Author: WorkCompAcademy

Radiologists, who receive years of training and are some of the highest paid doctors, are among the first physicians who will have to adapt as artificial intelligence expands into health care.

Precise numbers are hard to come by, but most estimates place radiology as an $8 billion industry in the U.S. Globally, the market is expected to grow from $28 billion to $36 billion by 2021. And the tech and radiology communities expect artificial intelligence to transform medical imaging, providing better services at lower costs. For example, if you’re getting an MRI, an AI program can improve the analysis, leading to better treatment.

“This is going to be transformational,” said Keith Dreyer, vice chairman of radiology computing and information sciences at Massachusetts General Hospital. “Every month there’s going to be a new algorithm that we’re going to use and integrate into our solutions. When you look back we’ll say, ‘How did I ever live without this?'”

Today radiologists face a deluge of data as they serve patients. When Jim Brink, radiologist in chief at Massachusetts General Hospital, entered the field in the late 1980s, radiologists had to examine 20 to 50 images for CT and PET scans. Now, there can be as many as 1,000 images for one scan.

The work can be tedious, making it prone to error. The added imagery also makes it harder for radiologists to use their time efficiently. Brink expects artificial intelligence to act as a diagnostic aid, flagging specific images that a human should spend more time examining.

Arterys, a medical imaging startup,reads MRIs of the heart and measures blood flow through its ventricles. The process usually takes a human 45 minutes. Arterys can do it in 15 seconds.

The remarkable power of today’s computers has raised the question of whether humans should even act as radiologists. Geoffrey Hinton, a legend in the field of artificial intelligence, went so far as to suggest that schools should stop training radiologists.

Those on the front lines are less dramatic.

“There’s a misunderstanding that someone can program a bot that will take over everything the radiologist does,” said Carla Leibowitz, head of strategy and marketing at Arterys. “Radiologists still use the product and still make judgment calls. [We’re] trying to make products to make their lives easier.”

According to Dreyer, a radiologist spends about half the day examining images. The rest is spent communicating with patients and other physicians. There’s only so much that automated systems can take over.

“Our desire to have somebody in control, I don’t think that will go away anytime soon,” said General Leung, cofounder of MIMOSA Diagnostics, which is testing a smartphone device that uses AI to aid diabetics. “Someone’s always going to want a person to have made the decision.”

The future for radiologists may be similar to airline pilots. While planes generally fly on auotpilot, there’s still a human in the cockpit.

Dreyer’s hospital is enthusiastically embracing the potential of AI to transform radiology. They’ve bulked up their computing power and are organizing their data to train algorithms. But there’s a long road ahead. Artificial intelligence will need to be able to respond to thousands of situations to match the image interpretation that a radiologist does. Right now, Massachusetts General Hospital is focusing on 25 of them.

“The foreseeable future is not going to be human vs. machine, but human plus machine vs. a human without a machine,” Dreyer said. “The human plus machine is going to win.”

The future of radiologists appears to offer a lesson for any worker concerned about automation. If you can’t beat the machines, join them.

July 13 was a big day for California workers’ compensation law being tested in a downtown Los Angeles federal courtroom where Judge George H. Wu was schedule to hear arguments for and against imposing a preliminary injunction halting the implementation of newly adopted SB 1160. This new law provides for a stay on lien claims filed by indicted medical providers until after their case has been resolved.

Dr. Eduardo Anguizola is facing multiple counts of insurance fraud filed by Orange County prosecutors. His federal lawsuit claims that SB 1160 and Labor Code 4615, the anti-fraud law that took effect January 1, violates his rights to due process of law and to make a contract and to hire and pay his criminal defense attorneys. His request for a preliminary injunction was scheduled for hearing on July 13

Dr. Anguizola is alleging that Senate Bill 1160 and Labor Code 4615 violate the 5th, 6th, and 14th amendments of the United States Constitution. He also claims the legislation violates the Supremacy clause, and California contracts clause.

The July 13 oral arguments on the preliminary injunction request took about 16 minutes of the crowded court calendar. Judge Wu focused the case on issues surrounding the distinction between “procedural” as opposed to “substantive” due process requirements of constitutional law.

Plaintiff attorney, M. Chris Arminta, had argued that there were problems with procedural due process while Judge Wu seemed more interested in the law on substantive due process.

Procedural Due Process aims to protect individuals from the coercive power of government by ensuring that adjudication processes under valid laws are fair and impartial (e.g., the right to sufficient notice, the right to an impartial arbiter, the right to give testimony and admit relevant evidence at hearings, etc.).

In contrast, Substantive Due Process aims to protect individuals against majoritarian policy enactments which exceed the limits of governmental authority – that is, courts find the majority’s enactment is not law, and cannot be enforced as such, regardless of how fair the process of enforcement actually is.

In other words, procedural due process consists of the restrictions that the law places on the legal process; substantive due process is the determination of whether or not the law itself exceeds government authority.

Judge Wu was concerned that attorney Arminta had not adequately briefed the issue of substantive due process. Thus the court gave the plaintiff attorney 3 days to prepare and file an amended brief addressing the issue of substantive due process,

The California Attorney General who appeared for the defense would then have until August 8th to respond, and then the plaintiff would have until August 15th to respond to the AG response.

There was no preliminary injunction ordered at this time. Another hearing was set for August 24th.

Scott McCartney was diagnosed with actinic keratosis in October 2013. In his June 2014 application for workers’ compensation benefits, he alleged that this injury arose out of the course of his employment as a deputy Sheriff for the County of Sacramento.

The County requested that he submit to the QME (a dermatologist) for an evaluation. The QME noted that McCartney had been a surfer/body surfer growing up in Southern California. He described his skin as burning easily, and he had experienced blistering sunburns. During most of his 21 years working for the County, he was on motorcycle patrol, with his arms and face exposed to UV radiation (though he had used sunscreen from 1991 on). In his leisure time, he also was active outdoors with sports, exercise, and golf. At the time of the QME examination, the County had contracted his services to the City of Rancho Cordova, where he was out of doors 70 percent of the time. In 2013, he began noticing scabbed and crusty red lesions on his face and arms; a biopsy showed these to be actinic keratosis, which is not itself a form of cancer.

The QME could not find any documented support for a 51 percent certainty linking the on-job sun exposure to the manifestation of the skin condition, because medical literature had not identified any particular dosage of sunlight as triggering it. Therefore, attributing the skin condition to any contribution from workplace sunlight – as opposed to the sun exposure McCartney received throughout his life or during his pursuit of outdoor activities in his leisure time – would simply be pure speculation.

At the deposition the QME testified that sunlight is but one of the factors leading to development of these lesions, which also include aging, genetics, and the responses of the immune system.

After a trial, the WCJ found that work-related sun exposure was not proven to be a contributing factor to McCartney’s condition by a reasonable medical probability. On reconsideration the WCAB reversed and amended the Order finding the McCartney had suffered an industrial injury, and that the QME applied the wrong legal standard.

The Court of Appeal reversed the WCAB finding that McCartney did not suffer the industrial injury he alleged in the unpublished case of County of Sacramento v WCAB (McCartney).

On appeal, McCartney argued that the recent case of South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd. (2015) 61 Cal.4th 291 (South Coast) compelled a finding of injury.

In South Coast, the decedent was taking three drugs as a result of an injury on the job; his personal physician prescribed two other drugs for anxiety and sleeplessness. He was found dead of respiratory failure with all five of the drugs present in his system, the autopsy attributing the cause to the synergistic effect of the medications and early stages of pneumonia. One physician concluded the drugs separately and in combination could cause respiratory depression or arrest.

The Court of Appeal held that “the present case is distinguishable” from South Coast.

“Both respondents (McCartney and the WCAB) misapprehend the QME testimony. The QME never acknowledged that there was a causative role of unknown degree arising out of McCartney’s employment. Rather, she took great pains to explain (repeatedly) that it was not possible to attribute the cause of McCartney’s condition to any particular period of exposure to the sun, and therefore it was nothing more than speculation to identify the work-related exposure as a contributing cause.”

The Santa Barbara County District Attorney’s office has confirmed to reporters at news station KEYT that Dr. Richard Scheinberg, an orthopedic surgeon with offices in Santa Barbara, Oxnard, Santa Maria and Bakersfield, is “under investigation.”

However, officials would not say why.

A NewsChannel 3 crew visited Scheinberg’s office at 401 Chapala St., Ste. 102 near the end of June, and saw at least a handful of plainclothes detectives coming into and out of the building “all day long.” They were removing boxes of what appeared to be files. A posted sign directed patients to reschedule their appointments with Dr. Scheinberg.

The Scheinberg Orthopedic Group’s website states that he is a board-certified orthopedic surgeon with more than 30 years of experience. He is currently on staff at Santa Barbara Cottage Hospital, the Pueblo Surgery Center and Carrillo Surgery Center. He also claims to have treated many professional athletes, including tennis players Jimmy Connors, Maria Sharapova, Andre Agassi and Patrick Rafter.

Public court records shed some light on his medical business interests. He and his former wife, Celeste, had less than a friendly divorce. According to a Court of Appeal unpublished opinion, they separated in December 2009, and Celeste petitioned for dissolution. During the marriage, the parties lived on income from Richard’s three corporations: Richard D. Scheinberg, M.D., Inc., Pueblo Surgery Center, Inc., and Oxnard Industrial Physical Therapy, Inc. Celeste provided bookkeeping and billing services for these businesses.

In April 2010, they stipulated to a judgment which provided Celeste $8 million in cash as her portion of the community estate. And monthly spousal support of $12,500, child support of $10,000 monthly, and the opportunity to continue as Richard’s medical biller with income of at least $30,000 per month. It provided that if her billing income fell below $30,000 for two consecutive months, Celeste could request modification of spousal support.

When Celeste’s billing income fell below the agreed-upon level, Celeste moved the Court for modification of her spousal support and sought damages for breach of contract. Richard moved to terminate her employment contract, among other things. A mediation of these disputes in August 2012 resulted in a settlement agreement in which the parties terminated their employment relationship. Richard agreed to pay Celeste a lump sum spousal support payment of $1.6 million, in exchange for a waiver of further spousal support.

But that was not the end of their litigation. The parties went on to dispute the proceeds of an IRS refund check in the amount of $419,009.23, payable to Celeste. That dispute was resolved by the 2014 unpublished Court of Appeal opinion.

Scheinberg is a 1975 graduate of Duke University School of Medicine, and has been licensed as a physician and surgeon in California since 1980.

Anyone with relevant information about Dr. Scheinberg’s practice is asked to call John Savrnoch with the Santa Barbara County District Attorney’s Office at (805) 568-2300.

Time will tell if the investigation will lead to a prosecution for some reason, or to nothing at all.

Walmart Stores Inc. operates over 290 retail stores in California; approximately 283 of these locations have pharmacies.

U.S. Attorney Phillip A. Talbert announced that the company has agreed to pay $1.65 million to resolve allegations that it violated the federal False Claims Act when it knowingly submitted claims for reimbursement to California’s Medi-Cal program that were not supported by applicable diagnosis and documentation requirements.

“These Medi-Cal regulations are essential to protect both patients and limited heath care funding,” said U.S. Attorney Talbert. “My office will continue to hold pharmacies accountable when they fail to comply with regulations like these.”

Medi-Cal utilizes a formulary list, commonly known as “Code 1” drugs, which designates certain restrictions for each listed drug, including restrictions pertaining to diagnoses. Medi-Cal will reimburse certain Code 1 drugs only for approved diagnoses, taking into account criteria such as the drug’s safety, efficacy, misuse potential, and cost.

Pharmacies serve the critical gatekeeping function of confirming and certifying that these Code 1 drugs are dispensed for the approved diagnoses. Walmart may bill for drugs prescribed outside of the approved diagnoses only if it submits a request to DHCS that includes a justification for the non-approved use.

The current settlement resolves allegations that Walmart failed to confirm and document the requisite diagnoses, and in some instances dispensed drugs for non-approved diagnoses, then knowingly billed Medi-Cal for these prescriptions.

The allegations resolved by this settlement were first raised in a lawsuit filed against Walmart under the qui tam, or whistleblower, provisions of the False Claims Act by a pharmacist who has worked at Walmart locations in the greater Sacramento area. The False Claims Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The whistleblower in this matter will receive approximately $264,000 of the recovery proceeds.

This settlement is the result of a joint effort by the United States Attorney’s Office for the Eastern District of California and California’s Bureau of Medicaid Fraud and Elder Abuse. Assistant U.S. Attorney Catherine J. Swann handled the matter for the United States, with assistance from the Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. The claims settled by this agreement are allegations only, and there has been no determination of liability.

Last May Talbert announced that Walmart competitor Walgreen Co. paid $9.86 million to resolve similar allegations. Walgreens is one of the largest drugstore chains in the United States, operating approximately 630 stores in California.

The allegations resolved by Walgreen settlement were first raised in two lawsuits filed against Walgreens also under the qui tam, or whistleblower, provisions of the False Claims Act by a former Walgreens pharmacist and a former pharmacy technician. The whistleblowers in the Walgreen case will collectively receive approximately $2.3 million of the recovery proceeds.