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Fake Doctor in Fake Long Beach Clinic Sentenced

James Wilson, 56, was sentenced by United States District Judge Terry J. Hatter Jr.  At the conclusion of a bench trial in March, Judge Hatter found Wilson guilty of two counts of illegally distributing oxycodone.

The evidence presented at trial showed that Wilson, during two different transactions in early 2016, sold a total of four prescriptions to an undercover operative working with the Drug Enforcement Administration. Each of the four prescriptions were for 120 30-milligram oxycodone pills, which is the maximum strength of the opioid sold through pharmacies.

Wilson, who is neither a doctor nor a pharmacist, owned and operated what prosecutors called a “sham medical clinic.” The illegal prescription sales took place in the parking lot of Wilson’s clinic, where he charged $200 for each of the illegal prescriptions.

Wilson was arrested in this case in August 2017, at which time investigators found 160 blank prescriptions in his vehicle.

Wilson’s “scheme involved the diversion of oxycodone, a powerful and deadly opioid at the center of the nation’s opioid crisis,” prosecutors wrote in a sentencing memorandum.

This case was investigated by the DEA and was conducted with the support of the Organized Crime Drug Enforcement Task Force (OCDETF). This matter was prosecuted by Assistant United States Attorneys Marina A. Torres and Brittney M. Harris of the International Narcotics, Money Laundering, and Racketeering Section.

December 16, 2019 News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Court of Appeal Resolves WCAB Concurrent Jurisdiction Issue, Insurers Tell Supreme Court Obamacare was “Massive Bait-and-Switch”, Tort Claim Removable to Federal Court Until Employer Intervenes, San Joaquin County Doctor Indicted, Amador County Staffing Company Owner Sentenced for Premium Fraud, FDA Rapidly Approving Breakthrough Drugs, ACOEM Concerned About Cannabis Legalization and Safety, Apple, Amazon and Google to Take Over Healthcare by 2030, Newly Unsealed Court Records Bad News for Opioid Industry, Sedgwick Institute Book Ponders Future for Work Comp Systems.

More Lawsuits and Layoffs Follow Passage of AB-5 Employment Law

The American Society of Journalists and Authors (ASJA) is the nation’s largest professional organization of independent nonfiction writers. Its membership consists of freelance writers of magazine articles, trade books, and many other forms of nonfiction writing. The ASJA was founded in 1948 as the Society of Magazine Writers. Its membership consists of more than 1,100 freelance writers.

The National Press Photographers Association (NPPA) is an American professional association made up of still photographers, television videographers, editors, and students in the journalism field. It was founded in 1946. As of 2017, NPPA had total membership at just over 6,000.

Both the American Society of Journalists and Authors, Inc., and National Press Photographers Association as plaintiffs have just filed a lawsuit federal court against California, over the state’s controversial Assembly Bill 5 (AB 5), saying the law forces their independent contractors to “become employees of their clients,” whether or not this is preferable or even feasible.

“We have no choice but to go to court to protect the rights of independent writers and freelance journalists as a whole,” said Milton C. Toby, JD, president of ASJA. “The stakes are too high, and we cannot stand by as our members and our colleagues face ill-conceived and potentially career-ending legislation.”

“Under the law, a freelancer like me can write 200-plus press releases in a year for a marketing firm, and it’s no problem. But if a newspaper wants me to write a weekly column about local politics, it must put me on staff – a very unlikely prospect – or violate the law. Otherwise I am silenced,” said San Diego freelance writer Randy Dotinga, a board member and former president of ASJA.

The lawsuit asserts that the law violates the U.S. Constitution because it penalizes some freelancers while allowing other visual artists (including marketing photographers, fine artists, and graphic artists) to continue to perform as independent contractors, unencumbered by limits on the number of assignments they do.

Additionally, AB5 forbids any freelancing by visual journalists who shoot video, a provision that is challenged in the lawsuit as a content-based restriction on speech. For still photojournalists, the bill imposes a limit of 35 “submissions” or assignments per year for any single client, another content-based First Amendment violation. Similar limits are imposed on freelance writers, editors, and newspaper cartoonists.

And and an article in Forbes just announced that Vox Media, a large digital media company with an array of niche sites, abruptly terminated hundreds of freelance writers in the state of California. The company will cancel its agreements with about 200 contractors to comply with a new law that goes into effect on January 1, 2020.

The cuts target writers for the SB Nation blog, which covers sports in California. Vox intends to replace the freelance writers with roughly 20 new part-time and full-time staffers.

WCIRB Quarterly Report Shows Escalating Premium Decreases

WCIRB insurer experience summaries are released approximately three to five months after the end of the quarter. These reports contain information such as written premium, average cost of a claim, accident year combined loss and expense ratios, etc. It has just published its Quarterly Experience Report as of September 30, 2019. Here are some of the highlights.

Written premium for the first 9 months of 2019 is 7% below the same period for 2018, suggesting that premium decreases are escalating in 2019. Written premium for 2018 is 4% below that for 2017 and 6% below that for 2016. The decreases since 2016 are primarily driven by decreases in insurer charged rates more than offsetting increases in employer payroll.

The Average charged rate for the first 9 months of 2019 is 11% below that for 2018 and 32% below the peak in 2014. The January 1, 2020 approved advisory pure premium rates are on average 47% below those for January 1, 2015.

The projected loss ratio for 2018 is 3 points above that for 2017, driven by higher severities for 2018 and lower premium rates. These ultimate projections as of September 30, 2019 are generally consistent with those as of June 30, 2019 and March 31, 2019 as recent trends in downward loss development are moderating.

The projected combined ratio for 2018 is 5 points higher than 2017 as premium levels have lowered while average claim severities increased moderately. Despite the recent increase, combined ratios for the last six years remain below 100% and are the lowest since the 2003 through 2007 period.

Indemnity claims have settled quicker over the last several years, largely driven by SB 863 and SB 1160 reforms. The ratio for 2019 is only modestly higher than 2018, which is driven by more recent accident years, suggesting claim settlement rates may be plateauing.

Claim frequency increased by 11% from 2009 to 2014, but has decreased by 6% from 2014 through the first 9 months of 2019. The recent declining frequency is more consistent with patterns in other states though more modest compared to decreases in other states as well as the long-term trend in California.

Cumulative trauma (CT) claim rates continue to increase in 2017 and the ratio of CT claims to all indemnity claims has increased by over 80% since 2005. The sharp increase in CT claims since 2012 is in the Los Angeles and San Diego areas, as CT claims in other regions of CA have generally decreased.

Projected claim severity for 2018 is 5% higher than that for 2017, following several years of modest declines in claim severities. 2018 is projected from claims valued at 21 months and while the growth may still moderate as the year matures, the growth rate as of September 30, 2019 is consistent with that of the prior quarterly evaluation.

Pharmaceutical costs per claim decreased more than 80% from 2012 through the first half of 2019. These reductions have been driven by SB 863’s IMR & IBR, reduced utilization of opioids, changes to Medi-Cal reimbursement rates, efforts to combat fraud, and the new drug formulary. Pharmaceutical utilization continued to decrease significantly in 2018 and 2019, the first periods in which the new drug formulary is in effect.

The number of liens filed in the first three quarters of 2019 are more than 60% below pre-SB 1160 and AB 1244 levels.

Privette Doctrine Precludes Security Guard’s Suit

ABC contracted with the landowners to use a gas station/food mart and car wash for two days to film an episode of a television show. The contract gave ABC “the right to use both the real and personal property . . . together with access to and egress from the Property with its personnel and equipment.”

The property sits on the corner of Foothill Boulevard and Terra Bella Street in Sylmar, California and is surrounded by an eight-foot high metal fence. ABC planned to close the property to the public during filming and needed access through three gates to the interior food mart and the parking areas.

On the side of the property along Terra Bella Street was a parking lot, a wall, and a metal rolling gate weighing approximately 900 pounds. The gate slid along a track that ran through containment towers to keep it upright. Cal-OSHA standards require that “[a]ll horizontal sliding gates . . . be equipped with positive stops or devices that limit the gate travel to the designed fully open and closed positions.” Without stops, the gates are unsafe. The Terra Bella gate lacked stops.

ABC’s location scout, Gary Watt, visited the premises multiple times but did not inspect the gates. During his visits, Watt looked for clearly observable problems, “what they call bear traps, anything that could be a safety hazard or anything that might present a danger to cast, crew, [or] the public.” Watt did not note that the gate was in any particular state of disrepair.

ABC hired Executive Assurance to provide security for the property during filming. On the day of filming, Reina Castro, a licensed security guard employed by Executive Assurance attempted to stop the Terra Bella gate from striking a truck that was backing out. The gate fell on her causing a broken leg, multiple fractures to her left shoulder, and torn ligaments and degenerative arthritis in her knee.

Castro sued ABC Studios, Inc. to recover for for her personal injuries.The trial court granted ABC’s motion for nonsuit under Privette v. Superior Court (1993) 5 Cal.4th 689 and its progeny, ruling that Castro had presented no evidence that ABC controlled the manner or mode by which its independent contractor’s employees, such as Castro, performed their work.

The Court of Appeal agreed that the Privette doctrine applies to this case and that Castro failed to adduce evidence of an exception in the unpublished case of Castro v. ABC Studios.

Subject to certain exceptions, the Privette doctrine bars employees of independent contractors from recovering damages from the hirer of the contractor for workplace injuries.

The rationale is twofold. First, because workers’ compensation insurance generally provides the exclusive remedy for employees who are injured on the job, allowing the employee to recover from the contractor’s hirer, who did not cause the injury, would unfairly subject the hirer to greater liability than that faced by the contractor who was negligent.

Secondly, by hiring an independent contractor, the hirer implicitly delegates to the contractor any tort law duty it owes to the contractor’s employees to ensure the safety of the specific workplace that is the subject of the contract.

DWC Updates MTUS Drug List

The Division of Workers’ Compensation has issued an order updating the Medical Treatment Utilization Schedule (MTUS) Drug List effective January 15, 2020 pursuant to Labor Code section 5307.29.

The Administrative Director’s update order adopts changes to the MTUS Drug List, based on the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, including the new drug recommendations addressed in the Hip and Groin Disorder Guideline.

The MT US Drug List must be used in conjunction with 1) the MTUS Guidelines, which contain specific treatment recommendations based on condition and phase of treatment and 2) the drug formulary rules. (See 8 CCR §9792.20 – §9792.27.23.)

Exempt” indicates drug may be prescribed/dispensed without seeking authorization through Prospective Review if in accordance with MTUS.

Non-Exempt” or “Unlisted” drug requires authorization through Prospective Review prior to prescribing or dispensing. (See 8 CCR §9792.27.1 through §9792.27.23 for complete rules.)

Special Fill – Indicates the Non-Exempt drug may be prescribed/dispensed without Prospective Review: 1) Rx at initial visit within 7 days of injury, and 2) Supply not to exceed #days indicated, and 3) is a generic or single source brand, or brand where the physician substantiates medical necessity, and 4) if in accord with MTUS. (See 8 CCR § 9792.27.12.)

Perioperative Fill – Indicates the Non-Exempt drug may be prescribed/dispensed without Prospective Review: 1) Rx issued during the perioperative period (4 days before through 4 days after surgery), and 2) Supply not to exceed #days indicated, and 3) is a generic or single source brand, or brand where physician substantiates medical necessity, and 4) is in accord with MTUS. (See 8 CCR § 9792.27.13.)

The updated MTUS Drug List v.6 and the order can be accessed on the DWC MTUS drug formulary webpage.

10 NFL Players Charged with Health Care Fraud

Ten former National Football League (NFL) players have been charged in the Eastern District of Kentucky for their alleged roles in a nationwide fraud on a health care benefit program for retired NFL players.

The alleged fraud targeted the Gene Upshaw NFL Player Health Reimbursement Account Plan (the Plan), which was established pursuant to the 2006 collective bargaining agreement and provided for tax-free reimbursement of out-of-pocket medical care expenses that were not covered by insurance and that were incurred by former players, their wives and their dependents – up to a maximum of $350,000 per player.  According to the charging documents, over $3.9 million in false and fraudulent claims were submitted to the Plan, and the Plan paid out over $3.4 million on those claims between June 2017 and December 2018.

Two separate indictments filed in the Eastern District of Kentucky outline two alleged conspiracies involving different players related to the same scheme to defraud the Plan. Those charged in the indictments are the following:

Robert McCune, 40, of Riverdale, Georgia, is charged with one count of conspiracy to commit wire fraud and health care fraud, nine counts of wire fraud and nine counts of health care fraud.

John Eubanks, 36, of Cleveland, Mississippi; Tamarick Vanover, 45, of Tallahassee, Florida; and Carlos Rogers, 38, of Alpharetta, Georgia, are each charged with one count of conspiracy to commit wire fraud and health care fraud, two counts of wire fraud and two counts of health care fraud.

Clinton Portis, 38, of McLean, Virginia; Ceandris Brown, 36, of Fresno, Texas; James Butler, 37, of Atlanta, Georgia; and Fredrick Bennett, 35, of Port Wentworth, Georgia, are each charged with one count of conspiracy to commit wire fraud and health care fraud, one count of wire fraud and one count of health care fraud.

Correll Buckhalter, 41, of Colleyville, Texas, and Etric Pruitt, 38, of Theodore, Alabama, are charged with one count of conspiracy to commit wire fraud and health care fraud.

In addition, the government has filed notice that it intends to file criminal informations charging Joseph Horn, 47, of Columbia, South Carolina, and Donald “Reche” Caldwell, 40, of Tampa, Florida, with conspiracy to commit health care fraud in the Eastern District of Kentucky.

The indictments charge that the scheme to defraud involved the submission of false and fraudulent claims to the Plan for expensive medical equipment – typically between $40,000 and $50,000 for each claim – that was never purchased or received.  

The expensive medical equipment described on the false and fraudulent claims included hyperbaric oxygen chambers, cryotherapy machines, ultrasound machines designed for use by a doctor’s office to conduct women’s health examinations and electromagnetic therapy devices designed for use on horses.

According to allegations in the indictments, McCune, Eubanks, Vanover, Buckhalter, Rogers and others recruited other players into the scheme by offering to submit or cause the submission of these false and fraudulent claims in exchange for kickbacks and bribes that ranged from a few thousand dollars to $10,000 or more per claim submitted.  As part of the scheme, the defendants allegedly fabricated supporting documentation for the claims, including invoices, prescriptions and letters of medical necessity.  After the claims were submitted, McCune and Buckhalter allegedly called the telephone number provided by the Plan and impersonated certain other players in order to check on the status of the false and fraudulent claims.

East Bay Men Arrested for Fake Oxycodone Sales

Jose Ricardo Loza and Randy Lee Walker were charged in a criminal complaint with distributing fentanyl and heroin.

An affidavit filed in the case alleges that Loza sold blue counterfeit oxycodone pills that were laced with Fentanyl. According to the affidavit, Loza sold to a third party 50 Fentanyl-laced pills on August 22, 2019, when at the auto body shop where he works in Pittsburg, California.

Loza allegedly did not initially have enough pills to sell, so he texted Walker, who arrived with more Fentanyl-laced pills.

During the transaction, Loza warned the customer to be careful when taking these pills because he (Loza) gave the same pills to a mutual friend who overdosed and died. According to the affidavit, a laboratory test verified that a sample of the pills Loza sold contained fentanyl.

In addition, the affidavit alleges that on November 22, 2019, Loza sold 500 more counterfeit pills to an undercover officer and then told the officer that he had 10,000 more of the same pills for sale. Further, the affidavit alleges Loza sold two ounces of heroin on September 10, 2019.

Loza and Walker are charged with distribution of controlled substances, in violation of 21 U.S.C. §§ 841(a)(1) and (b)(1)(C).

Loza and Walker were arrested on December 12, 2019. At the time of Loza’s arrest, law enforcement agents found more than 2,000 counterfeit oxycodone pills hidden in hallowed out compartments of his furniture.

Both defendants currently are in custody. Walker’s next court appearance is scheduled for Monday, December 16, 2019, for appointment of counsel. Loza’s next court appearance is scheduled for Wednesday, December 18, 2019, for a hearing to address detention issues.

If convicted, the defendants face a maximum statutory penalty of up to 20 years in prison. A term of supervised release, fines, forfeitures, and restitution also may be ordered, however, any sentence following conviction would be imposed by the court only after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553.

Tramadol – The Other Opioid Crisis

The world has been told that the drug Tramadol, is safer than the OxyContins, the Vicodins, the fentanyls that have wreaked so much devastation. But now they are the root of what the United Nations named “the other opioid crisis” – an epidemic featured in fewer headlines than the American one, as it rages through the planet’s most vulnerable countries.

Mass abuse of the opioid tramadol spans continents, from India to Africa to the Middle East, creating international havoc some experts blame on a loophole in narcotics regulation and a miscalculation of the drug’s danger. The man-made opioid was touted as a way to relieve pain with little risk of abuse. Unlike other opioids, tramadol flowed freely around the world, unburdened by international controls that track most dangerous drugs.

But abuse is now so rampant that some countries are asking international authorities to intervene.

Grunenthal, the German company that originally made the drug, is campaigning for the status quo, arguing that it’s largely illicit counterfeit pills causing problems. International regulations make narcotics difficult to get in countries with disorganized health systems, the company says, and adding tramadol to the list would deprive suffering patients access to any opioid at all.

Tramadol has not been as deadly as other opioids, and the crisis isn’t killing with the ferocity of America’s struggle with the drugs. Still, individual governments from the U.S. to Egypt to Ukraine have realized the drug’s dangers are greater than was believed and have worked to rein in the tramadol trade. The north Indian state of Punjab, the center of India’s opioid epidemic, was the latest to crack down. The pills were everywhere, as legitimate medication sold in pharmacies, but also illicit counterfeits hawked by street vendors.

This year, authorities seized hundreds of thousands of tablets, banned most pharmacy sales and shut down pill factories, pushing the price from 35 cents for a 10-pack to $14. The government opened a network of treatment centers, fearing those who had become opioid addicted would resort to heroin out of desperation. Hordes of people rushed in, seeking help in managing excruciating withdrawal.

Jeffery Bawa, an officer with the United Nations Office on Drugs and Crime, realized what was happening in 2016, when he traveled to Mali in western Africa, one of the world’s poorest countries, gripped by civil war and terrorism. They asked people for their most pressing concerns. Most did not say hunger or violence. They said tramadol.

Most of it was coming from India. The country’s sprawling pharmaceutical industry is fueled by cheap generics. Pill factories produce knock-offs and ship them in bulk around the world, in doses far exceeding medical limits.

In 2017, law enforcement reported that $75 million worth of tramadol from India was confiscated en route to the Islamic State terror group. Authorities intercepted 600,000 tablets headed for Boko Haram. Another 3 million were found in a pickup truck in Niger, in boxes disguised with U.N. logos. The agency warned that tramadol was playing “a direct role in the destabilization of the region.”

The United Kingdom and United States both regulated it in 2014. Tramadol was uncontrolled in Denmark until 2017, when journalists asked doctors to review studies submitted to regulators to support the claim that it has a low risk for addiction, said Dr. Karsten Juhl Jorgensen, acting director of the Nordic Cochrane Centre and one of the physicians who analyzed the materials. They all agreed that the documents did not prove it’s safer.

The Broken FDA Drug Recall System

In mid-September the U.S. Food and Drug Administration received a 19-page document with some startling claims about a popular medicine. The online pharmacy Valisure, which tests prescription drugs before dispensing them, said it had found extremely high levels of a probable human carcinogen in the antacid ranitidine, best known under the brand name Zantac.  As for the carcinogen, NDMA, the FDA knew it well: For more than a year the agency had been recalling batches of the blood pressure medication valsartan because they were contaminated with it.

The FDA issued an alert, one that seemed to downplay Valisure’s findings. The agency said it had learned that some ranitidine medicines contained low levels of NDMA, but it wasn’t advising people to stop taking the drug. In fact, Valisure had found high levels of NDMA in every version of ranitidine it tested and concluded the problem was inherent to the molecule itself. In other words, if Valisure is correct, there is no safe version of ranitidine.

The muted quality of the FDA’s statement didn’t stop concern from going global. By mid-October, a month after the FDA’s alert, at least two dozen countries had pulled ranitidine from stores or halted its distribution. Numerous companies had acted on their own to slow or stop the supply of the drug. The FDA continued to conduct tests.

Finally, on Nov. 1, the agency announced that it had found higher-than-acceptable levels of NDMA in some ranitidine- though not nearly as high as Valisure detected. The FDA then deployed the strongest weapon available to it: The agency asked manufacturers to voluntarily recall some of the Zantac on the market.

At a time when a poorly policed global supply chain and demand for ever-cheaper generics have exposed drugs to new safety risks, an effective recall system is crucial. Spotting problems earlier is getting harder: From 2016 to 2018 the number of FDA inspections of drug manufacturers declined 10% overseas and 13% for domestic facilities, according to a recent report from the Government Accountability Office.

But the agency’s authority over this system is limited. It can only request a pullback – manufacturers can and do say no. It can’t contact patients directly; it relies on pharmacies for that. It doesn’t control how the recall is conducted or how its effectiveness is assessed.

Rosa DeLauro, in her role on the House committee that oversees the agency, has tried to give it more authority over recalls. She sponsored a bill that gave the FDA the power to order food recalls; it was signed into law by President Barack Obama in 2011. The agency also has recall power over manufacturers of vaccines, medical devices, infant formula, and tobacco products. As of last year, it can order a recall of opioids deemed dangerous. It can do all of that, but it can’t order a recall of any other prescription drug.

DeLauro tried to push a bill two years ago to change that.  The bill went nowhere. At least one reason was opposition to it from the trade group representing drug manufacturers. Now, after two high-profile recalls of common drugs have exposed flaws in the system, DeLauro plans to try again to give the FDA more clout.

When the federal government couldn’t make progress, states tried. The first was California, which, because of its size, can establish de facto national standards for industries. In 2004, California passed a law requiring electronic tracking of drugs all the way to the patient by 2009. The drug industry pushed back, saying the changes were technologically impossible to make that quickly. The deadline was extended to 2014. Nothing happened.

Then, in 2013, the industry preempted the California statute and its deadline by winning passage of a federal drug tracking law. The law created a uniform national system for electronically tracing pharmaceuticals from the manufacturer to the pharmacy’s back door. The industry was given 10 years – until November 2023 – to fully comply. Other countries trying to create tracking systems aren’t moving any faster, says Eric Marshall, executive director of a new industry governance group for implementation of the law.

The legislation exempts pharmacies completely. Even after the law goes into full effect, pharmacies won’t have to track which lots they sell to which customers. Nor will they be required to put lot numbers on labels. Some pharmacies do that now, and others don’t. One concern is patient privacy. To further complicate matters, high-volume pharmacies, such as mail-­order companies, mix pills from different lots. Pharmacies can also subdivide packages.