Author: WorkCompAcademy

Democratic Representative Pramila Jayapal from Washington state, has introduced a new bill that would transition the U.S. healthcare system to a single-payer “Medicare for All” program funded by the government in two years.
The legislation is the party’s most high-profile and ambitious single-payer proposal in the new Congress and has more than 100 co-sponsors, many from the party’s progressive flank.

Jayapal highlighted support from various labor unions and public interest groups on Wednesday. She also disputed the notion that House members from ideologically balanced districts would not support the plan. One congressman who won a swing district last year – Rep. Josh Harder of California – appeared with Jayapal to back her plan Wednesday.

It is unlikely to gain the support of any Republicans in the House or the Senate, who have derided single-payer healthcare as a socialist policy and oppose government interference in healthcare. It also remains unclear whether Democratic House Speaker Nancy Pelosi will bring the legislation up for a vote.

Medicare currently serves about 60 million Americans who are age 65 or older, or disabled. Jayapal’s legislation would eliminate the age threshold. The new Medicare would not require any beneficiaries to pay premiums or deductibles and would not charge patients co-pays or out-of-pocket costs after receiving care.

It does not include new or increased taxes or other additional revenues to pay for the healthcare overhaul. Jayapal said possible ways to pay for the bill include a tax on millionaires and billionaires, employer premiums and closing tax loopholes for the wealthy.

The idea of Medicare for All was first proposed by Independent Bernie Sanders as a single-payer system that would largely replace private insurance. It gained traction among Democrats running for congressional office in 2018, and is now a central campaign issue for party members vying for the 2020 presidential nomination.

The health industry has opposed single-payer proposals, saying they would ultimately lead to less access to care. Critics include the American Hospital Association and America’s Health Insurance Plans (AHIP), the health insurance industry’s biggest trade group.

This month a slew of conspirators involved in a massive Workers’ Compensation kickback scheme were ordered to serve prison sentences and pay millions in financial penalties for their roles in the corrupt payment of millions of dollars to induce doctors and other medical professionals to refer hundreds of injured workers for medical treatments and services.

Defendant Fermin Iglesias and co-defendant Carlos Arguello operated a patient-capping enterprise, in which they found individuals who would file Workers’ Compensation claims against their employers. Iglesias and Arguello then sold, bartered and exchanged these applicants with others in the Workers’ Compensation industry, including attorneys, primary care physicians, and providers of medical goods and services.

Each of these entities had to “pay to play,” and as the patient was referred throughout this corrupt system, money changed hands at each step.

Arguello operated several patient-recruitment entities, including one called Centro Legal. Through billboards, flyers, advertisements and business cards, Centro Legal recruited persons to seek workers’ compensation benefits from their employers or former employers. When the injured worker called the 1-800 number on the billboard or card, he or she reached a call center, which might be located in another country. From there, Iglesias’ company, Providence Scheduling, took over brokering the patient to maximize the profit that could be extracted from him or her.

Centro Legal referred the newly-acquired patient to complicit Workers’ Compensation attorneys, including, in San Diego, attorney Sean O’Keefe, who had one of the largest Workers’ Comp caseloads in the region. To get these new clients, the attorneys in the corrupt network were expected to comply with certain conditions.

First, they had to use Arguello’s copying service to fulfil document requests for all of the new client’s medical records. Next, they had to agree to designate as their client’s primary treating physician (“PTP”) one of the complicit physicians within the corrupt network.

In exchange, the attorneys received compensation. For O’Keefe, the compensation took a variety of forms. One hospital administrator paid the salaries of two employees of O’Keefe’s law firm, as a kickback to O’Keefe for referring spinal surgeries to that hospital. In another variation, the kickback payments were disguised as payments for nonexistent legal services, for which O’Keefe generated phony “legal invoices” to cover up those obviously illegal payments.

The corrupt physician could serve as the patients’ primary care physician in the Workers’ Comp system. Iglesias required that the chiropractors prescribe a certain minimum quota of goods and services, on average, for each patient. If the chiropractor failed to live up to the quota, Iglesias would cut off the flow of new patients.

Dr. Steven Rigler was one of the chiropractors involved in the corrupt referral network. He had clinics in Calexico, San Diego, and Escondido.

Jennifer Louise White represented providers of other types of services, namely, Autonomic Nervous System (“ANS”) studies and sleep studies. She worked with Alex Martinez and with providers of the ANS and sleep studies to pay nearly $200,000 in kickbacks to Rigler to refer patients for these services.

SENTENCES
Ronald Grusd, Los Angeles, CA – – 10 years, $1.3 million forfeiture, $250,000 fine
California Imaging Network Medical Group – – 5 years’ Probation, $500,000 fine
Willows Consulting Company – – 5 years’ Probation, $500,000 fine
Alex Martinez, El Centro, CA – – 37 months’ custody
Ruben Martinez, Murietta, CA – – 33 months’ custody
Line of Sight, Inc. – – 5 years’ Probation, $45,000 fine
Desert Blue Moon, Inc. – – 5 years’ Probation, $20,000 fine
Fermin Iglesias – – 60 months’ custody, $1,005,000 forfeiture
MedEx Solutions – – 5 years’ Probation, $500,000 fine
Meridian Medical Resources – – 5 years’ Probation, $500,000 fine
Miguel Morales – – 12 months 1 day custody, $140,000 forfeiture
Julian K. Garcia, National City, CA – – 33 months’ custody, $10,000 fine
Jennifer Louise White, Glendale, CA – – 24 months, $25,000 fine
Sean Enrique O’Keefe – – 13 months, $300,000 forfeiture
Steven J. Rigler – – 6 months, $150,000 forfeiture

Christopher Devereux was employed as an attorney by State Compensation Insurance Fund. He sustained an admitted industrial injury in the form of hypertension, diabetes, heart, circulatory, and cognitive impairment, as a result of continuous trauma ending in 2015.

The cardiology QME reported that the cardiac impairment was separate and distinct from the cognitive impairment reported by the neuropsychology QME. Thus he said that the most accurate rating in this case would be to add the impairment ratings, and do not require the Combined Values Chart.

The QME went on to say “frankly, when we are dealing with mental impairments and physical impairments, in terms of the ultimate disability there often is not much the way of overlap. It is my perspective that these two impairments that are discrete and. in very different areas are best combined through a strict adding procedure than anything else. I do not hrave a basis to argue that they are synergistic to..any. significant-degree. That is, I would not argue that the actual disability is greater than the simple additive combining of the impairments.

The WCJ found applicant sustained 90% permanent disability by adding rather than combining the disabilities. The WCJ determined that applicant’s combined permanent disability rating, from the WPI ratings of the two QMEs should be based upon adding the impairments rather than using the CVC, in view of the physicians’ opinions that this was most appropriate in the absence of overlapping impairments.

The petition for reconsideration of this finding by the State Fund was denied in the panel decision of Devereux v. SCIF.

“The rating schedule provides that the CVC is “generally” used to combine multiple disabilities, but that other methodology may be used depending upon the relevant circumstances. It is the role of the medical expert to make a medical determination as to how to combine the separate impairments. One reason for using the CVC is to avoid combining impairments that lead to a rating greater than 100% permanent disability. However, this concern is not justified here, since applicant cannot receive a permanent disability award for a single injury greater than 100%”.

“Multiple cases have held that this determination is best based upon the extent to which the impairments affect applicant’s ability to perform activities of daily living. It is the opinions of the medical evaluators and not a rigid application of the CVC in the rating schedule that should prevail. (Athens Administrators v. Workers’ Comp, Appeals Bd. (Kite) (2013) 78 Cal.Comp.Cases 213.”

“It has been recognized that a disability rating, ‘should reflect as accurately as possible an injured employee’s diminished ability to compete in the open labor market.’ (LeBoeuf. v. Workers’ Comp. Appeals Bd, (1983) 34 Cal.3d 234,245-246 [48 Cal.Comp.Cases 587].) In this case, the WCJ reasonably concluded that the medical evaluators properly determined that adding the hypertension and cognitive impairment disabilities more accurately reflects applicant’s entire permanent disability than results from using the CVC.”

Reuters reports that Berkshire Hathaway Inc. is in advanced discussions to sell its Applied Underwriters workers compensation unit to a consortium of insurance firms, people familiar with the matter said Friday.

The deal would be a rare divestment by Warren Buffett, who has built a corporate empire of more than 90 businesses in sectors spanning insurance, chemicals, energy, railroads, food and retail. Unlike private equity firms, the 88-year-old billionaire investor does not seek to cash out once he takes over a company.

However, San Francisco-based Applied Underwriters now sits outside Berkshire Hathaway’s insurance focus, making it a noncore asset Mr. Buffett wishes to shed, the sources said.

Berkshire Hathaway’s insurance businesses include the auto insurer Geico, reinsurer General Re, and a unit that protects against major catastrophes or unusual risks.

Applied Underwriters, on the other hand, provides bundled workers compensation and other employment-related insurance products targeted to small and medium-sized businesses.

A grouping of insurance firms and a hedge fund-backed reinsurance firm are in talks to buy Applied Underwriters at around the value of its book of business, the sources said, declining to disclose the price and the identity of the buyers.

The sources cautioned there is always a possibility that deal negotiations end unsuccessfully and asked not to be identified because the matter is confidential.

Berkshire Hathaway did not immediately respond to a request for comment.

Applied Underwriters has also been in the crosshairs of California’s insurance regulator, reaching a settlement agreement in June 2017 over “bait and switch marketing tactics,” according to a statement from the state’s insurance commissioner at the time. Berkshire Hathaway acquired Applied Underwriters in May 2006.

Mr. Buffett is scheduled to publish his annual letter to Berkshire Hathaway shareholders this weekend, alongside the company’s annual report. Berkshire Hathaway’s cash pile reached $103.6 billion as of the end of September, as Mr. Buffett has struggled to find attractive acquisition opportunities to put money to work.

Mr. Buffett’s efforts to divest Applied Underwriters come as one of his biggest investments, Kraft Heinz Co., has soured. On Thursday, the food giant announced a multibillion-dollar write-down on its marquee brands, raising concerns that years of rigorous cost cuts had eroded the value of its Kraft and Oscar Mayer products.