Author: WorkCompAcademy

A massive federal lawsuit aims to hold pharmaceutical companies responsible for contributing to the opioid crisis, and a federal judge is seeking a quick resolution.

More than 200 individual cases have been consolidated in a multi-district process being overseen by U.S. District Judge Dan A. Polster in Cleveland.,

The governments are suing over what they claim are false marketing practices by pharmaceutical companies that manufacture prescription painkillers, as well as claims that drug wholesalers brought more pills than needed into areas with high levels of addiction, knowing that the pills would be diverted for illegal use.

At an initial hearing on Tuesday, Judge Polster pushed for the pharmaceutical manufacturers and governments to settle the dispute quickly. Attorneys from across the country filled every corner of Polster’s courtroom at the federal courthouse in downtown Cleveland, with others either in an overflow room watching a video feed or listening on the phone.

According to the transcript of the hearing and news reports, he told more than 100 attorneys that the United States is at risk this year of seeing life expectancy go down for the third straight year, a statistic unmatched since the 1918 influenza pandemic, which killed at least 50 million people worldwide, including 550,000 in the United States.

But unlike that particularly deadly strain of flu virus, “this is 100 percent manmade,” Polster said. “I’m pretty ashamed that this has occurred while I’ve been around.”

“I don’t think anyone in the country is interested in a whole lot of finger pointing at this point, and I’m not either. People aren’t interested in depositions, and discovery,and trials. People aren’t interested in figuring out the answer to interesting legal questions like preemption and learned intermediary,or unraveling complicated conspiracy theories.”

Among other things, he said that “what I’m interested in doing is not just moving money around, because this is an ongoing crisis. What we’ve got to do is dramatically reduce the number of the pills that are out there and make sure that the pills that are out there are being used properly. … So that’s what I want to accomplish. And then we’ll deal with the money. We can deal with the money also and the treatment. I mean, that’s what — you know, we need a whole lot — some new systems in place, and we need some treatment.”

He acknowledged to those in the courtroom that his statements were likely not what they expected to hear in the first hearing but that he had given it a lot of thought prior to hearing. He wants to find a way to stop the flow of pills onto the street, while still ensuring that those who really need them can still acquire them.

Despite Polster’s call for a quick settlement, Young predicted that the litigation would involve months of discovery, test cases and monthly meetings before the judge. “We don’t need a lot of briefs and we don’t need trials.”

The California Labor Commissioner issued citations totaling $7,137,036 to the operator of six adult care facilities in Los Angeles for wage theft and other labor law violations.

Adat Shalom Board & Care, Inc. was ordered to pay underpaid wages and penalties to 149 former and current employees who provided care to elderly residents 24 hours a day, six days a week. For years, officials say the caregivers were paid less than $3 an hour for their work.

The Labor Commissioner’s Office opened its investigation last June after receiving a report of labor law violations. The investigation uncovered that from July 2014 to July 2017, the caregivers at the six facilities in West Hills were:

– Paid less than the minimum wage for each hour they worked.
– Not paid overtime for working 24-hour shifts, six days a week.
– Not relieved from their duties to take meal or rest breaks.
– Provided pay stubs that withheld key information such as hourly rate of pay and total number of hours worked.

The live-in caregivers were responsible for monitoring and caring for elderly residents and hospice patients, many of them suffering from Alzheimer’s or dementia. The caregivers were paid fixed amounts ranging from $1,500 to $1,800 per month, or $2.40 to $2.88 per hour.

The citations issued against Adat Shalom Board & Care include $2,272,343 for under payment of minimum wages, $1,871,990 in overtime wages, $128,196 for meal period violations, and $2,689,907 in liquidated damages.

When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid minimum wages plus interest.

In addition to the money for the workers, $174,600 in civil penalties were levied for nonpayment of overtime and minimum wages, meal period violations as well as for failing to provide workers accurate itemized wage statements with their paychecks. The civil penalties collected will be transferred to the State’s General Fund, as required by law.

Day laborers in California hired on a one-time basis would be covered by the state’s workers compensation laws under amendments to a year-old bill intended to extend coverage to more workers.

A.B. 206, introduced by Assemblywoman Lorena Gonzalez Fletcher, D-Chula Vista, in January 2017, was amended Thursday to include workers comp coverage mandates for a “person, including a day laborer, employed by the owner or occupant of a residential dwelling whose duties are incidental to the ownership, maintenance, or use of the dwelling, including the care and supervision of children, or whose duties are personal and not in the course of the trade, business, profession, or occupation of the owner or occupant,” according to the latest draft of the bill.

The draft defines a day laborer as “a person who is directly hired by the home owner or occupant on a one-time basis, to perform general maintenance, repairs, upgrades, gardening, or landscaping, and who does not have a valid business license or contractor’s license, or is not required to have those licenses for the work performed.”

This requirement would apply without regard to immigration status, according to the draft.

According to the Legislative Analysis, the proposed bill expands the definition of “employee” for workers’ compensation purposes thereby expanding the scope of standard homeowners’ insurance policies. Specifically, this bill deletes from the definition of “employee” the exclusion of workers who work for a homeowner for less than 52 hours in a 90 day period.

According to the author, “the 52 hour requirement is detrimental to day laborers because they are usually hired to work for short-term jobs. This outdated provision in the workers’ compensation system prevents legitimate day laborers who are injured on the job from obtaining workers’ compensation benefits because these workers are specifically defined as not ’employees.’ AB 206 is designed to remedy this anachronism in the law. “

There are a range of people who perform work in various contexts who are not eligible for workers’ compensation benefits because they are defined as “not employees.” One such group is excluded because the work they perform is covered by the “52-hour” rule in the Labor Code.In essence, this exclusion provides that certain workers are simply, as a matter of definitional law, “not employees” for workers’ compensation purposes..

By merely deleting the 52-hour rule, a fairly large actual list of workers, would now be “employees” eligible for workers’ compensation benefits. The Legislative Analysis points out that this would include the teenager you hire to mow your lawn; the high school girl who babysits twice a month for you and the man who congregates in the Home Depot parking lot who is hired on a 1 or 2 day basis by a roofing contractor; and the tax preparer who works in tax season out of her home, and who is hired from a Craigslist ad.

Allianz has agreed to a $59.2 million investment and strategic partnership with leading telehealth platform American Well to develop digital solutions that will widen access, lower cost and improve quality of healthcare for millions of patients worldwide.

Allianz X, the digital investment unit of Allianz, led the investment and will join American Well’s Board of Directors.

Allianz and American Well will develop digital health solutions that build on American Well’s platform and leverage Allianz’s international expertise by combining wearable sensors, remote monitoring, and virtual visits. Working with local healthcare stakeholders, the partnership will deliver healthcare to both developed and emerging markets, addressing local regulations, clinical preferences and financing choices.

This global telehealth system will allow providers to treat patients more successfully in the transforming world of connected care.

Boston-headquartered American Well has developed a telehealth platform that connects patients live with doctors, specialists and other healthcare providers over secure video. It handles clinical, administration, and security requirements consistent with US healthcare regulations and best practices.

American Well serves millions of patients, working with national health plans, hospitals, employers and pharmacies in the United States.

Allianz X, led the investment and was supported by the Health Innovation Center of Allianz Partners, the B2B2C unit of the Allianz Group dedicated to developing protection and care solutions.

Allianz has local knowledge of healthcare financing, regulation and delivery, and a qualified network of more than 800,000 medical providers across the world.

The joint effort of Allianz X and Allianz Partners should enable Allianz to deliver the greatest value from Allianz to American Well and strengthens the Group’s ability to provide best-in-class healthcare in a mobile, digital world.

“Allianz X’s investment with American Well will result in better access, lower cost and more connected care for our customers through a leading-edge health platform. This collaboration emphasizes Allianz’s commitment to digitalization, our goal of investing in digital frontrunners and encourages advancements within the whole healthcare ecosystem,” said Solmaz Altin, the Chief Digital Officer of Allianz Group.

The operator of two now-defunct medical supply companies in Hawthorne and Ventura, as well as two former employees, have been arrested on federal healthcare fraud charges for allegedly billing Medicare well over $24 million for medically unnecessary power wheelchairs (PWC) and the repair of medical equipment.

The scheme is outlined in a 29-count indictment that was returned by a federal grand jury on December 14. According to the indictment, Tamara Yvonne Motley operated Action Medical Equipment and Supplies, which was based in Hawthorne until 2014, and Kaja Medical Equipment & Supply, which was based in Ventura until late 2016. Motley allegedly orchestrated a scheme in which corrupt physicians prescribed medically unnecessary durable medical equipment (DME), such as PWCs, and Motley oversaw the submission of fraudulent bills to Medicare.

In January 2011, when Medicare changed the reimbursement rules for PWCs, Action largely stopped Medicare billing for PWCs and, instead, started billing Medicare for PWC repairs. Action and Kaja allegedly submitted bills for PWC repair or replacement services that were not medically necessary, were not needed to make the PWCs serviceable, and often simply were not performed. The majority of bills submitted in this case allegedly involve fraudulent repair work.

According to the indictment, over a nearly eight-year period, Action billed Medicare more than $18.2 million for DME – most for PWCs, but also for PWC accessories, knee braces and back braces – and the repair or replacement of PWCs. Medicare paid Action nearly $10.3 million.

Between July 2013 and November 2016, Kaja billed Medicare $6.3 million for PWCs, PWC-related accessories, and the repair or replacement of PWCs. Medicare paid Kaja approximately $2.8 million for those claims, the indictment alleges.

The indictment charges all three defendants with 20 counts of healthcare fraud and one count of conspiring to launder money.

Motley and Marquez are further charged with two counts of aggravated identity theft in relation to the use of other persons’ names to operate the medical supply companies. Motley is additionally charged with six counts of structuring cash transactions to avoid federal reporting requirements for transactions of more than $10,000.

If convicted, each of the three defendants would potentially face decades in federal prison. Each count of healthcare fraud carries a statutory maximum sentence of 10 years in federal prison.

All three defendants entered not guilty pleas to the charges in the indictment and a trial was scheduled for February 13. A United States Magistrate Judge set bond for Motley and Murillo, and Marquez was ordered detained.