johar] abandoned her job.”

When she initiated her appeal at the CUIAB she was in pro per. After the hearing she secured representation from the Workers’ Rights Clinic, one of the Community Justice Clinics affiliated with the Hastings College of the Law. The Clinic proffered some new evidence that had not been available at the time of the ALJ hearing. CUIAB said that it did “not think that the additional evidence is relevant.”

The Court of Appeal reversed in the published case of Johar v. California Unemployment Insurance Appeals Board – A162563 (September 2022).

Three days after the CUIAB issued its decision denying Johar’s appeal and refusing to consider the new evidence she proffered, Division One of this court filed its opinion in Land v. California Unemployment Insurance Appeals Board (2020) 54 Cal.App.5th 127 (Land).

In that case, the CUIAB, just as it did here, refused to consider the new evidence, citing due process concerns. The Land court viewed the proffered new evidence there to be “pivotal” and vacated the CUIAB’s affirmance of the ALJ’s decisions. The court remanded with directions that the CUIAB either take the new evidence into account directly, or remand to the ALJ to “make new findings of fact” and issue “new reasons for decision.”

However, “in the case a remand to review the new evidence was not necessary, because “the CUIAB’s decision was incorrect on the administrative record before it.” Thus the Court of Appeal held ” it was an abuse of discretion to withhold mandamus relief pending further administrative proceedings.”

Here there “was no evidence that, when Johar left, SWS had an established leave of absence policy which Johar knew or should have known, and simply ignored. And to the extent there was an informal leave protocol established by the parties’ prior conduct, Johar followed it.”

The dispositive question in this case is whether, having voluntarily left work for good cause, Johar manifested an intention to abandon her job while she was gone. Johar claims she did not.

An anticipatory breach of contract occurs when one contracting party “positively repudiates the contract by acts or statements indicating that [she] will not or cannot substantially perform essential terms thereof . . . .” [Citation.] “Anticipatory breach must appear only with the clearest terms of repudiation of the obligation of the contract.”

In the eight days between Johar’s departure and the “quit” date SWS reported to the EDD) or for that matter in the 13 days between her departure and the day her supervisor sent out Johar’s “final check,” nothing on this record comes close to meeting this test.

SWS took the position in the proceedings before the ALJ that Johar’s intention to quit may be inferred by her silence in the face of Mari Lynn Johnson’s post-departure requests for a specific return date.

But that is not enough to show a repudiation of future contractual duties. The emails of record show that Johar did eventually respond, saying she would “get back to you when the emergency ceases.” But even if we assume arguendo she failed to respond at all, as Mari Lynn Johnson testified, the evidence is still insufficient to show a “positive” repudiation in “the clearest terms.”

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61% of 6.2 Million Disabled People are Episodic and Not Permanent

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The term “permanent disability” is frequently used in legal definitions, medical and rehabilitation terminology, insurance coverage, and government compensation programs. People with episodic disabilities who need to use a variety of financial support programs face challenges since the definitions of these programs and benefits vary from one source to the next.

An episodic disability is characterized by periods and degrees of wellness and disability that fluctuate over time. A growing percentage of people are affected by episodic disability.

According to a Statistics Canada survey report, “of the 6.2 million Canadians with disabilities aged 15 years and over, just 39 percent (2.4 million) experienced conventional, continuous limitations, while 61 percent (3.8 million) experienced some type of disability dynamic..

Many people suffer from episodic disabilities, and the unexpected nature of their illnesses makes it difficult for them to achieve long-term goals, find work, maintain a stable income, or get social assistance. Moreover, these phases of health and disability are unpredictable. Consequently, a person may enter and exit the labor force with unpredictability.

In 2015, the Episodic Disabilities Employment Network (EDN) updated its list of episodic conditions, which is continuously expanding with time. The diseases and conditions that are the potential causes of episodic disabilities include; arthritis, asthma, some forms of cancer, chronic obstructive pulmonary disease, chronic bronchitis, emphysema, chronic fatigue syndrome, chronic pain, chronic inflammatory demyelinating polyneuropathy (CIDP), Crohn’s & colitis, diabetes, epilepsy, fibromyalgia, hepatitis C, human immunodeficiency virus/ Acquired immunodeficiency syndrome (HIV/AIDS), lupus, depression, anxiety, bipolar disorder, schizophrenia, Meniere’s disease, multiple sclerosis, migraines, Parkinson’s disease, and systemic exertion intolerance disease (SEID).

In California workers’ compensation the distinction between episodic and permanent disabilities can make a major difference in long term benefit awards. This is especially significant when consideration is given to claims of “Kite” disability (Athens Administrators v. Workers’ Comp. Appeals Bd. (Kite) (2013) 78 Cal.Comp.Cases 213),  In Kite cases total disability can be awarded when a vocational rehabilitation expert claims an injured worker is unable to compete on the open labor market at all – forever.  

Such a conclusion must consider the episodic nature of some disabilities.

Rehabilitation involves any services or providers who address or prevent disability experienced by people living with chronic episodic illness. Rehabilitation should be disability focused, goal oriented, person centered, focused on function and tailored to an individual’s goals, abilities and interests.

The bulk of the literature on episodic disabilities and rehabilitation has been related to those suffering with HIV. And currently the issue of episodic disabilities is resurfacing for those with Long COVID.

For example one study found that “Contextual factors that influenced disability were integral to participants’ experiences and emerged as a key component of the framework. Extrinsic contextual factors included social support (support from friends, family, partners, pets and community, support from health care services and personnel, and programme and policy support) and stigma. Intrinsic contextual factors included living strategies (seeking social interaction with others, maintaining a sense of control over life and the illness, “blocking HIV out of the mind”, and adopting attitudes and beliefs to help manage living with HIV) and personal attributes (gender and aging). These factors may exacerbate or alleviate dimensions of HIV disability.”

Perhaps it is now prudent to consider concepts learned from the growing body of literature on episodic disability when evaluating a claim of disability based on the Kite decision. Is there enough data to be deemed that such an injured worker will not be employable forever, no matter what?  Or is is episodic, meaning perhaps for now and the immediate future, but not necessarily forever.

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September 12, 2022 – News Podcast

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Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Class Action Claims Amazon 8′ Warehouse Pods Violate FEHA. Johnny Depp’s Attorney Hired to Defend High Profile Comp Fraud Case. Jury Convicts Silicon Valley Man for $77M COVID Test Kickbacks. Newsom Signs Fast Food Standards and Accountability Recovery Act. CDC Reports Alarming Surge in Construction Worker Suicides. State Fund Reports 82% Reduction in Opioid Use since 2014. Scripps Performs First ACL Reconstruction-Alternative Repair. Boeing, Concentra, Shutterfly Join NSC Pledge to Reduce Work Injuries.

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Newsom Signs SB 1242 Adding Premium Fraud Reporting Provisions

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Governor Newsom has signed Senate Bill 1242 into law. This bill is the Senate Insurance Committee’s biannual omnibus bill, which includes several changes that are non-controversial, technical, or otherwise classified as code cleanup.

Prior to passage of this law, an insurer that reasonably believes or knows that a fraudulent claim is being made was required to send a form and additional information about the fraudulent claim to the Fraud Division of the Department of Insurance within 60 days after determination by the insurer that the claim appears to be a fraudulent claim.

The new law requires an insurer to send that form and information within 60 days after it that has determined, after the completion of an investigation, that it reasonably suspects or knows an act of insurance fraud may have occurred or might be occurring. The changes to this law seem only to set timing for filing information with the DOI rather than any other substantive change to the obligations of the claim administrator. The language was added to section 1872.4 of the Insurance Code.

Several provisions, taken together, are intended to help insurance agents and brokers identify, and help CDI crack down against, insured insurance fraud.

These include a requirement that agents and brokers who reasonably suspect or know a fraudulent application is being made to report that fact to CDI’s fraud division (if the application has not yet been submitted to an insurance company) or to an insurer’s special investigative unit (if the application has been submitted to the insurance company). This language appears in section 1872.41 of the Insurance Code.

The new law clarifies that these reports do not subject the agent or broker to civil liability, as long as the agent or broker is acting in good faith; and a clarification that an insurer should complete its special investigative unit investigation into suspected fraud before reporting that fraud to CDI.

Effective March 1, 2023, requires the twelve-hour ethics course that is required in connection with the pre-licensing education of specified new license applicants and the three-hour ethics course that is required as a condition of license renewal to each include one hour of study on insurance fraud. These provisions were added to section 1749 of the Insurance Code.

In essence, the new law will bring insurance and agents up to speed in terms of fraud by the insured during the policy application process. In workers’ compensation this is typically premium fraud where the insured incorrectly reports the number or classification of employees to reduce the premium to be paid.

Existing law requires an insurer to include a statement indicating that it is a crime to present false and fraudulent information to obtain or amend insurance coverage on a form it uses for an application, policy changes, or making a claim in connection with an insurance application, contract, or provision of contract for liability insurance, or on a rider attached to that form.

The new law requires that statement to appear on the form, exclusive of schedules attached to the form, or an endorsement separate from the form, if used in connection with an insurance application, contract, or provision of contract. The bill would also make conforming changes.

During the legislative process during the year, the record does not reflect opposition to the bill.

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NICB Partnerships Intensifies its Focus on California Insurance Fraud

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The National Insurance Crime Bureau (NICB), the insurance industry’s association dedicated to predicting, preventing, and prosecuting insurance crime, is strengthening its longstanding relationship with the California Department of Insurance (CDI). California currently ranks third in the nation for vehicle thefts per 100,000 people, and CDI is committed to reducing crime through its enforcement actions targeting insurance fraud.

As crime continues to increase across the U.S., including the highest vehicle theft numbers since 2008, staggering catalytic converter thefts, and fraud exceeding $300 billion nationwide each year, California is experiencing some of the highest crime rates, and therefore, is the perfect place to address these issues.

NICB President and CEO David Glawe will met with CDI Assistant Chief Shawn Conner on Monday, Sept. 12 in San Diego to discuss their continued partnership and ways to combat insurance fraud and crime.

“CDI is a valued partner of NICB, and we have maintained a strong partnership with them for many, many years,” said Glawe. The face-to-face with Assistant Chief Conner was to discuss ways to strengthen the partnership and identify collaboration opportunities to help combat rising crime.”

“CDI and NICB have worked together hand-in-hand since 1992,” said CDI Assistant Chief Shawn Conner. “We value the intelligence and support that NICB Special Agents offer us during an investigation.”

NICB and CDI are looking forward to continuing their valued partnership as they battle the ever-growing crime trends seen in California. Together, they will investigate all areas of insurance fraud including, auto fraud, staged accidents, health care fraud, workers’ compensation, and property investigations.

As vehicle and catalytic converter thefts and carjackings continue to plague many U.S. cities, including cities across California, the NICB also announced it is strengthening its longstanding relationship with the California Highway Patrol (CHP). California currently has the third highest rate of vehicle thefts per 100,000 people, and crime is no stranger to California residents. NICB and CHP are focusing on ways to combat these crimes.

NICB announced it is also strengthening its longstanding relationship with the San Diego District Attorney’s Office. NICB President and CEO David Glawe and San Diego County District Attorney Summer Stephan will meet on Wednesday, Sept. 14 to discuss their partnership and future collaborations as they work to investigate and prosecute offenders.

During the meeting in San Diego, Glawe, Senior Vice President and Chief Operating Officer Tim Slater, Senior Vice President and General Counsel Pat Martin, and other NICB leadership will meet with Stephan, Insurance Fraud and Workplace Justice Division Chief John Philpott, and Assistant Chief Luis Mendez.

“NICB is grateful for our partnership with the San Diego District Attorney’s Office,” said NICB President and CEO David Glawe. “After an investigation leaves our hands, we look to the District Attorney to prosecute these criminals in California.”

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Hartford and Yale Team Up to Treat Injured Worker Addictions

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The Hartford is extending its partnership with the Yale Program in Addiction Medicine (Yale-PAM) to provide a newly-developed training on addiction, pain management and stigma to more medical providers who treat injured workers.

The Hartford launched the partnership with Yale School of Medicine following a record level of overdose deaths in the U.S. in 2021. To address the opioid crisis, the company has also supported federal funding for opioid education and treatment programs and advocated for federal and state reforms, such as the adoption of robust medication formularies, mandatory physician and provider education, restrictions on unneeded opioid prescriptions, and improved drug monitoring programs.

Built on 30 years of pioneering research, Yale’s Program in Addiction Medicine is internationally recognized. Known for developing innovative treatment models, training programs and attracting leaders in the field, Yale’s model programs have been replicated nationally and internationally.

The Yale Program in Addiction Medicine works to expand access to and improve the effectiveness of prevention, treatment, and harm reduction services for people with unhealthy substance use and those with addiction. The program operates across four key pillars: Clinical Practice, Research, Education, and Policy.

“Science and empathy are both critical to addressing the ongoing opioid crisis, and the unique training developed as part of our partnership has both,” said The Hartford’s Chairman and CEO Christopher Swift. “By partnering with an internationally recognized leader in evidence-based treatment, we are advancing stigma-free education and compassionate care to help more working Americans return to active, productive lives following an injury.”

David Fiellin, M.D., and Jeanette Tetrault, M.D., F.A.C.P., F.A.S.A.M., led the Yale-PAM team that developed the original curriculum, which helps clinicians better understand opioids and work-related injuries, identify and treat acute pain and chronic pain, and assess substance and opioid use disorders among injured workers.

The Hartford’s Chief Medical Officer Adam Seidner, M.D., served as a consultant to the Yale-PAM team to ensure the curriculum focuses on improving workers’ ability to do their job, preventing chronic pain development through the appropriate management of acute pain, and enabling a safe return to work following a workplace injury.

Leveraging the new curriculum, the Yale-PAM team conducted an in-depth virtual training session for 25 clinicians in June. Participants were highly satisfied with the training, saying it was “comprehensive” and “interactive.” Additionally, a knowledge gain from pre- to post- knowledge assessment scores was noted among participants, who scored on average an 88% on the post-training.

In the coming year, the Yale-PAM team will refine and update the curriculum based on pilot participant feedback, conduct additional virtual and in-person training sessions, and develop train-the-trainer resources so that more instructors can conduct the training.

“We are grateful for The Hartford’s unrestricted gift to support the development of a new unique educational resource that will help address the deadly opioid crisis,” said Dr. Fiellin. “With ongoing support, we will reach more clinicians with the new curriculum and help countless U.S. workers who have experienced injuries with evidence-based treatment approaches with a goal of return to work.”

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Telehealth Utilization Fell 4% Nationally in June 2022

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In June 2022, after two months of growth, national telehealth utilization fell 3.7 percent, from 5.4 percent of medical claim lines in May to 5.2 percent in June, according to FAIR Health’s Monthly Telehealth Regional Tracker.

Declines also occurred in the Northeast (4.8 percent) and South (2.4 percent), but there was an increase in telehealth utilization of 2.9 percent in the West and no change in the Midwest. The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid.

In June 2022, COVID-19 maintained the same ranking among the top five telehealth diagnoses that it held in May, both nationally and in every US census region. It ranked at number two nationally and in every region but the South, where it ranked at number three. This stability contrasted with the period from April to May, when COVID-19 climbed in the rankings nationally and in every region except the Northeast, where it remained stable.

Certain other diagnoses shifted in the rankings in June 2022. For example, from May to June, developmental disorders and joint/soft tissue diseases and issues traded places nationally, with the latter ending in fourth place and the former in fifth place. Similarly, skin infections and issues and urinary tract infections traded places in the South, with the latter ending in fourth place and the former in fifth place.

From May to June 2022, in the West, psychologist fell from fourth to fifth place in the list of top five telehealth specialties, switching places with primary care nonphysician.

In June 2022, the rankings of the top five telehealth procedure codes did not change nationally or in any region when compared to the prior four months. The number one telehealth procedure code nationally and in every region remained CPT®2 90837, one-hour psychotherapy.

For June 2022, the Telehealth Cost Corner spotlighted the cost of CPT 90836, 45-minute psychotherapy with evaluation and management visit. Nationally, the median charge amount for this service when rendered via telehealth was $180.72, and the median allowed amount was $111.81.3

Launched in May 2020 as a free service, the Monthly Telehealth Regional Tracker uses FAIR Health data to track how telehealth is evolving from month to month. An interactive map of the four US census regions allows the user to view an infographic on telehealth in a specific month in the nation as a whole or in individual regions. Each infographic shows month-to-month changes in telehealth’s percentage of medical claim lines, as well as that month’s top five telehealth procedure codes, diagnoses and specialties.

Additionally, in the Telehealth Cost Corner, a specific telehealth procedure code is featured, with its median charge amount and median allowed amount.

FAIR Health President Robin Gelburd stated: “We welcome sharing these varying windows into telehealth utilization as it continues to evolve. This is one of the many ways we pursue our healthcare transparency mission.”

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