Author: WorkCompAcademy

The Centers for Disease Control and Prevention (CDC) is set on Tuesday to recommend masks for vaccinated people indoors under certain circumstances.

“Federal officials met on Sunday night to review new evidence that may have prompted the reversal,” the report continued. “The new guidance would mark a sharp turnabout from the agency’s position since May that vaccinated people do not need to wear masks in most indoor spaces.

New cases of COVID-19 are popping up in San Francisco and elsewhere in the Bay Area in what local media is calling “clearly a fourth wave of the pandemic”, and everyone is clearly anxious and exhausted.

The latest surge in new cases arrived swiftly over the last two weeks, with the numbers in San Francisco still fairly low in the first days of July. The city was averaging 12.6 new cases per day in the month of June, and that rose to an average of 39 per day in the week after the July Fourth holiday. Now, SF’s seven-day average, as of Sunday (with a couple of days of delay in the health department’s reporting of numbers), was 147 new cases per day. 218 new infections were tallied in SF on Sunday alone, with 196 the previous day, which compares to days in mid-January when we were in the midst of the winter surge. July 20 also saw 215 new cases.

There has not been a day with over 200 new cases in San Francisco since the first week of February.

The number of hospitalized COVID patients has also risen sharply in SF in the last two weeks, rising from 24 on July 1 to 61 as of Saturday, according to state data.

UCSF’s Dr. Bob Wachter tweeted a lengthy thread Sunday about the current surge and the precautions he plans to take. He notes that everything they are seeing at UCSF points to the ongoing efficacy of the vaccines, but now 77% of cases they are seeing through routine testing of many patients are among the vaccinated, the chances of encountering the virus in public are much higher in SF now than a month ago. Based on internal data about asymptomatic cases, Wachter says you now have a 1 in 50 chance of encountering an asymptomatic COVID infection while out in the city, compared to about 1 in 1000 back in June.

California Gov. Gavin Newsom announced Monday that his state will be the first in the nation to impose a vaccine mandate on state employees and healthcare workers, requiring they show proof of vaccination or submit to regular tests.

California will also be requiring health care settings to verify that workers are fully vaccinated or tested regularly. Unvaccinated workers will be subject to at least weekly COVID-19 testing and will be required to wear appropriate PPE. This requirement also applies to high-risk congregate settings like adult and senior residential facilities, homeless shelters and jails.

The new policy for state workers will take effect August 2 and testing will be phased in over the next few weeks. The new policy for health care workers and congregate facilities will take effect on August 9, and health care facilities will have until August 23 to come into full compliance.

Interface Rehab, headquartered and operating in Orange County, has agreed to pay $2 million to resolve allegations that it violated the False Claims Act by causing the submission of claims to Medicare for rehabilitation therapy services that were not reasonable or necessary.

The settlement resolves allegations that, from January 1, 2006, through October 10, 2014, the Placentia-based Interface knowingly submitted or caused the submission of false claims for medically unreasonable and unnecessary “Ultra High” levels of rehabilitation therapy for Medicare Part A residents at 11 Skilled Nursing Facilities.

These facilities include Colonial Care Center, Covina Rehabilitation Center, Crenshaw Nursing Home, Green Acres Lodge, Imperial Care Center, Laurel Convalescent Hospital, Live Oak Rehabilitation Center, Longwood Manor Convalescent Hospital, Monterey Care Center, San Gabriel Convalescent Center, and Whittier Pacific Care Center.

In July 2020, the Department of Justice announced that Longwood Management Corporation and 27 affiliated skilled nursing facilities agreed to pay $16.7 million to the United States to resolve allegations that they violated the False Claims Act by submitting false claims to Medicare for rehabilitation therapy services that were not reasonable or necessary.

This newly announced  settlement resolves Interface’s role in that alleged conduct.

During the relevant time period, Medicare reimbursed skilled nursing facilities at a daily rate that reflected the skilled therapy and nursing needs of qualifying patients. The greater the patient’s needs, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for skilled nursing facilities was for “Ultra High” therapy patients, who required a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, or speech therapy), one of which had to be provided five days a week.

The United States contends that Interface pressured therapists to increase the amount of therapy provided to patients in order to meet pre-planned targets for Medicare revenue. These alleged targets could only be achieved by billing for a high percentage of patients at the “Ultra High” level without regard to patients’ individualized needs.

This civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Keith Pennetti, a former Director of Rehab at Interface. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Mr. Pennetti, will receive $360,000 of the settlement proceeds. The qui tam case is captioned United States ex rel. Pennetti v. Interface Rehab, et al., No. CV-14-4133 (C.D. Cal.).

The claims resolved by the settlement are allegations only and there has been no determination of liability.

A new study from the Workers Compensation Research Institute (WCRI) investigates patterns of medical care access and utilization that are specific to workers’ compensation during the first quarters of 2020 to understand how the timing and delivery of medical treatment were impacted by the pandemic.

“In our previous work, we examined the effect of the spread of COVID-19 along with the accompanying massive decline in economic activity on workers’ compensation claim composition. In this report, we continue examining the impact of the pandemic on workers’ compensation, shifting our attention to the timing and patterns of medical care delivery,” said John Ruser, president and CEO of WCRI.

The main focus of the study, The Early Impact of COVID-19 on Medical Treatment for Workers’ Compensation Non-COVID-19 Claims, is on non-COVID-19 lost-time claims with injury dates in the first two quarters of 2019 (pre-pandemic) or 2020 (pandemic period). The following is a sample of the study’s major findings:

– – Claims with injury dates in the first two quarters of 2020 did not experience any noticeable delay in medical treatment as compared with the waiting time for claims with injuries in the first two quarters of 2019. In fact, several service types showed some slight improvement in waiting time from injury to medical treatment – in particular, for claims with injuries in the second quarter of 2020, emergency room services, physical medicine, major surgery, and neurological and neuromuscular testing were provided sooner.
– – In states hit hardest by the pandemic during the study period (Connecticut, Massachusetts, and New Jersey), patients sustaining work-related injuries during the early months of the pandemic did not have longer waiting times before getting medical treatment across eight service groups. There was shorter duration for select service types. In particular, major surgery on average happened sooner – 2020Q2 claims had about a 5-day shorter waiting time than 2019Q2 claims, with the average number of days decreasing from 16.3 days to 11.7 days from injury to major surgery.
– – Fractures and lacerations/contusions occurring in the first half of 2020 and 2019 did not have statistically different times before first medical services for most service types, except for a slightly shorter time before emergency services in 2020. In particular, for lacerations and contusions occurring in the second quarter of 2020, time to emergency services decreased from 0.6 days to 0.4 days on average.
– – For soft-tissue claims with injury dates in the first two quarters of 2020, no substantial delay in treatment for most services was observed, with some exceptions. The average number of days to major surgery increased for other non-spinal sprains and strains occurring in the first quarter of 2020 – an increase of about 3 days, from 57 days in 2019 to 60 days in 2020.
– – For lost-time claims with injury dates in the first two quarters of 2020, the shares of claims across eight types of services remained largely the same as the two first quarters of 2019. However, the study reports a 4-percentage point drop in the share of claims with emergency room services, which is consistent with the expectation that people would want to avoid going to the emergency room because of fear of virus contraction.

The study tracks changes in key measures describing medical service utilization patterns for workers injured in 27 states: Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin. These study states represent 68 percent of the workers’ compensation benefits paid in the United States.

With a $26 billion nationwide settlement in sight over claims that the three largest U.S. drug distributors and Johnson & Johnson helped fuel a nationwide opioid epidemic, state and local governments will soon turn their attention to pharmacies and a handful of drugmakers.

Reuters reports that U.S. state attorneys general are expected to unveil a settlement proposal this week with distributors McKesson Corp (MCK.N), Cardinal Health Inc (CAH.N) and AmerisourceBergen Corp (ABC.N) contributing a combined $21 billion, while Johnson & Johnson would pay $5 billion.

Noticeably absent from the potential $26 billion deal are pharmacy operators including Walgreens Boots Alliance, Walmart Inc , Rite Aid Corp and CVS Health Corp, which have been accused of ignoring red flags that opioid drugs were being diverted into illegal channels.

The deal also would not include drugmakers AbbVie Inc, Teva Pharmaceutical Industries Ltd or Endo International Plc, which have been accused of misleadingly marketing their pain medicines as safe.

The pharmacies and drugmakers have denied the claims, saying rising opioid prescriptions were driven by doctors, that they followed federal law and that the known risks were included in U.S.-approved labels for the drugs.

News of the proposed nationwide settlement came three weeks into a jury trial in New York, and legal experts said upcoming court proceedings will pressure the remaining defendants to reach a deal.

The drugmakers are currently defending themselves at the New York trial and a trial in Orange County, California, and are expected to face another trial in San Francisco along with the pharmacies later this year. The pharmacies, which settled the New York case shortly before trial, also face an October trial in Ohio.

After start of the Orange County case earlier this year, Allergan defense counsel Donna Welch, in her opening statements in front of Judge Wilson, initially threw co-defendants in the opioid litigation “The Pharmacy Chains” under the bus, claiming they were the responsible party in unleashing hundreds of millions of prescription opioids, the “firewall” in mitigating the now defense asserted, non-existent opioid crisis.  This illustration of the “blame others” defense strategy has fewer targets as supply chain participants settle cases, removing opportunities for remaining defendants to shift blame.

Richard Ausness, a law professor at the University of Kentucky, said a settlement this week reduces the groups of defendants in the litigation and makes it harder for the remaining companies to blame others.

Endo is scheduled to go to trial next week to assess damages over a lawsuit brought on behalf of Tennessee counties and an infant allegedly born addicted to opioids, in which a judge has already ruled the company liable. District Attorney General Barry Staubus of Tennessee’s Sullivan County told WHLJ television that the company offered to settle, but the deal would be limited to that case.

Peter Mougey, a lawyer representing the local governments pursuing opioid litigation around the country, said at a news conference to discuss proposed settlements that he was “frustrated” pharmacies were not part of the nationwide deal.

“They’ve had ample time to assess where they are with their liability, and we all have the common goal of trying to end this opioid epidemic,” he said.

The pharmacies did not immediately respond to requests for comment.

One of the largest hospital systems in the nation and two of its doctors will pay $37.5 million to resolve violations of the False Claims Act and the California False Claims Act. The settlement – which resolved two cases – is a joint resolution with the U.S. Department of Justice and the California Department of Justice.

The United States and California entered into a settlement agreement with the Prime Healthcare Services system; Prime’s founder and Chief Executive Officer, Dr. Prem Reddy; and interventional cardiologist Dr. Siva Arunasalam to resolve alleged violations of the False Claims Act and the California False Claims Act based on kickbacks paid by Prime to Arunasalam for patient referrals.

Prime includes the Ontario-based Prime Healthcare Services Inc., Prime Healthcare Foundation Inc., Prime Healthcare Management Inc., High Desert Heart Vascular Institute (HDHVI), and Desert Valley Hospital Inc.

Under the settlement agreement, Arunasalam will pay $2 million. Reddy has already paid $1,775,000, and Prime has paid $33,725,000. The United States will receive $35,463,057 of the settlement proceeds, and California will receive $2,036,943.

In 2018, Prime and Reddy paid $65 million to settle unrelated allegations of false claims and overbilling.

The settlement resolves allegations that:

– – Prime paid kickbacks when it overpaid to purchase Arunasalam’s physician practice and surgery center because the company wanted Arunasalam to refer patients to its Desert Valley Hospital in Victorville. The purchase price, which was substantially negotiated by Reddy, exceeded fair market value and was not commercially reasonable. Prime also knowingly overcompensated the doctor when HDHVI entered into an employment agreement with him that was based on the volume and value of his patient referrals to Desert Valley Hospital;
– – For approximately two years between 2015 and 2017, HDHVI and Arunasalam used Arunasalam’s billing number to bill Medicare and Medi-Cal for services that were provided by Dr. George Ponce, even though they knew Ponce’s Medicare and Medi-Cal billing privileges had been revoked, and that billing Ponce’s services under Arunasalam’s billing number was improper; and
– – Certain Prime hospitals billed Medi-Cal, the Federal Employees Health Benefits Program, and the U.S. Department of Labor’s Office of Workers’ Compensation Programs for false claims based on inflated invoices for implantable medical hardware. Arunasalam was not implicated in this conduct.

In connection with the settlement, Prime and Reddy entered into a five-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). The CIA requires, among other things, that Prime maintain a compliance program and hire an Independent Review Organization to review arrangements entered into by or on behalf of its subsidiaries and affiliates.

The civil settlement includes the resolution of claims brought under the qui tam, or whistleblower, provisions of the False Claims Act in two lawsuits filed in federal court in Los Angeles. One suit was filed by Martin Mansukhani, a former Prime executive. The second suit was filed by Marsha Arnold and Joseph Hill, who were formerly employed in the billing office at Shasta Regional Medical Center, a Prime hospital in Redding, California.

Under the qui tam provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. Although the United States did not intervene in these cases, it continued to investigate the whistleblowers’ allegations and helped to negotiate the settlement announced today. Mr. Mansukhani will receive $9,929,656 as his share of the federal government’s recovery.