Author: WorkCompAcademy

The Workers’ Compensation Appeals Board (WCAB) has issued a notice of public hearing regarding proposed additions, amendments and repeals to its Rules of Practice and Procedure (Rules).

The public hearing is scheduled at 9 a.m. on Tuesday, September 24 in Room 7 of the Elihu Harris State Office Building, 1515 Clay Street, Oakland. Members of the public may also submit written comments until 4 p.m. that day.

The purposes of this rulemaking are to organize articles to reflect the order of events in a case, eliminate duplicative rules, break up complex rules, simplify and modernize language of rules for clarity, and create some room between rules so that additional rules can be added in the future without need for decimals.

WCAB’s notice of the proposed rulemaking, the text of the proposed regulations and the initial statement of reasons can be found on its rulemaking page.

Although equal weight will be accorded to oral and written comments, WCAB prefers written comments submitted by email. Comments may be submitted by email to WCABRules@dir.ca.gov or by mail to:

Workers’ Compensation Appeals Board
Attention: Rachel E. Brill, Industrial Relations Counsel
P.O. Box 429459
San Francisco CA 94142-9459

WCAB will consider all timely public comments and encourages all interested members of the workers’ compensation community to participate in this important process.

Neuropathic pain is a typically persistent and intractable type of chronic pain. This condition is not a symptom of a disorder but a pathological state caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain caused by nerve injury or disease remains a major challenge for modern medicine worldwide.

It is certainly a challenge in the administration of workers’ compensation claims now that use of opiate medications are on the decline.

A recent review article published this year discusses emerging evidence by integrating recent advances related to Schwann cells and neuropathic pain. Their findings showed that that an improved and extended comprehension of the underlying neurobiological mechanisms of neuropathic pain would allow the development of successful targeted pain therapy.

The role of Schwann cells in pain perception has been further explored this year, and new conclusions were just published this month in the Science Journal. A new organ involved in the sensation of pain has been discovered by these scientists, raising hopes that it could lead to the development of new painkilling drugs.

Researchers say they have discovered that the special cells that surround the pain-sensing nerve cells that extend into the outer layer of skin appear to be involved in sensing pain. The scientists say the finding offers new insight into pain and could help answer longstanding conundrums.

:The major question for us now is whether these cells are actually the cause for certain kinds of chronic pain disorders,” Prof Patrik Ernfors, a co-author of the research from the Karolinska Institute in Sweden, told the Guardian.

The researchers reveal how they examined the nature of cells in the skin that, they say, have largely been overlooked. These are a type of Schwann cell, which wrap around and engulf nerve cells and help to keep them alive.

The study has revealed these Schwann cells have an octopus-like shape. After examining tissues, the team found the body of the cells sits below the outer layer of the skin, but that the cells have long extensions that wrap around the ends of pain-sensing nerve cells that extend up into the epidermis, the outer layer of the skin.

The scientists were surprised at the findings because it has long been believed that the endings of nerve cells in the epidermis were bare or unwrapped. “In the pain field, we talk about free nerve endings that are responsible for pain sensation. But actually they are not free,” Ernfors said.

David Williams, a personal trainer, spent years posing as a doctor and billing the nation’s top insurers, making off with millions of dollars.

Williams called himself “Dr. Dave” because he had a Ph.D. in kinesiology. But he didn’t have a medical license. Yet he wrongfully obtained, with breathtaking ease, federal identification numbers that allowed him to fraudulently bill insurers as a physician for services to about 1,000 people.

Getting one through the federal government’s Medicare program is a rite of passage for medical professionals and organizations. Without it, they can’t bill insurers for their services.

Williams discovered and exploited an astonishing loophole: Medicare doesn’t check NPI applications for accuracy. Instead, as one federal prosecutor later noted in court, Medicare “relies on the honesty of applicants.”

Williams first applied for an NPI under his own name as far back as 2008. But it wasn’t until 2014 that Williams began to ramp up his scheme, even though now he wasn’t just unlicensed, he was a two-time felon.

He got a second NPI under the company name, Kinesiology Specialists. The following year, he picked up another under Mansfield Therapy Associates. In 2016, he obtained at least 11 more, often for entities he created in the areas where he found fitness clients: Dallas, Nevada, North Texas and more. By 2017, he had 20 NPIs, each allowing him a new stream of billings.

For every NPI application, Williams also obtained a new employer identification number, which is used for tax purposes. But he never hid who he was, using his real name, address, phone number and email address on the applications. He added the title “Dr.” and listed his credentials as “PhD.” Under medical specialty he often indicated he was a “sports medicine” doctor and provided a license number, even though he wasn’t a physician and didn’t have a medical license.

“Now accepting most health insurance plans,” his Get Fit With Dave website announced. He added a drop-down menu to his site, allowing potential clients to select their health insurance provider: Aetna. Blue Cross Blue Shield. United.

He began building a team, soliciting trainers from the strength and conditioning department at Texas Christian University. He met with new recruits at local fast food joints or coffee shops to set them up. To the trainers, the business appeared legit: They even signed tax forms. Before long, Williams’ network stretched throughout Texas and into Colorado, Idaho and Nevada.

He used his favorite billing code – 99215. The code is supposed to be used less often because it requires a comprehensive examination and sophisticated medical decision-making, warranting higher reimbursement. In all, Williams used the code to bill United for more than $20.5 million – without apparently triggering any red flags at the insurer. For that code alone, the insurance giant rewarded him with $2.5 million in payments.

He ran the scheme for more than four years, fraudulently billing several of the nation’s top insurance companies – United, Aetna and Cigna – for $25 million and reaping about $4 million in cash.

A case summary, prepared by the Texas Department of Insurance, shows it first learned of the Williams case in January 2015 but lacked staff to investigate.

Cigna appears to have been the quickest to intervene. In January 2015, Cigna sent Williams a letter, noting that he wasn’t a licensed medical provider and had misrepresented the services he provided. The insurer said he needed to pay back $175,528 and would not be allowed to continue billing.

Williams had more than one National Provider Identifier, so he just switched numbers and kept billing Cigna. More than a year later, in May 2016, Cigna sent another letter, saying he now owed $310,309 for inappropriate payments. In total, the company paid him more than $323,000. Williams never gave any of it back.

In October 2017, Williams’ long run came to an end when he was arrested by the FBI. After a two day trial, a jury convicted Williams of four counts of health care fraud. He was sentenced him to a little more than nine years in federal prison and ordered him to pay $3.9 million in restitution to United, Aetna and Cigna.

A researcher from the University of Houston has found that adults who take prescription opioids for severe pain are more likely to have increased anxiety, depression and substance abuse issues if they also use marijuana.

“Given the fact that cannabis potentially has analgesic properties, some people are turning to it to potentially manage their pain,” Andrew Rogers, said in describing the work published in the Journal of Addiction Medicine.

Rogers focuses on the intersection of chronic pain and opioid use, and identifying the underlying psychological mechanisms, such as anxiety sensitivity, emotion regulation, pain-related anxiety, of these relationships. Rogers is a doctoral student in clinical psychology who works in the University of Huston Anxiety and Health Research Laboratory and its Substance Use Treatment Clinic.

Rogers surveyed 450 adults throughout the United States who had experienced moderate to severe pain for more than three months. The study revealed not only elevated anxiety and depression symptoms, but also tobacco, alcohol, cocaine and sedative use among those who added the cannabis, compared with those who used opioids alone. No increased pain reduction was reported.

Importantly, said Rogers, while the co-use of substances generally is associated with poorer outcomes than single substance use, little work has examined the impact of mixing opioids and cannabis.

Opioid misuse constitutes a significant public health problem and is associated with a host of negative outcomes. Despite efforts to curb this increasing epidemic, opioids remain the most widely prescribed class of medications. Prescription opioids are often used to treat chronic pain, despite the risks, and chronic pain remains an important factor in understanding this epidemic.

Cannabis is another substance that has recently garnered attention in the chronic pain literature, as increasing numbers of people use it to manage chronic pain.

“There’s been a lot of buzz that maybe cannabis is the new or safer alternative to opioid, so that’s something we wanted to investigate,” said Rogers, who said the idea for the study evolved from a conversation with Zvolensky. Rogers was studying opioid use and pain management when they began discussing the role of cannabis in managing pain.

“The findings highlight a vulnerable population of polysubstance users with chronic pain and indicates the need for more comprehensive assessment and treatment of chronic pain,” said Rogers.

A High Desert pharmacist who illegally distributed oxycodone by filling hundreds of counterfeit prescriptions was ordered to serve 63 months in federal prison.

Pauline Tilton, 50, of Hesperia, a licensed pharmacist and the owner of Oasis Pharmacy in Victorville, was sentenced by United States District Judge Otis D. Wright II.

Tilton pleaded guilty on April 29 to one count of distribution of oxycodone and one count of money laundering related to more than a quarter millions dollars of revenue she received from the illegal sales.

Tilton filled at least 345 fraudulent prescriptions for oxycodone during a one-year period that ended in July 2017. The prescriptions were written under the name and DEA registration number of a retired doctor. When she pleaded guilty, Tilton admitted knowing the prescriptions were fraudulent, outside the usual scope of professional practice, and without a legitimate medical purpose.

As a result of the 345 prescriptions, Tilton and Oasis Pharmacy illegally diverted approximately 62,100 tablets of oxycodone to the black market. Many of the fraudulent oxycodone prescriptions also included prescriptions for alprazolam and promethazine with codeine. Those three drugs – oxycodone, alprazolam, and promethazine with codeine – comprise the “Holy Trinity,” a frequently abused and life-threatening cocktail of controlled substances.

In return for filling the fake prescriptions, Tilton and Oasis Pharmacy received hundreds of thousands of dollars in cash payments. Between January 2016 and June 2017, Tilton deposited $268,621 of illicit cash proceeds from her illegal drug distribution into three banks accounts over which Tilton held sole signature authority.

As he imposed the prison term – and ordered Tilton to pay a $30,000 fine – Judge Wright said the defendant demonstrated a “callous disregard for her own customers’ health.”

When Tilton pleaded guilty, Oasis Pharmacy also pleaded guilty to the same drug distribution and money laundering offenses. Judge Wright today placed Oasis Pharmacy on probation for one year.

This case was the first to be charged as the result of an ongoing investigation into corrupt pharmacies dubbed “Operation Faux Pharmacy.”

This case is being investigated by the Drug Enforcement Administration; the U.S. Department of Health and Human Services, Office of Inspector General; IRS Criminal Investigation; and the California Board of Pharmacy.