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LAPD Employee Sentenced for Fraud

The Los Angeles County District Attorney’s Office announced.that a former civilian employee of the Los Angeles Police Department pleaded guilty to one felony count of insurance fraud.

Deputy District Attorney Arunas Sodonis of the Healthcare Fraud Division said Gerald Ray Pulley (DOB – 12/5/66),had been on temporary disability leave and was cleared to go back to work in February 2017, but he didn’t return to his job.

Instead, Pulley allegedly returned to his other job working as a security guard while continuing to receive disability benefits from the police department, Sodonis said.

Pulley, who worked as a senior clerk typist, will have the charge reduced to a misdemeanor if he pays restitution of $3,491 and does 50 hours of community service as part of the negotiated plea agreement.

He is scheduled to return for a sentencing hearing on July 12, 2019, in Department 50 of the Foltz Criminal Justice Center.

Pulley resigned from the LAPD in March.

Case BA464228 was investigated by the Los Angeles Police Department’s Special Operations Division, Workers’ Compensation Fraud Unit.

First 3D Color X-ray Dramatically Improves Diagnostics

A high-contrast, black-and-white image of your bones is an effective tool for spotting fractures or breaks. But after 120+ years, x-ray imaging is getting a remarkable update with 3D, full-color images that reveal far more than just the bones inside you. These images will improve what a doctor can diagnose without cutting you open.

The traditional approach to imaging the insides of a patient involves blasting them with x-rays. This electromagnetic radiation has a shorter wavelength than visible light, so it can easily pass through soft tissue, but it has more trouble passing through harder materials like bones. On the other side of your body, a sensor, or film, produces an image based on the intensity of the x-rays that make it through, thus revealing what’s inside you.

A New Zealand company called Mars Bioimaging has developed a new type of medical imaging scanner that works in a similar fashion, but borrows technology developed for the Large Hadron Collider at CERN to produce far more detailed results. The Medipix3 chip works similar to the sensor in your digital camera, but it detects and counts the particles hitting each pixel when a shutter opens.

When used in the new scanner developed by father and son scientists Phil and Anthony Butler from the Universities of Canterbury and Otago in New Zealand, the Medipix3 chip, enhanced with custom data-processing algorithms, can detect the change in wavelengths as x-rays pass through different materials in the body. This allows the scanner to differentiate bone, muscle, fat, liquids, and all the other material in the human body, while additional software uses that data to produce stunning full-color images that allow a three-dimensional view of the inside of the body.

While the flat black-and-white x-rays doctors currently use are typically enough for them to notice if the bone in your arm has a fracture, they reveal very little about the tissue and muscle surrounding that bone. Doctors could use these new 3D x-rays to help diagnose issues in the bone and everything around it, too.

So while a doctor is examining images of your arm, looking for signs of a break or fracture after a nasty fall, he or she could also look for other potentially dangerous medical conditions that might not be apparent in typical x-ray results. In fact, smaller test versions of this scanner are already being used to study cancer, as well as bone and joint health in patients—but the technology will be useful in countless other medical fields as well, from dentistry to brain surgery.

It will be years before the new Spectral CT scanner receives all the clearances and approvals it needs so that it can be used in hospitals and clinics. But it’s well past the research stages at this point, and clinical trials are expected to get underway in New Zealand in the coming months.

“This technology sets the machine apart diagnostically because its small pixels and accurate energy resolution mean that this new imaging tool is able to get images that no other imaging tool can achieve,” Phil Butler said in a CERN news release.

DWC Announces New Pharmacy and Therapeutics Committee

The Division of Workers’ Compensation announced the formation of the Pharmacy and Therapeutics (P&T) Committee.

The P&T Committee is established pursuant to Assembly Bill No. 1124 (2015) as an advisory body that will consult with the DWC Administrative Director on updates to the Medical Treatment Utilization Schedule Drug Formulary.

The committee’s first meeting will be held on Wednesday, September 26 from 12:30 p.m. to 3:30 p.m. in the Elihu M. Harris State Building, conference room #1 on the second floor, located at 1515 Clay Street in Oakland. The P&T Committee will be chaired by DWC Executive Medical Director Raymond Meister, M.D. The six appointees are California-licensed medical doctors and pharmacists.

“We were fortunate to receive applications from many distinguished physicians and pharmacists for this committee and selected a very well qualified team for this important work,” said Dr. Meister. “DWC appreciates the commitment of these volunteer committee members and looks forward to a productive collaboration that will improve the therapeutic outcomes for the many injured workers that rely on the MTUS Drug Formulary.”

Each member of the P&T Committee will serve a term of two years and remain in the position until the selection of a successor. The current committee members are:

— Lori A. Reisner, Pharm.D.
— Todd Shinohara, Pharm.D.
— Raymond Tan, Pharm.D.
— Basil R. Besh, M.D.
— Rajiv P. Das, M.D.
— Steven Feinberg, M.D.

The agenda and further information regarding the P&T Committee meeting will be posted on the DWC MTUS Drug Formulary web page at least 10 days prior to the meeting and will also be distributed to the DWC Newsline mailing list.

The public may submit questions or comments about the formulary to the DWC MTUS Drug Formulary email inbox: formulary@dir.ca.gov.

No Medical Marijuana for Maine Injured Workers

Gaetan H. Bourgoin worked as a paper machine laborer for Fraser Papers. which was subsequently acquired by Twin Rivers, at a paper mill when he sustained a work-related back injury.

Bourgoin suffers from severe chronic pain syndrome. He consulted with a number of pain management specialists and attempted a variety of treatments, including opioid medications, for his pain. Due to adverse side effects of his continued use of opioids, and on the recommendation of his primary care physician, Bourgoin stopped using narcotic medications.

Bourgoin was then issued a certification to use medical marijuana. He successfully petitioned the Workers’ Compensation Board for an order requiring his former employer, Twin Rivers Paper Company, LLC, to pay for the medical marijuana.

Twin Rivers appealed to the Appellate Division, which affirmed the hearing officer’s decision in August of 2016. Twin Rivers Paper Company, LLC, and Sedgwick Claims Management Services appealed to the Maine Supreme Court..

The Maine Supreme Judicial Court was are called upon for the first time to consider the relationship between the federal Controlled Substances Act (CSA) and the Maine Medical Use of Marijuana Act (MMUMA).

Twin Rivers argues that the Controlled Substances Act, 21 U.S.C.S. §§ 801-904, preempts application of the MMUMA as a predicate for an order that would compel Twin Rivers to reimburse Bourgoin for the use of medical marijuana.

The preemption analysis must begin with the Supremacy Clause of the United States Constitution, which “unambiguously provides that if there is any conflict between federal and state law, federal law shall prevail.”

Federal law can preempt state law in three ways: first, by express preemption, where Congress expressly states that federal law preempts the state law; second, by field preemption, where Congress explicitly or implicitly leaves “no room” for state law, or where federal law is “so dominant” that it “will be assumed to preclude enforcement” of the state law; and third, by conflict preemption, where the state law “actually conflicts with federal law.”

Congress has specified that the principles of conflict preemption are to be invoked to determine if state laws must yield to the CSA. Consequently, when framed in terms of the conflict preemption rubric, the dispositive question presented here is whether Twin Rivers is necessarily in violation of the CSA if it were to comply with the Board’s order to pay for the medical marijuana that Bourgoin is authorized to use pursuant to the MMUMA.

We conclude that in the narrow circumstances of this case – where an employer is subject to an order that would require it to subsidize an employee’s acquisition of medical marijuana – there is a positive conflict between federal and state law, and as a result, the CSA preempts the MMUMA as applied here. We therefore vacate the decision of the Appellate Division.

So. Cal. Man to Serve 26 Years for Counterfeit Opioids

The leader of a narcotics distribution ring that imported a powerful fentanyl analogue from China and produced hundreds of thousands of opioid pills that were distributed in bulk across the nation was sentenced yesterday to 320 months in federal prison.

Gary Resnik, 33, of Long Beach, led a conspiracy that imported acetylfentanyl, a drug very similar to fentanyl, a powerful and highly addictive opioid. Acetylfentanyl, which is many times more potent that heroin, is not approved for any legal use in the United States.

Resnik pled guilty in August 2017 to two felony offenses – conspiracy to manufacture and distribute narcotics (including acetylfentanyl and ecstasy), and possession with the intent to distribute acetylfentanyl.

According to court documents, Resnik “was the leader of a conspiracy to manufacture, possess with intent to distribute, and distribute hundreds of thousands of pills designed to look like legitimate pharmaceuticals such as Vicodin and OxyContin, but which actually contained highly potent, illegal drugs that defendant imported from China,” including acetylfentanyl, ecstasy, alprazolam, and a designer drug known on the street as PVP.

“Resnik led a sophisticated operation that used dangerous Chinese-made chemicals to manufacture counterfeit pharmaceuticals,” said United States Attorney Nick Hanna. “Through his makeshift labs, he put thousands of fentanyl analogue pills on the streets, risking the lives of unsuspecting people. This sentence is well-deserved.”

When he pled guilty last year, Resnik admitted to importing from China bulk chemicals, including acetylfentanyl, that were used to manufacture opioid pills. His drug organization also illegally imported pill presses from China that were used to make pills in homemade labs in a Long Beach storage unit and Baldwin Park house. Resnik acknowledged that drug enforcement agents seized over 11 kilograms of acetylfentanyl from the Long Beach lab in addition to other large quantities of acetylfentanyl and other illegal drugs from both labs.

“Mr. Resnik preyed on our communities by flooding our streets with fentanyl. Today’s lengthy prison sentence is appropriate and further emphasizes the dangers that fentanyl and opioids pose to our communities,” said DEA Los Angeles Acting Special Agent in Charge Daniel C. Comeaux. “The DEA will tirelessly collaborate with our local, state and federal counterparts to take vicious drug traffickers, like Mr. Resnik, off the street.”

Over the course of nine months in 2015 and 2016, Resnik’s organization sold approximately 40,000 to 45,000 pills each month, for between $4 to $8 per pill, according to prosecutors.

On one occasion during the course of an investigation by the Drug Enforcement Administration, authorities seized narcotics – including thousands of opioid pills containing acetylfentanyl, alprazolam pills, and ecstasy pills – from a man who had just purchased the drugs from members of the drug-trafficking organization operated by Resnick.

A co-defendant in this case – Christopher Bowen, 32, of downtown Los Angeles – was sentenced in May of this year to 320 months in federal prison for participating in the drug-trafficking conspiracy.

Former NBA Player to Serve 5 Years for Fraud Scheme

A former professional basketball player was just sentenced in federal court on charges related to an extensive charity fraud scheme.

Kermit Alan Washington, 66, of Las Vegas, Nevada., was sentenced by U.S. District Judge Greg Kays six years in federal prison without parole. The court also ordered Washington to pay $967,158 in restitution. Washington was taken into federal custody at the conclusion of his sentencing hearing.

Washington played for five NBA teams in the 1970s and 1980s. Washington may be best known for knocking out Houston’s Rudy Tomjanovich with a devastating punch in a 1977 game

He was with the Los Angeles Lakers when he hit Tomjanovich in what has since been remembered as “The Punch.” Washington was suspended for 60 days after Tomjanovich was hospitalized for several injuries — a fractured skull, broken jaw, broken nose and leakage of spinal fluid. He eventually needed surgery to reconstruct his face.

Washington admitted in federal court that he referred professional athletes to attorney Ronald Jack Mix, 80, of San Diego, Calif., so that Mix could file workers’ compensation claims in the state of California on behalf of the athletes. Mix then agreed to make donations to Washington’s charity, as well as a PayPal fraudulent charity scheme and other offenses.

Washington accepted approximately $155,000 in donations to his charity, which were actually illegal referral payments from Mix and his law firm. Washington diverted those funds from the charity’s bank account to pay himself or for personal spending. Washington admitted that he failed to account for this income to the charity on Project Contact Africa’s IRS filings during those years.

Former San Diego Chargers great Ron Mix, a member of the Pro Football Hall of Fame, pleaded guilty back in 2016 in federal court in Missouri to a tax fraud charge stemming from his post-football career as a workers compensation lawyer.

He was a former offensive lineman who played for the Chargers from 1960 to 1969 and then two years for the Oakland Raiders, Mix has been a successful workers compensation lawyers since his retirement from the game. Many of his clients are former professional athletes who made claims for injuries suffered during their playing days, usually years after their careers ended. State Bar records reflect he is no longer eligible to practice law in California.

Federal prosecutors said that Mix got referrals for clients from Washington, a non-lawyer. He would then file claims on behalf of those clients. In return, Mix donated to a charity called Project Contact Africa. He then claimed those donations as charitable deductions on his tax forms, court records show. The government says the donations were payments for the referrals, and should not have been claimed as deductions.

Mix’s lawyer argued that Mix thought Washington’s charity was legitimate. Mix represented many older athletes who did not make the kind of money in their day that athletes make today.

Cal/OSHA Fines Company $205K for Forklift Fatality

Cal/OSHA has issued citations to marine cargo handler SSA Pacific Inc. for willful and serious safety violations following the investigation of a fatal forklift accident at the Port of San Diego.

On January 3, Phillip Vargas, 54, a longshoreman, was driving a forklift into a transit shed when he collided with a concrete support column and suffered fatal injuries after being thrown from the forklift. The accident took place at the 10th Avenue Marine Terminal at the Port of San Diego, California.

Vargas’ family says he was a third-generation longshoreman who worked on the waterfront since the age of 16.

Cal/OSHA’s investigation found that the employee was not wearing a seatbelt and that the forklift had multiple safety devices disabled, including a seatbelt warning buzzer and mast interlock system designed to disconnect power from the hydraulic lift when the operator is unseated.

‘Forklift safety and training of operators must be taken seriously,’ said Cal/OSHA Chief Juliann Sum. ‘Employers must ensure that seat belts are used and that safety devices such as warning systems to ensure seat belt use are not altered.’

Cal/OSHA issued six citations totaling $205,235 in proposed penalties to SSA Pacific Inc., a division of Seattle-based international marine cargo handler SSA Marine. The citations issued included four serious violations for the employer’s failure to ensure that forklift operators use seatbelts, properly maintain and inspect forklifts, ensure operators were effectively trained and for improperly altering forklift safety features. A general violation was cited for the employer’s failure to establish and maintain an effective heat illness prevention plan.

SSA Pacific was also issued a citation for a willful-serious violation as the employer failed to ensure workers perform a forklift safety check at the beginning of each shift and report unsafe conditions, a violation the company was cited for in 2016 following an accident inspection at the Port of Long Beach.

The incident in 2016 occurred when two workers improperly attempted to lift a 15-ton forklift from the hatch of a ship with a crane. One worker was hospitalized overnight for injuries to his ribs and lungs when he was pinned by the mast of the running forklift.

A citation is classified as willful when evidence indicates that the employer committed an intentional and knowing violation, or was aware that a hazardous condition existed and made no reasonable effort to eliminate it. A citation is classified as serious when there is a realistic possibility that death or serious harm could result from the actual hazard created by the violation.

Forklift safety requirements are summarized on page 65 of Cal/OSHA’s Pocket Guide for the Construction Industry.

Drug Makers Slammed for Recent Price Hikes

President Trump took aim at Pfizer Inc and other U.S. drugmakers on Monday, after they raised prices on some of their medicines on July 1, saying his administration would act in response.

Pfizer raised list prices on around 40 medicines earlier this month. Those include Viagra, cholesterol drug Lipitor and arthritis treatment Xeljanz, according to Wells Fargo. List prices do not include rebates and discounts drugmakers may offer.

Pfizer spokeswoman Sally Beatty told Reuters that “the list price remains unchanged for the majority of our medicines. Our portfolio includes more than 400 medicines and vaccines. We are modifying prices for approximately 10 percent of these, including some instances where we’re decreasing the price,”

Pfizer was not the only major drug company to raise prices after Trump suggested they would voluntarily slash prices. Israeli generic drugmaker Teva Pharmaceutical Industries Ltd hiked prices on 14 drugs in June and Roche Holding’s Genentech division raised prices on a number of its drugs on July 1, according to Wells Fargo.

Teva and Roche could not be immediately reached for comment.

“Pfizer & others should be ashamed that they have raised drug prices for no reason.” Trump wrote in a post on Twitter on Monday. “We will respond!”

Health and Human Services Secretary Alex Azar followed up with his own tweet saying that drugmakers who have raised prices have created a tipping point in U.S. drug pricing policy.

“Change is coming to drug pricing, whether painful or not for pharmaceutical companies,” Azar wrote.

Neither Trump nor Azar detailed what policy changes would be implemented to decrease prices.

Trump had said in May that some drug companies would soon announce “voluntary, massive” cuts in prices, but none have materialized yet. During his presidential campaign, he promised lower U.S. drug costs.

Pfizer’s stock fell after Trump’s tweet – they closed up 5 cents at $37.16, but had been trading at $37.44 just before the tweet.

FDA Okays Late-Stage Trials of Non Opioid Pain Drug

Reuters reports that Israeli pharmaceuticals company PainReform has received approval from the U.S. Food and Drug Administration (FDA) to begin late-stage clinical studies for a pain relief drug that is a departure from opiate-based narcotics, it said on Tuesday.

Many patients today dealing with pain after surgery are prescribed opioids, which can be highly addictive and are at the heart of a costly health crisis in the United States.

PainReform said the FDA had given it a green light to carry out two Phase 3 trials on its product PRF-110, which prolongs the action of a local analgesic, or painkiller, called ropivacaine. The studies will focus on post-operative pain relief in soft and hard tissue.

The drug is administered during surgery, before the wound is sutured. An earlier study showed PRF-110 was able to relieve pain for up to 72 hours – 10 times longer than the current standard of care, PainReform said.

This is a crucial period when pain is maximal and opioids are often given, said Chief Executive Eli Hazum.

“This kind of drug can help delay or prevent the prescription of opiates,” he told Reuters.

PainReform estimates the market potential for such treatment at $5 billion.

FDA Commissioner Scott Gottlieb said in a statement on Monday the agency “remains focused on striking the right balance between reducing the rate of new addiction by decreasing exposure to opioids and rationalizing prescribing, while still enabling appropriate access to those patients who have legitimate medical need for these medicines”.

Should PainReform’s treatment pass its trials, results for which Hazum estimated could come within a year after they start, it would compete with other non-opiate drugs like Heron Therapeutics’ HTX-011, which just finished Phase 3 studies.

“This market will not depend on a single drug,” Hazum said.

The company has raised $12 million and is looking for an additional $15 million before beginning the trials, which focus on bunion and hernia operations.

It would consider an initial public offering in New York after the trials are finished, or even at the time of interim results, which could be after about six months, Hazum said.

July 9, 2018 Edition


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Daniel Capen M.D. – and Dozens More – Indicted, Southland Psychiatrist Arrested, So. Cal. Pharmacy Settles DEA Charges, $647K in Penalties for Farm Labor Wage Theft, Drugmakers Battle PBMs Over Copay Manipulation, Jones Targets Comp Carrier Profits and Tax “Savings”, Gov Brown Appoints Non-Attorney to WCAB, AI Defeats Physician In Diagnostic Competition.