Author: WorkCompAcademy

Under the authority of the Affordable Care Act (ACA), a federal hospital price transparency rule took effect January 1, 2021, requiring hospitals to post all prices online, easily accessible without barriers such as having to submit personal identifying information.

In July 2021, the PatientRightsAdvocate.org research team conducted its first review of hospital compliance and found widespread failure of hospitals to fully publish their prices across all payers and plans. It estimated that only 5.6% of the 500 random hospitals reviewed were compliant with the rule.

January 1, 2022 began the second year of the legal requirements for hospitals to post all prices online. This 2022 report assessed the compliance with the law by reviewing 1,000 U.S. hospitals out of the over 6,000 accredited hospitals in the country, including the original 500 hospitals it previously reviewed.

A team of four PatientRightsAdvocate.org research analysts assessed the websites for hospital compliance. Separately, an independent review and validation of the report using a substantial sample of the data were performed from January 19 to 28, 2022 for PatientRightsAdvocate.org by FireLight Health LLC, an independent healthcare price data company with expertise in hospital price transparency data.

Of the 1,000 total hospitals reviewed, it found:

– – Only 14.3% were complying with the transparency rule.
– – Only 37.9% of the hospitals posted a sufficient amount of negotiated rates, but over half were not compliant in other criteria of the rule, such as rates by each insurer and named plan.
– – Only 0.5% of hospitals owned by the three largest hospital systems in the country – HCA Healthcare, CommonSpirit Health, and Ascension – were in compliance.

Notably, only two of the 361 hospitals owned by these three hospital systems were compliant with the rule. Strikingly, for HCA Healthcare, the largest for-profit hospital system in the country, none of its 188 hospitals (0/188) were in compliance. In 2021, these three large noncompliant hospital systems’ combined total revenue approached $120 billion. The cost of compliance calculated in the rule is only $12,000 per hospital.

The most prevalent omission deeming noncompliance was non-posting or incomplete posting of all of the negotiated prices for each item and service clearly associated with all of the payers and plans accepted by the hospital.

Based on this review, it estimated that only 14.3% of the 1,000 hospitals (143/1,000), were in compliance with all of the price transparency rule requirements. It estimated that 85.7% (857/1,000) were noncompliant, because one or more price transparency requirements were not met. The largest hospital systems are effectively ignoring the law, with no consequences.

Accusing law firm Potter Handy of shaking down small businesses for cash payments, the district attorneys of San Francisco and Los Angeles are seeking the return of millions of dollars the owners paid to settle thousands of groundless disability-rights lawsuits.

According to the report by Courthouse News, the lawsuit filed jointly by San Francisco District Attorney Chesa Boudin and Los Angeles District Attorney George Gascón in San Francisco County Superior Court claims the firm files thousands of boilerplate Americans with Disabilities Act lawsuits on behalf of a handful of disabled clients against small businesses, then pressures the owners to settle as quickly as possible for an amount between $10,000 and $20,000.

“Conservatively assuming an average settlement figure of $10,000 per case, Defendants have extracted over $5,000,000 from California’s small businesses from the cases filed on behalf of just one of their serial filers in just over two years,” the complaint says. The district attorneys believe the firm has systematically drained California businesses, many owned by immigrants who do not speak English or fully understand the vagaries of the American legal system, out of millions of dollars over the past four years.

One Potter Handy client, Orlando Garcia, has filed more than 800 lawsuits. Another client, Brian Whitaker, filed more than 1,700 federal cases. The complaint also lists serial filers Chris Langer, Rafael Arroyo, and Scott Johnson, who was indicted by a federal grand jury in 2019 for failing to report the income he received from the lawsuits on his taxes.

The San Diego-based firm has offices in San Francisco and Los Angeles, as well as Utah and Texas. Its website says it attorneys specialize in disability rights, employee rights and mass tort litigation, and also represent wildfire victims.

Boudin and Gascon say the firm’s filings took an especially nefarious turn during the Covid-19 pandemic, when its attorneys and serial filers Orlando and Whitaker began targeting small businesses in San Francisco’s Chinatown, like Hon’s Wun-Tun House. Whitaker claims to have visited Hon’s Wun-Tun House in March 2021 and encountered outdoor dining tables that were wheelchair inaccessible despite that the fact the restaurant was only offering takeout and did not have any sit-down service. The same was true for coffee shop Latte Express, which was also hit with one of Whitaker’s boilerplate lawsuits.

Renmin Yan, who owns Hon’s Wun Tun House, immigrated to the U.S. from China 15 years ago, working for 11 years as a waitress before purchasing the restaurant from its previous owner in 2018. Yan ended up settling with Whitaker, and estimates that it will take her 2-3 months to recover the cost.

The district attorneys’ lawsuit says Johnny Ly, the owner of Latte Express, did not understand Whitaker’s lawsuit and couldn’t afford a lawyer, so his contractor son-in-law sent workers to the cafe to fix the alleged ADA violations. Despite this good faith effort, Whitaker and Potter Handy simply moved for a default judgment against Ly, which they obtained.

Boudin and Gascón believe the sheer number of lawsuits indicate that they are bogus, since the serial filers could not have possibly encountered each barrier they list, let alone intend to return to the businesses since they are located hundreds of miles away from where they live. Security footage from some of the businesses reveal that the serial filers never visited them at all.

“Still others were sued for alleged violations that objectively did not exist; for example, one Chinatown business was sued for allegedly having an illegally steep 12.5% ramp to its front door, when in fact the entranceway was nearly flat,” the lawsuit says.

Potter Handy partner Dennis Price strongly denied the complaint’s allegations. “The allegation that we targeted any particular community is a heinous lie and not supported by any evidence,” he told Courthouse News. “If any amount of effort had been made to look into where our cases were filed, they would see that our cases are filed throughout the state. They don’t target any particular neighborhood or business.”

Price said Boudin and Gascon appear to be trying to curry favor with small business owners at a time when both are up for recall “based on perception that they are not faithfully executing the duties of their offices.”

Adan Deniz, 43, a contractor from Santa Clarita, was arraigned on 21 felony counts of forgery, theft by false pretense, and workers’ compensation insurance fraud after allegedly creating fraudulent certificates to secure jobs and underreporting payroll by over $425,000 to save thousands on insurance premiums.

The California Department of Insurance began an investigation after a licensed insurance agent reported they had received a copy of a fraudulent certificate of insurance, which had been issued in the agent’s name, and contained a forgery of his signature.

The investigation revealed that Deniz created the alleged fraudulent certificate and nine other fraudulent certificates of insurance between May of 2018 and July of 2020. Each of the fraudulent certificates contained false information about insurance coverage, as well as a forged signature from a licensed insurance agent.

Deniz submitted the fraudulent certificates to his clients and to government agencies, in order to convince them he had the required insurance coverage. These fraudulent certificates allowed Deniz to unfairly secure several lucrative plumbing jobs and government permits related to those jobs, which he would have otherwise been unable to secure.

While investigating the fraudulent certificates, Department investigators also discovered that Deniz underreported his company’s payroll from July of 2016 through July of 2019. A review found he allegedly underreported payroll by $426,750 in order to avoid paying $52,269 in insurance premiums to the State Compensation Insurance Fund.

The case is being prosecuted by the Los Angeles County District Attorney’s Office, Healthcare Fraud Division. Deniz is scheduled to return to court on May 25, 2022.

Tiffany Aveau sustained a work-related injury to her back on September 6, 2016, and was placed on an extended leave of absence until September 15, 2017. Russian River terminated Aveau on September 18, 2017.

On April 16, 2018, Aveau filed a workers’ compensation petition pursuant to Labor Code section 132a, alleging Russian River had discriminated against her when it fired her due to her work-related injury.

More than a year after her termination, Aveau filed an administrative complaint with the Department of Fair Employment and Housing (DFEH), alleging Russian River discriminated against her due to her work-related injury. That same day, November 20, 2018, the DFEH issued a Notice of Case Closure and Right to Sue letter.

On June 17, 2019, Aveau filed a civil complaint against Russian River alleging three causes of action for wrongful termination. Russian River filed a motion for summary judgment arguing that Aveau failed to comply with DFEH’s one-year filing requirement and, as such, Aveau’s “cause of action for Wrongful Termination is barred by the applicable Statute of Limitations.”

The court subsequently granted Russian River’s motion. The Court of Appeal reversed in the unpublished case of Aveau v. 23 Bottles of Beer.

On appeal Aveau contended the trial court erred by summarily adjudicating her wrongful termination in violation of public policy claim because it was timely brought within the applicable statute of limitations set forth in Code of Civil Procedure section 335.1, which provides a two-year statute of limitations for tort actions.

Russian River maintained that Aveau’s claim is barred by FEHA’s one-year statute of limitations. Alternatively, Russian River asserts that even if the two-year statute of limitations applies, Aveau’s claim still fails for failing to adequately plead a cause of action for wrongful termination in violation of public policy. Both of Russian River’s arguments were rejected.

Citing Prue v. Brady Co./San Diego, 242 Cal.App.4th 1367 (2015) 196 Cal.Rptr.3d 68, the Court concluded that FEHA’s one-year statute of limitations does not apply to Aveau’s common law tort cause of action for wrongful termination in violation of FEHA’s public policy against disability discrimination, and Aveau’s failure to exhaust her administrative remedies for the underlying FEHA claims does not, standing alone, bar her wrongful termination claim.

Thus the summary judgment for the first and second causes of action – (1) disability discrimination in violation of Government Code section 12940, subdivision (a), (2) failure to engage in a timely, good faith interactive process (§ 12940, subd. (n)), – were appropriate.

However summary judgment for the third cause of action – wrongful termination in violation of the public policy articulated under the Fair Employment Housing Act (FEHA) (Gov. Code, § 12920 et seq.) – was reversed. Instead, Code of Civil Procedure section 335.1 applies, providing a two-year statute of limitations for tort actions based on injuries to plaintiffs caused by the wrongful act or neglect of others.