Author: WorkCompAcademy

Escondido pain clinic doctor, and board-certified physiatrist, Bradley Chesler, M.D., has paid the United States $153,000 to resolve allegations that he overprescribed opioids.

Dr. Chesler is listed as a Qualified Medical Evaluator by the DWC in the specialties of Pain Medicine and Physical Medicine and Rehabilitation. His QME office address is 1955 Citracado Pkwy, in Escondido.

This settlement stems from the investigation into whether Dr. Chesler illegally prescribed opioids to his patients in violation of the Controlled Substances Act.

Pursuant to the Controlled Substances Act, doctors may write prescriptions for opioids only for a legitimate medical purpose while acting in the usual course of their professional practice.

Federal investigators alleged that from January 1, 2014 to August 31, 2019, Dr. Chesler wrote opioid prescriptions that violated the Controlled Substances Act, which included prescriptions for fentanyl, hydromorphone, methadone, and oxycodone.

Dr. Chesler allegedly prescribed opioids while he concurrently prescribed benzodiazepines, and he prescribed to some patients a combination of at least one opioid, one benzodiazepine, and one muscle relaxant.

Drug abusers colloquially refer to the opioid, benzodiazepine, and muscle relaxant combination as the “Trinity” because of its rapid euphoric effects. These drug combinations are known to increase the risk of abuse, addiction, and overdose.

Chesler prescribed large quantities of opioids to his patients that reached high daily Morphine Milligram Equivalent (MME) levels (sometimes even exceeding 180 MME). The United States further alleged that Dr. Chesler failed to properly address aberrant urine drug test results when prescribing opioids.

Public health experts have long warned health care providers that overdose risk is elevated in patients receiving medically prescribed opioids, particularly those receiving high dosages. Among other things, tracking MMEs advances better practices for pain management by reinforcing the need for providers to consider alternatives to using high-dosage opioids to treat pain, and to appropriately justify decisions to use opioids at dosages that place patients at high risk of addiction, abuse, and overdose.

DEA Special Agent in Charge John Callery said, “Although 99 percent of medical professionals abide by DEA guidance and federal law, we will investigate those who put illicit profits before their oaths and bring them to justice.”

The National Council on Compensation Insurance (NCCI) is undertaking several activities to better understand the impacts of the COVID-19 pandemic on the Workers Compensation system. One action is monitoring several medical data-related metrics, which were developed to provide insight into the effect of COVID-19 on several aspects of the medical system as it relates to WC.

These metrics track quarterly results over time, allowing it to compare the data before the onset of the pandemic and workers compensation medical experience thereafter. Looking at the first two quarters of 2020, it identified general demographics and cost characteristics of claims having COVID-19 medical treatments.

In it’s recent article NCCI shares some of the aggregated-multi-state results for these metrics including data from the first and second quarter of 2020.

Some of the conclusions of the report show:

— Hospitalization and intensive care unit (ICU) treatment are key cost indicators of COVID-19 claims.
— Overall active claim volume decreased during 2Q20.
— Increased use of telemedicine in 2Q20, to varying degrees across states.
— Evaluation and management and physical medicine show a decrease in the utilization of in-person services in 2Q20.
— The share of claims with surgery has remained steady, but the decreased intensity of surgery procedures seems to reflect a change in injuries or surgery mix.
— Drug share of medical costs took an upward turn, in part driven by increased utilization of opioids.

While it is too early to fully assess the impact that the COVID-19 pandemic will have on the WC system, NCCI is beginning to identify the medical aspects of the system that are likely to be affected.

Furthermore, the measures of the potential indirect impact of the pandemic on medical services provided to all injured workers in the first two quarters of 2020, at first blush, do not show evidence of substantial disruption.

As data emerges, future updates to these metrics will be available on NCCI.com. A medical data dashboard will include state-specific results, allowing the user to compare a state’s experience to a multi-state benchmark.

The European Medicines Agency (EMA) reports that the agency has been subject to a cyber attack and that some documents relating to the regulatory submission for Pfizer and BioNTech’s COVID-19 vaccine candidate, BNT162b2, which has been stored on an EMA server, had been unlawfully accessed, BioNTech revealed in a statement published on its website.

The German biotechnology company, previously best-known for its work pioneering cancer immunotherapy research, stressed that “no BioNTech or Pfizer systems” were accessed during the breach, suggesting that it was the European Union regulator whose security failed.

They added that they were “unaware” of any of their study participants being identified as a result of the breach and that they are awaiting “further information about EMA’s investigation and will respond appropriately and in accordance with EU law.”

“Our focus remains steadfast on working in close partnership with governments and regulators to bring our COVID-19 vaccine to people around the globe as safely and as efficiently as possible to help bring an end to this devastating pandemic,” they concluded.

The British National Cyber Security Centre (NCSC) has indicated that the hack should not impact the BioNTech/Pfizer vaccine’s rapid and at-times troubled rollout in the United Kingdom.

The Medicines and Healthcare products Regulatory Agency (MHRA) has advised that the coronavirus prophylactic should not be administered to people with a “history of a significant reaction” to medicines, foods, or vaccines, after two National Health Service (NHS) workers showed symptoms of an “anaphylactoid reaction” shortly after being injected.

The regulator now advised that “resuscitation facilities” should be present at all vaccination sites, and vaccinations not carried out if they are now available.

On the hacks, the NCSC said that it was “working with international partners to understand the impact of this incident affecting the EU’s medicine regulator, but there is currently no evidence to suggest that the UK’s medicine regulator has been affected.”

According to the BBC, it is “not clear” whether or not cyber-attackers also hacked the EMA’s documents on the Moderna vaccine at present.

China, Iran, and Russia have all been accused of using hackers against coronavirus vaccine research by Western governments.

34 year old Perry Adam Lieber, who lives in Santa Barbara and who was a former Ventura County firefighter, was charged earlier this year with three felonies in a case involving workers’ compensation fraud.

Lieber allegedly made material misrepresentations about the nature and extent of an industrial injury as well as his true physical abilities, the DA’s office said. Prosecutors also say he misrepresented his income while getting disability pay and lied under oath during a deposition.

Lieber, ultimately pled guilty this month to felony workers’ compensation fraud under Insurance Code section 1871.4(a), admitting a special allegation that the theft totaled more than $100,000 in losses to the victims.

During his guilty plea, Lieber admitted making false and material misrepresentations for the purpose of obtaining disability benefits to which he was not entitled during his workers’ compensation claim.

Victim agencies York Risk Services and the County of Ventura are alleged to have sustained losses of approximately $148,177.

Chief Mark Lorenzen of the Ventura County Fire Department said Lieber resigned from the agency in early March.

According to a report in the Ventura County Star at the time of his arrest, the Chief said the department was not surprised by the charges the DA’s office has brought against Mr. Lieber. “We were aware of a number of irregularities during the last portion of his career. We brought those to the attention of the county risk management unit.”

The maximum penalty for a violation of Insurance Code 1871.4(a) is five years in jail, as well as a fine of up to double the amount of fraud, or approximately $296,354.

At the time this case was filed, the Ventura County District Attorney’s Office Workers’ Compensation Fraud Unit obtained a temporary restraining order seizing Lieber’s bank accounts and other assets in connection with the fraud investigation.

As a condition of Lieber’s plea, a portion of these assets will be liquidated to pay victim restitution and criminal fines.

Lieber is scheduled to be sentenced on January 6, 2021, at 9:00 a.m. in courtroom 12 of the Ventura County Superior Court.

On November 20, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”), which has not been significantly updated since it was enacted in 1989. .

Under the Stark Law, a physician is prohibited from making referrals to an entity for healthcare services if the physician has a financial relationship with the entity. The regulations were intended to protect patients in a health care system that reimbursed providers on a fee-for-service basis. In this type of system, there is a motivation to provide more services.

The new final rule supports the CMS “Patients over Paperwork” initiative by reducing the unnecessary regulatory burdens on physicians and other healthcare providers while reinforcing the Stark Law’s goal of protecting patients from unnecessary services and being steered to less convenient, lower quality, or more expensive services because of a physician’s financial self-interest.

Through the Patients over Paperwork initiative, the final rule opens additional avenues for physicians and other healthcare providers to coordinate the care of the patients they serve – allowing providers across different healthcare settings to work together to ensure patients receive the highest quality of care.

In addition, as part of the Regulatory Sprint to Coordinated Care, CMS worked closely with the Department of Health and Human Services Office of Inspector General in finalizing policies that advance the transition to a value-based healthcare delivery and payment system that improves the coordination of care among physicians and other healthcare providers in both the federal and commercial sectors.

Healthcare Leadership Council President Mary Grealy said, “This should be recognized as one of the most important health policy achievements of recent years. We are moving toward an era in healthcare that recognizes the importance of care coordination and fully integrated care involving primary care providers, specialists, hospitals, pharmacies, drug and device manufacturers and more.”

Grealy continued, “These laws, as written, discouraged innovative patient-focused multi-sector collaborations at a time in which we should be enthusiastically encouraging them. What these new rules recognize is that we can protect patients from fraud and abuse while still allowing the healthcare system to evolve in a way that benefits patients and achieves greater cost-efficiency.“

It remains to be seen if regulators in California will follow this thinking in terms of regulating those involved in workers’ compensation medical delivery systems