Author: WorkCompAcademy

Failed back surgery (continued low back and leg pain after surgery) is relatively common. With each reoperation, success, as defined by pain reduction, becomes less likely and most patients do not improve.

However, preliminary studies using a simple procedure to remove scar tissue or adhesions suggests a new treatment could help those with post-surgical, chronic low back pain.

The study was approved by the Boston University Medical Center Institutional Review Board. This was a retrospective cohort, in which all patients had decompressive spine surgery that involved L4-5 or L5-S1 more than six months earlier. Current continuous symptoms included severe intractable radicular low back pain that failed conservative management including medications, physical therapy, and conventional epidural steroid procedures.

The Simplified Epiduralysis After Laminectomy/fusion (or SEAL) was performed on 30 patients who continued to experience low back and leg pain after back surgery.

Short-to moderate-term pain relief was reported in 74 percent of these patients. Nearly 40 percent reported greater than 50 percent pain relief. After three years of follow-up, only one patient went on to repeat lumbar spine surgery.

The SEAL procedure uses a low-cost standard obstetric epidural kit to place the epidural (via catheter) near the post-surgical site. The goal is to break up scar tissue or adhesions that are pushing up against the nerves.

There are more complex procedures and implantable devices that help failed back surgery, but SEAL is less invasive and done in one outpatient visit.

“SEAL could be an efficacious intervention for failed back surgery with a simplified procedure, lower costs, shorter procedure times and minimal adverse events,” explained author Michael Perloff, MD, assistant professor of neurology at Boston University School of Medicine.

One of the study authors cautions that these findings could have bias yet given their promising results a clinical trial is planned for next year.

Details of the study, The Simplified Epiduralysis After Laminectomy/Fusion (SEAL) Procedure for Postsurgical Radicular Low Back Pain can be found in the journal Pain Medicine, 2018; DOI: 10.1093

The SMART Act was passed into law by President Obama on January 10, 2013, as a mechanism to modify and improve upon Medicare’s Secondary Payer requirements. Those provisions of the Social Security Act were enacted in 1980 to establish Medicare as a secondary payer to certain primary plans if payment has not been made or cannot reasonably be expected to be made to the beneficiary by a primary plan.

In those cases, Medicare may make a “conditional payment” with the expectation it will be repaid when the beneficiary receives a settlement, judgment, award or other payment. Conditional payments are for items or services that are later determined to be the financial responsibility of a health plan.

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added mandatory reporting requirements with respect to Medicare beneficiaries who who receive settlements, judgments, awards or other payment from workers’ compensation

As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts.

For the last two years 2017-2018, CMS has maintained the threshold of $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance.

The threshold means that if the Total Payment Obligation to the Claimant (TPOC) amount is $750 or less, the claim does not need to be reported to Medicare and parties do not need to be concerned with reimbursement of conditional payments.

CMS has announced that the threshold for 2019 will remain at $750, therefore, no changes to reporting/conditional payment practices are necessary at this time.

CMS has additionally posted an Alert regarding an upcoming MSPRP webinar: November 19, 2018 – Webinar for Upcoming Enhancements to the Medicare Secondary Payment Recovery Portal (MSPRP):

Effective January 7, 2019, new functionality will be added to the MSPRP that will allow authorized users to self-report, Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) leads.

CMS will host a webinar on December 18, 2018 to provide additional information on this enhancement.

Salvatore Carbone, 58, pleaded no contest to insurance fraud and will serve 40 days in Monterey County Jail.

Carbone, a Sand City resident, has owned and operated Sal’s Alley Side Cafe and Carbone’s Bar in Monterey since 2007.

The Workers’ Compensation Fraud Unit at the Monterey County District Attorney’s Office received a tip in June 2017 that Carbone had presented to his workers’ compensation carrier – State Compensation Insurance Fund – that he had no employees for the insurance policy period of August 2014 through August 2015.

Investigators with the District Attorney’s Office obtained business and payroll records and interviewed Carbone, his employees and his accountant.

The District Attorney’s Office concluded the evidence showed Carbone intentionally misrepresented his payroll in order to obtain a lower insurance premium from the State Compensation Insurance Fund.

Carbone pleaded no contest to a misdemeanor Wednesday and Judge Stephen Sillman sentenced him to 40 days in county jail, three years probation and suspended a $10,000 statutory penalty, which will remain suspended if he complies with the conditions of his probation.

The District Attorney’s Office said that business owners and the public need to be aware that California law requires all employers to secure workers’ compensation insurance for their employees so there is adequate medical coverage and benefits for employees for any work-related injuries that may occur.

Making a material misrepresentation to obtain a lower workers’ compensation insurance premium has a maximum penalty of five years and a fine of up to double the amount of the fraud.

Thousands of California farm workers have been exposed to Monsanto glyphosate weed killer products . For decades there has been controversy over what the health effects might be. Glyphosate is the world’s most widely used weed killer. Nonetheless, there has not been much activity in terms of continuous trauma claims from this group of workers.

However, recent civil litigation by some California workers exposed to these chemicals has been successful. Dewayne Johnson, who sued Monsanto in 2016 was the first success. He has a $289 million verdict in the first glyphosate trial in San Francisco, in which a jury found Monsanto liable for causing a school groundskeeper’s cancer.

Damages awarded to Johnson were later reduced to $78 million, and Bayer, which denies the allegations, said it would appeal the decision.

The company, which faces more than 8,700 U.S. lawsuits over glyphosate, says decades of scientific studies and real-world use have shown glyphosate to be safe for human use. It is likely that the workers’ compensation industry will end  up with some of thee claims.

There is now another California case  that has just been set for trial.

A California judge on Thursday granted an expedited trial in the case of a California couple suffering from cancer who sued Bayer AG’s Monsanto unit, alleging the company’s glyphosate-containing weed killer Roundup caused their disease.

The trial of California residents Alva and Alberta Pilliod is scheduled to begin on March 18, 2019. The couple are suffering from cancer and sued Bayer AG’s Monsanto unit, alleging the company’s glyphosate-containing weed killer Roundup caused their disease.

The Pilliods, who are in their 70s, allege their regular use of Roundup between 1975 and 2011 caused them to develop non-Hodgkin lymphoma, a cancer of the lymph system.The couple filed their lawsuit in June 2017, after being diagnosed with the cancer in 2011 and 2015 respectively. Their lawyers earlier this year asked for an expedited trial, citing the couple’s risk of a relapse and their short life expectancy.

“While we have great sympathy for the plaintiffs, we are confident that our glyphosate-based herbicides were not the cause of their injuries and we will vigorously defend them at trial,” the company said in a statement.

Glyphosate jury trials will ramp up next year. The company is scheduled to face jurors in a Missouri state court in St. Louis, where the first trial was set to begin in early February. That date, however, was vacated by a judge, Bayer said, and the trial is likely to be postponed to later in 2019.

A trial in San Francisco federal court, where federal Roundup lawsuits are consolidated, is scheduled to begin at the end of February.

A Hawthorne man was arrested last week on federal charges that allege he intentionally drove his domestic partner and two severely autistic children off a pier into the ocean to collect proceeds on accidental death insurance policies he had purchased on their lives.

44 year old Ali F. Elmezayen was arrested on November 7 by special agents with the FBI after being charged with defrauding insurance companies. Elmezayen made his initial appearance on November 8, when he was ordered held without bond pending this afternoon’s detention hearing.

According to a criminal complaint, Elmezayen purchased several accidental death insurance policies providing more than $6 million in coverage on himself, his domestic partner and his children in 2012 and 2013. Elmezayen allegedly paid nearly $6,000 a year for these policies – even though he was earning less than $30,000 a year – and he called at least two of the insurance companies to confirm they would not investigate claims made two years after the policies were purchased.

On April 9, 2015 – two years and 12 days after he bought the last of his insurance policies – Elmezayen drove a car with his partner and two youngest children off a wharf at the Port of Los Angeles. Elmezayen swam out the open driver’s side window of the car. His partner, who did not know how to swim, survived when a nearby fisherman threw her a flotation device. The two children, ages 8 and 13, were unable to escape the car and drowned.

Witnesses told police they heard the tires of the vehicle screech as it accelerated toward the water. They also said Elmezayen swam quickly to one of the ladders while his partner came up screaming “My kids, my kids.”

At the time, Los Angeles police said the focus of the investigation had shifted from “homicide/suicide” to “accident.” But it appears detectives later presented a case to prosecutors. The Los Angeles County District Attorney’s Office declined to file criminal charges against Elzemayen in December 2017 due to lack of sufficient evidence, said spokesman Greg Risling.

Elmezayen made numerous claims as to why he drove off the wharf, including the parking spaces were too close to the edge, the car’s brake system was not working and an evil presence took over him and he wasn’t himself. He also lied to police and said he did not have any life insurance policies on his children, prosecutors said.

Elmezayen then collected more than $260,000 in insurance proceeds from American General Life Insurance and Mutual of Omaha Life Insurance on the accidental death insurance policies he had taken out on the children’s lives, according to the complaint. In addition to posing as his domestic partner in communications with the insurance companies without her knowledge, Elmezayen allegedly made several false statements, including stating that the cause of his children’s deaths was accidental and that he had no other insurance policies on his children.

Elmezayen also filed a wrongful death lawsuit in May 2016 against multiple defendants, including the Port of Los Angeles and Los Angeles County, but the case was ruled in favor of the defendants that October, the new federal criminal complaint says.

“This case alleges a calculated and cold-hearted scheme to profit off the deaths of two helpless children,” said United States Attorney Nick Hanna. “The alleged conduct shocks the conscience, and we will use every tool available to us to ensure that justice is done.”

“The defendant is accused of orchestrating a scheme to defraud insurance companies by taking the lives of his vulnerable young sons,” said Paul Delacourt, the Assistant Director in Charge of the FBI’s Los Angeles Field Office. “The defendant faces serious consequences as we seek justice on their behalf.”

The criminal complaint specifically charges Elmezayen with mail fraud, wire fraud and aggravated identity theft for posing as his domestic partner in calls to the insurance companies.

During last week’s court hearing, a preliminary hearing was scheduled for November 23, and Elmezayen was ordered to appear for an arraignment on November 29.

If he were to be convicted of the charges in the complaint, Elmezayen would face a statutory maximum sentence of 20 years in federal prison for each of the fraud counts. The charge of aggravated identity theft carries a mandatory consecutive sentence of two years in prison.

This case is being investigated by the Federal Bureau of Investigation and IRS Criminal Investigation. The federal investigators received substantial assistance from the Los Angeles Police Department, the Los Angeles Port Police and the Los Angeles City Attorney’s Office.