Author: WorkCompAcademy

At its Silicon Valley headquarters, network gear maker Cisco Systems Inc is going to unusual lengths to take control of the relentless increase in its U.S. healthcare costs.

According to Reuters, the company is among a handful of large American employers who are getting more deeply involved in managing their workers’ health instead of looking to insurers to do it. Cisco last year began offering its employees a plan it negotiated directly with nearby Stanford Health medical system.

Under the plan, physicians are supposed to keep costs down by closely tracking about a dozen health indicators to prevent expensive emergencies, and keep Cisco workers happy with their care. If they meet these goals, Stanford gets a bonus. If they fail, Stanford pays Cisco a penalty.

Cisco said costs for Stanford plan patients are 10 percent lower than conventional coverage still used by most of its employees. Chipmaker Intel Corp told Reuters it is saving 17 percent on its workers enrolled in a similar plan, known as Connected Care. Aircraft manufacturer Boeing Co and Walmart Inc, the world’s largest retailer, have likewise hammered out health plans directly with providers.

The movement is small, just a few very large U.S. corporations that have signed up tens of thousands of workers so far. Their early efforts show the challenges of changing behaviors among patients and doctors.

But they speak volumes about corporate America’s frustration with inexorably rising medical costs and the traditional insurers that sell them coverage.

Corporations help pay for healthcare for more than 170 million Americans, in most cases working with an insurer to handle everything from the price of treatments to medical claims.

These employers will spend an estimated $738 billion on health benefits in 2018, a figure that has been rising about 5 percent annually in recent years, according to federal data.

Other big firms are watching closely. Amazon.com Inc, JPMorgan Chase & Co and Berkshire Hathaway Inc said in January they will form an independent company to improve healthcare for their roughly 750,000 U.S. employees, prompting speculation that they would displace health insurers and other industry “middlemen”.

To boost enrollment, all three companies have dangled sweeteners such as extra money for health savings accounts or lower monthly premiums and co-pays. The approach also requires employers to take a more hands-on role.

Cisco’s experiment began in 2008 when it opened the campus clinic for all of its employees there. Designed like a spa, the facility offered primary care in new-age sounding treatment areas: body, mind, heart and spirit.

The savings were notable: about 30 percent compared to an offsite doctor’s office. Cisco later brought in Stanford to develop a full-blown medical plan, which took effect in 2017. Stanford operates the clinic and provides more specialized services through Stanford University’s medical system.

Adrian Camacho began working as a cashier at Target in 2012.

Target has a zero-tolerance policy with respect to harassment and discrimination in the workplace. Camacho complained to his supervisor and to individuals in the Human Resources Department, and also called Target’s “Anonymous Hotline,” regarding repeated verbal harassment from his coworkers at Target based on the fact that he is gay. According to Camacho, his coworkers would ridicule, mimic, and mock him, sometimes in the presence of Target customers.

Camacho alleges that rather than take corrective action in response to his complaints, Target instead retaliated against him by denying him a promotion and allowing the hostile work conditions to continue, unabated.

In August 2014, prior to resigning, Camacho filed a claim for workers’ compensation benefits, based on his assertion of workplace injuries that he suffered as a result of the harassment he endured while employed at Target. Specifically, Camacho asserted injuries related to head and neck pain, as well as digestive and psychological problems.

Camacho settled his workers’ compensation case with Target. He executed the mandatory preprinted Compromise and Release (C&R) form that is utilized in all workers’ compensation cases. Camacho and Target also executed an addendum and received $12,000 in exchange for executing the settlement document.

Camacho received a right-to-sue letter from the DFEH and then filed a civil complaint against Target in which he asserted several causes of action for discrimination based on sexual orientation, and harassment causing a hostile work environment.

Target moved for summary judgment. The trial court concluded that the C&R and Addendum executed by the parties in Camacho’s workers’ compensation case constitutes a general release of all potential civil claims that Camacho might have as a result of the harassment he experienced at Target. The court entered judgment in favor of Target and Camacho appealed. The Court of Appeal reversed in the published case of Camacho v Target.

Target relied on language in the C&R Addendum that said he released Target for the Workers’ Compensation claim “or any other claims for reimbursement, benefits, damages, or relief of whatever nature.”

The Court concluded that “After examining the language of the entire document, including the preprinted C&R and Addendum A and considering each term within the context of the others, it is clear that there is no reference in either the C&R or Addendum A to any causes of action outside the workers’ compensation system, much less to a release of such claims in “clear and nontechnical language,” as is required under Claxton v. Waters (2004) 34 Cal.4th 367.

The Court of Appeal ruled that a couple who were seriously injured while checking on a neighbor who had made a 911 call at the request of a deputy sheriff were assisting in “active law enforcement” at the time. Thus their exclusive remedy was under California Workers’ Compensation.

A Trinity County deputy sheriff phoned citizens James and Norma Gund — who do not work for the County — and asked them to go check on a neighbor who had called 911 for help likely related to inclement weather.

The Gunds unwittingly walked into a murder scene and were savagely attacked by the man who apparently had just murdered the neighbor and her boyfriend. The assailant fled.

The Gunds sued the County of Trinity and the deputy — Corporal Ron Whitman — for negligence and misrepresentation, alleging defendants created a special relationship with the Gunds and owed them a duty of care, which defendants breached by representing that the 911 call was likely weather-related and “probably no big deal” and by withholding information known to defendants suggesting a crime in progress — i.e., that the caller had whispered “help me,” that the California Highway Patrol (CHP) dispatcher refrained from calling back when the call was disconnected out of concern the caller was in danger, and that no one answered when the county dispatcher called.

Defendants filed a motion for summary judgment on the ground that plaintiffs’ exclusive remedy was workers’ compensation. The trial court adopted the defense theory and entered summary judgment and the Gunds appealed. The Court of Appeal affirmed the judgment in the published case of Gund v County of Trinity.

Where workers’ compensation is available, it is the exclusive remedy for work-related injury. (§ 3602.) Workers’ compensation is generally not available to persons “performing voluntary service for a public agency” who do not receive remuneration for the services other than meals, transportation, lodging, or reimbursement for incidental expenses. (§ 3352, subd. (a).) Section 3366 provides an exception for civilians assisting peace officers in “active law enforcement.”

Section 3366 provides that each person “engaged in the performance of active law enforcement service as part of the posse comitatus [power of the county] or power of the county [sic], and each person . . . engaged in assisting any peace officer in active law enforcement service at the request of such peace officer, is deemed to be an employee of the public entity that he or she is serving or assisting in the enforcement of the law, and is entitled to receive compensation from the public entity in accordance with the provisions of this division [workers’ compensation]. . . .”

Corporal Whitman would have been performing “active law enforcement service” if he himself had gone to the 911 caller’s home to check on her. Plaintiffs knew they were responding to a 911 call, and therefore they were assisting in active law enforcement.

“We conclude plaintiffs were engaged in assisting in active law enforcement at the deputy’s request, and their remedy was worker’s compensation under section 3366.”

State Fund implemented a comprehensive opioid-reduction strategy that took a two-pronged approach, which included: 1) early prevention in new cases and 2) reduction of chronic opioid usage in existing cases.

“The opioid-reduction plan implemented by our Chief Medical Officer, Dr. Dinesh Govindarao, and his team has been remarkably successful,” said Vern Steiner, President and CEO of State Fund. “Through this effort, we have helped to improve – and potentially save – the lives of many injured workers, while also reducing expenses in the workers’ compensation system for California businesses.”

The strategy also included elements such as a peer-to-peer physician review program, education for injured workers and treating physicians, and a functional restoration program for injured workers taking chronic, high levels of opioids. Additional results include:

– The number of patients taking high doses of opioids over the past four years has decreased from 1,458 to 186.
– 74 percent reduction in expenditures on opioids prescribed to injured workers covered by State Fund.

“Peer-to-peer education of prescribing physicians has been instrumental in the success of State Fund’s opioid-reduction program,” said Dr. Dinesh Govindarao, Chief Medical Officer of State Fund. “Not all providers have adequate training on pain management and opioid prescribing, and many patients don’t understand the impacts of their medications, which is why education about appropriate and alternative treatments, such as cognitive behavioral therapy, has been a key focus area for our program.”

State Fund will continue to focus on reducing opioids by:

– Expanding its chronic pain program to reach even more injured workers
– Adopting the Division of Workers’ Compensation guidelines, which limits initial opioid prescriptions to four days, and
– Updating its online physician training modules for treating acute and chronic pain.

State Fund’s opioid-reduction program is one way the organization fulfills its purpose to provide fairly priced workers’ compensation insurance, make workplaces safe and restore injured workers.

Anyone who is interested in more information about the State Fund program may contact Jennifer Vargen by dialing 415-263-5419.

The Riverside District Attorney’s Office has charged a QME with offices in Corona and Wildomar with seven felonies related to a workers’ compensation insurance fraud scheme.

Dr. Sanjoy Banerjee, DOB: 12-1-75, of Corona, was charged on May 29, 2018, with two counts of insurance fraud and five counts of perjury. Dr. Banerjee has since posted bail and is scheduled to be arraigned on July 7, 2018, at 8:30 a.m. in Dept. 61 at the Hall of Justice in Riverside.

Banerjee claims on his website that he is the Founder and Medical Director of Pacific Pain Care.

He graduated medical school from Imperial College, School of Medicine in London, England. Completed his Anesthesiology Residency at University of Rochester N.Y. and ACGME accredited Pain Management Fellowship Program from the University of California at Davis.

He says he is triple board bertified in Anesthesiology, Pain Medicine and Addiction Medicine.. He is also a Qualified Medical Evaluator for the State of California Workers compensation system for both his Widomar and Corona office addresses.

He also claims on his website that he holds a Clinical Faculty position for the Adventist Health Family Practice Program and is an Assistant Professor in the Department of Medicine at Loma Linda University Medical Center as well as an Assistant Clinical Professor for the Department of Medicine at U.C. Riverside School of Medicine.

An investigation conducted by the DA’s Bureau of Investigation found that from November 2014 through December 2016, Banerjee, a Wildomar- and Corona-based workers’ compensation pain management doctor, allegedly illegally self-referred workers’ compensation patients to a clinical laboratory and an office-based surgical center he owned.

Through that laboratory and surgical center, Dr. Banerjee allegedly billed more than $180,000 for urine toxicology testing and/or epidural injections.

Dr. Banerjee also reportedly signed at least five doctor’s reports declaring under penalty of perjury he had not referred patients to his own companies. The investigation revealed that Dr. Banerjee referred some of his workers’ compensation patients to his business, Rochester Imperial Surgical Center, which was located in a patient exam room inside the Pacific Pain Care office suite in Wildomar.

The case, RIF1802535 is being prosecuted by Deputy DA Kristen Allison of the DA’s Insurance Fraud Team.