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Another Link for CT Cancer Claims for Cell Phone Use?

Male rats exposed to very high levels of the kind of radiation emitted by cellphones developed tumors in the tissues around their hearts, according to a draft report by U.S. government researchers on the potential health risks of the devices.

Female rats and mice exposed in the same way did not develop tumors, according to the preliminary report from the U.S. National Toxicology Program (NTP), a part of the National Institute of Environmental Health Sciences.

Reuters Health reports that the findings add to years of research meant to help settle the debate over whether cellphone radiation is harmful.

Although intriguing, the findings can not be extrapolated to humans, NTP scientists and the U.S. Food and Drug Administration (FDA) said on Friday. They noted that the animal studies were meant to test extreme exposures to cell phone radiation, and that current safety limits on cellphone radiation are protective.

However, the two 10-year, $25 million studies – the most comprehensive assessments of health effects and exposure to radiofrequency radiation in rats and mice to date – do raise new questions about exposure to the ubiquitous devices.

In the studies, about 6 percent of male rats whose entire bodies were exposed to the highest level of cell phone radiation developed schwannomas – a rare type of tumor – in nerve tissue near their hearts, while there were no schwannomas in animals that were not exposed to radiation.

“The intriguing part of this is the kind of tumors we saw were similar to tumors noted for quite some time in some epidemiological studies in heavy duty cellphone users,” John Bucher, a senior scientist with NTP, said in a telephone interview.

“Of course, these were in the nerves in the ear and next to the brain, but the tumor types were the same as we saw in the heart.”

Dr. Otis Brawley, chief medical officer of the American Cancer Society, noted that the studies were negative for common tumors.

“These draft reports are bound to create a lot of concern, but in fact they won’t change what I tell people: the evidence for an association between cellphones and cancer is weak, and so far, we have not seen a higher cancer risk in people,” he said in a statement on Twitter.

Brawley said if cellphone users are concerned about this data in animals they should wear an earpiece.

Unlike ionizing radiation such as that from gamma rays, radon and X-rays, which can break chemical bonds in the body and are known to cause cancer, radiofrequency devices such as cellphones and microwaves emit radiofrequency energy, a form of non-ionizing radiation.

The concern with this type of radiation is that it produces energy in the form of heat, and frequent exposure against the skin could alter brain cell activity, as some studies have suggested.

In the NTP study, rats and mice were exposed to higher levels of radiation for longer periods of time than what people experience with even the highest level of cellphone use, and their entire bodies were exposed all at once, according to the draft report.

Bucher said the effect likely only showed up in the male rats because they were larger, and likely absorbed more radiation than the female rats or mice.

Cellphones typically emit lower levels of radiation than maximum levels allowed, the draft report said.

Cellphone radiation quickly dissipates, so the risk, if any, would be to areas of the body in close proximity to the device emitting the radiation, Bucher said.

He said the findings are intended to help inform the design of future cell phone technologies. The study looked at only 2G and 3G frequencies, which are still commonly used for phone calls. It does not apply to 4G or 5G, which use different frequencies and modulation, he said.

NTP, a part of the National Institutes of Health, will hold an external expert review of its findings on March 26-28.

Dr. Jeffrey Shuren, head of the FDA’s radiological health division, said there is not enough evidence to say cellphone use poses health risks to people.

“Even with frequent daily use by the vast majority of adults, we have not seen an increase in events like brain tumors,” he said in a statement. “We believe the current safety limits for cellphones are acceptable for protecting the public health.”

Asked what the public should take from the study, Bucher said, “I wouldn’t change my behavior based on these studies, and I haven‘t.”

Nevertheless, the findings are potentially a concern for device makers, especially the world’s three biggest smartphone sellers, Apple Inc, Korea’s Samsung Electronics Co Ltd and China’s Huawei Technologies [HWT.UL].

The CTIA, the trade association representing AT&T Inc, Verizon Communications Inc, Apple Inc, Sprint Corp, DISH Network Corp, and others, said on Friday that previous studies have shown cellphone RF energy emissions have no known heath risks.

“We understand that the NTP draft reports for its mice and rat studies will be put out for comment and peer review so that their significance can be assessed,” the group said.

New York Jumps on Opiate Litigation Bandwagon

New York Attorney General Eric T. Schneiderman announced that his office has filed a lawsuit against Insys Therapeutics, Inc., a company that sells a highly addictive fentanyl drug called Subsys.

Although Subsys was approved by the Food and Drug Administration to treat excruciating cancer-related breakthrough pain, the complaint alleges that Insys recklessly marketed the drug for much wider use, covering a much broader set of patients.

Additionally, the company allegedly engaged in a pattern of deceptive and illegal conduct by downplaying the drug’s risks of addiction, bribing doctors to prescribe the drug, and lying to healthcare providers to skirt their authorization process.

As a result, the Attorney General’s office is seeking penalties and disgorgement of all revenues accumulated during the period of misconduct—up to $75 million.

“At a time when the opioid epidemic was ravaging New York, Insys Therapeutics allegedly marketed a drug illegally by blatantly disregarding the grave risks of addiction and death that opioids pose,” said Attorney General Schneiderman.

“As we allege, Insys showed a wanton disregard for the law and the lives of New Yorkers and we will hold them accountable. My office will continue to fight the opioid crisis at every level and hold corporations that prioritize profits above New Yorkers’ health and wellbeing to account.”

In late 2012, the FDA approved Subsys for the specific, limited treatment of breakthrough cancer pain in opioid-tolerant patients. Its purpose was to provide relief to cancer patients who were suffering from excruciating pain.

Beginning in 2012, Insys allegedly ignored this limited approval and instead broadly targeted many types of providers and patients, and represented that the drug was appropriate for flares of mild pain. Insys also downplayed Subsys’ risk of addictiveness.

The company further directed its sales representatives to urge providers to prescribe Subsys in high doses, which were more expensive than lower doses. A 30-unit prescription of the lowest strength medicine costs approximately $700, while a prescription for the highest strength costs over $3500.

Additionally, the complaint alleges that Insys sales representatives called on medical offices that employed providers who had been arrested for illegal opioid distribution.

In furtherance of their deceptive and illegal scheme, Insys allegedly formed a business unit devoted solely to securing prior authorization from health plans for as many patients as possible. Insys trained its prior authorization staff to imply that patients had cancer pain, even when they did not.

Additionally, Insys allegedly bribed prescribers to write prescriptions for Subsys. The company paid certain providers between $3000 and $5000 to act as “speakers,” at sham promotional events and implored its sales staff to obtain a “return on investment” on those payments by increasing prescription numbers.

According to Insys’ latest quarterly filing published in November, the company has received subpoenas from at least 15 other states and has already settled lawsuits filed by Oregon, Illinois, New Hampshire and Massachusetts.

Salinas Urologists Resolve Kickback and Self Referral Claims

Drs. Aytac Apaydin and Stephen Worsham, urologists based in Northern California, will pay $1.085 million to resolve allegations that they submitted and caused the submission of false claims to Medicare for image guided radiation therapy (IGRT) that was referred and billed in violation of the physician self-referral law (commonly known as the “Stark Law”) and the Anti-Kickback Statute.

Drs. Apaydin and Worsham own and operate Salinas Valley Urology Associates (SVUA) in Salinas, California. They also owned Advance Radiation Oncology Center (AROC), located in Salinas, California, which dissolved in 2016. IGRT is used to treat patients who are diagnosed with cancer, including prostate cancer patients.

The Anti-Kickback Statute and the Stark Law are intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives.

The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by federal health care programs, including Medicare. The Stark Law forbids health care providers from billing Medicare for certain services referred by physicians who have a financial relationship with the entity performing the service, unless an exception applies.

The United States alleged that Drs. Apaydin and Worsham knowingly caused eight urologists in Monterey and Salinas, California (the “Lessee Urologists”) to violate the Anti-Kickback Statute and the Stark Law. Drs. Apaydin and Worsham allegedly solicited the Lessee Urologists to enter into lease agreements with AROC under which the Lessee Urologists could bill for, and thereby profit from, their referrals of IGRT performed at AROC.

The United States also alleged that Drs. Apaydin and Worsham violated the Stark Law by improperly billing Medicare for their own IGRT referrals to AROC, despite the fact that AROC and SVUA were separate entities and their financial arrangements did not comply with any exceptions to the Stark Law.

The Lessee Urologists previously entered into settlement agreements pertaining to their IGRT claims, under which they collectively agreed to pay the United States $900,000.

The United States’ investigation was a coordinated effort by the Civil Division of the Department of Justice, the U.S. Attorney’s Office for the Northern District of California, and the Department of Health and Human Services Office of Inspector General.

Overturned Compactor Injury Not Sudden or Extraordinary

Jose A. Guzman was operating a compactor when he was injured. He had been employed by Carmel Valley Construction as a laborer for a little less than six months.The compactor, which is used to pack down soil, hit a rock while Guzman was working on a hillside with a 45-degree slope. The compactor rose in the air, caused Guzman to fall backwards, and then fell on top of him.

The WCJ determined that Guzman sustained an injury to his back and psyche arising out of his employment, and that the psychiatric injury was caused by a “sudden and extraordinary employment condition” thus circumventing the Labor Code 3208.3 requirement for six months of employment as a prerequisite for a psychiatric injury..

In reaching this determination, the WCJ referred to the following evidence: Guzman had never been injured by having a compactor fall on him, he had never experienced such an incident before, there was no evidence that this type of injury had occurred in a similar fashion before, Guzman never had any close calls involving an injury when using a compactor, he never had an accident using a compactor before, and he never thought there was any risk of injury while using the compactor.

The WCJ concluded that “having a compactor fall on top of an employee is not something that would reasonably be expected to occur. This type of injury is not a frequent, regular, or routine part of the job. In fact, there is no evidence that having a compactor fall on an employee had ever occurred before. For this reason, it is reasonable to find that this injury was not something that could have been anticipated. This was not the type of injury that would be foreseeable.”

The State Fund  petitioned for reconsideration which was denied. The Court of Appeal reversed in the unpublished opinion of State Compensation Insurance Fund v W.C.A.B. and Jose Guzman

The Court noted that “the language and legislative history of section 3208.3 instruct that the Legislature’s public policy goals should be considered when determining whether an award of benefits is warranted. The Legislature made quite clear that it intended to limit claims for psychiatric benefits due to their proliferation and their potential for fraud and abuse. Therefore, any interpretation of the section that would lead to more or broader claims should be examined closely to avoid violating express legislative intent.”

Guzman failed to meet his burden of proving that a “sudden and extraordinary employment condition” caused his injury. Guzman did not provide any evidence establishing that it is “uncommon, unusual, and totally unexpected” for a rock to be in soil, for a compactor to rise when striking a rock, or for an operator to become unbalanced and to fall when the compactor rises on a 45-degree hillside. Indeed, he did not introduce any evidence regarding what regularly or routinely happens if a compactor hits a rock on a slope.

Tustin Podiatrist Faces Extradition for Insurance Fraud

A former Tustin podiatrist is accused of insurance fraud for billing for medical services she never performed, according to prosecutors.

Dr. Renae Louise Witt, 47, of La Pine, Oregon, is awaiting extradition after being charged with seven felony counts of insurance fraud with sentencing enhancements for aggravated white collar crime over $100,000 and loss of over $65,000, according to the Orange County District Attorney’s office (OCDA).

Witt is a 2003 graduate of the California School of Podiatric Medicine at Samuel Merritt University in Oakland. Her California license is still active. However public records show that she was disciplined in 2014 for “Insurance Fraud.”

While practicing in Tustin between May 12, 2015, and March 31, 2017, Witt allegedly submitted fraudulent billing for services not rendered on six patients after their treatment was complete, prosecutors say.

She billed Anthem Blue Cross and Blue Cross/Blue Shield $174,395 for various medical services she never performed and deposited large sums of money from the insurance transactions into her business bank account, the OCDA alleges. Witt moved to Oregon this past Nov. 6.

Anthem Blue Cross contacted the OCDA to report potentially fraudulent billing by Witt. After an investigation by the Orange County prosecutors, Deschutes County sheriff’s deputies arrested her in La Pine on Friday.

Witt could be sent to state prison for 16 years if she is found guilty, according to the OCDA.

Harvard Engineering Students Accurately Identify Medical Fraud

Machine learning offers more efficient tools to smoke out fraudsters, as students from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) learned during the recent ComputeFest 2018 Student Data Challenge, organized by Institute for Applied Computational Science (IACS).

During the nine-hour hackathon, student teams put their computational skills to the test in a race against the clock, using machine learning techniques to detect fraudulent insurance claims. Presented with data from more than 18,000 health care providers, the open-ended problem challenged students to devise, test, and then refine the best algorithmic technique to identify fraud.

The winning team, consisting of Xuefeng Peng, M.E., a computational science and engineering student, and T.H. Chan School of Public Health master’s students Yi Ding and Linying Zhang, who were able to find fraud with 95.7 percent accuracy. They used an autoencoder, a type of neural network, which learned common patterns in the dataset to decode genuine data points. Since the autoencoder was unable to decode anomalies, it was sensitive to fraudulent claims, Peng explained.

Teammates Amil Merchant, A.B., an applied math concentrator, and Kate Zhou, a first-year mechanical engineering Ph.D. candidate, scoured the web for examples of medical fraud, such as overbilling or prescribing too many drugs.

Another team, comprised of visiting graduate student Christoph Kurz, and Chan School graduate students Hannah James and Anna Zink, tried two approaches in parallel – a linear regression model and a random forest algorithm – to study patterns and distinguish outliers. The students were surprised to find that the simplest technique, linear regression modeling, yielded the best results.

The massive data set included 86 features, such as percentage of a provider’s patients who suffer from depression or diabetes. Representing those features in a model through linear and nonlinear combinations was a challenge, said Alexander Munoz, A.B., an applied math concentrator.

Each team was able to submit an answer three times per hour, but only received feedback on how accurate their results were collectively. Using their most recent feedback, Munoz and teammates Eshan Tewari, A.B., and statistics Ph.D. candidate Niloy Biswas considered which features to include in the next iteration of their model.

The challenge was designed to teach students some fundamental machine learning techniques, while emphasizing their practical applications, said competition architect Marouan Belhaj, an IACS Fellow.

Many students had never encountered an unsupervised problem before, but those are the types of situations fraud detection agents often face, where billions of dollars and millions of lives are at stake. With so many ways to trick the system, machine learning is an ideal method to detect fraud quickly and precisely, while there is still time to intervene, he said.

“In real-world fraud detection, you rarely get feedback from inside the company about how your model is performing,” he said. “To improve the model is very difficult. You really need to think like a hacker or someone trying to defraud the system to understand which techniques you might use to trick the system and then try, through the modeling, to see if your results actually confirm your ideas.”

DWC Suspends 11 More Providers

The Division of Workers’ Compensation has suspended 11 more medical providers from participating in California’s workers’ compensation system, bringing the total number of providers suspended to 177. The providers were suspended for fraud or other criminal actions, or the loss of their license.

The most notorious on the list are Edward Aslanyan, Armen Shagoyen and Carolyn Vasquez, who were convicted in federal court for conspiracy to defraud Medicare through their medical clinics and durable medical equipment companies in Los Angeles County.

Their case dates back to 2008 when Federal and state Medicare Fraud Strike Force (MFSF) agents arrested 18 people in the greater Los Angeles area. Agents targeted durable medical equipment (DME) company owners, medical professionals and medical clinic owners who were alleged to have engaged in various schemes to defraud Medicare of $33,264,133 in fraudulent billing.

The eight indictments in which the defendants were initially charged outline various types of fraud including schemes involving the fraudulent ordering of power wheelchairs, orthotics, hospital beds, enteral nutrition and feeding supplies. Enteral nutrition is sustenance ingested by patients through a feeding apparatus. In addition, federal agents began executing search warrants at six locations throughout Los Angeles County.

The first indictment charged Armen Shagoyan, Edward Aslanyan, Carolyn A. Vasquez, and Zurama C. Espana, with conspiring to submit more than $16.3 million in Medicare claims for medically unnecessary power wheelchairs between April 2007 and June 2008 from medical clinics they owned in Los Angeles and Van Nuys.

In addition to the clinics, Aslanyan and Shagoyan were charged with owning multiple DME companies that allegedly billed Medicare for unnecessary items. Shagoyan, Aslanyan, Vasquez and Espana were charged with one count of conspiracy to commit health care fraud. Shagoyan, Aslanyan and Vasquez were also charged with six counts of submitting false claims to the Medicare program. Espana was additionally charged with four counts of submitting false claims to the Medicare program.

Aslanyan was sentenced to federal prison for 77 months and ordered to pay more than $10 million in restitution. Shagoyen was sentenced to federal prison for 12 months and 1 day. Vasquez was sentenced to federal prison for 60 months and ordered to pay more than $6 million in restitution.

Telehealth Expected to Save Taxpayers Billions

After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions.

Reuters reports that four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the United States’ huge over-65 health program Medicare from reimbursing doctors’ and medical visits, which often start over the phone.

The bills come at a time when the industry’s claims of cost savings – powered by apps and mass smartphone usage – have begun to gain traction with private insurers striving to save on healthcare costs.

One issue for public spending on telehealth has been the inability to charge across state lines. Another is that Medicare does not recognize medical consultations that do not happen in person as the equivalent of a visit to the doctor.

The fate of legislative amendments that unlock these barriers is far from clear in a fractured U.S. Congress, but investors and some of the world’s big healthcare providers are already circling firms like the U.S. sector’s dominant player Teladoc Inc.

Analysts say Teladoc racked up 75 percent of reported video or phone visits, according to 2016 estimates, but European insurance company Allianz Group earlier this month committed $59 million to American Well, one of a handful of smaller privately-run operations expanding in the sector.

Apple Inc’s Heart Study app, which flags irregular heart rhythms in users wearing Apple Watches, allows them to instantly connect with a doctor using American Well’s technology.

American Well Chief Executive Roy Schoenberg says that while revenue is steadily rising in the industry, it could grow 10-fold if payment parity, state-line and location-based constraints were lifted.

“There is a big black line between the availability of telehealth services to Americans under the age of 65 and Americans that are above the age of 65,” Schoenberg said.

“This (legislation) would be an earthquake.”

Amazon, Berkshire, JPMorgan Form Healthcare Company

Amazon, Berkshire Hathaway and JPMorgan Chase announced today that they are partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs.

News Tuesday that the three companies plan to join forces to change how health care is provided to their combined 1 million U.S. employees sent shock waves through the health-care industry. The plan, while focused solely on the three giants’ staff for now, seems almost certain to set its sights on disrupting the broader industry.

Amazon, Berkshire and JPMorgan are among the largest private employers in the U.S. And they’re among the most valuable, with a combined market capitalization of $1.6 trillion, according to data compiled by Bloomberg.

It’s the first big move by Amazon in the sector after months of speculation that the internet behemoth might make an entry. The Amazon-Berkshire-JPMorgan collaboration will likely pressure profits for middlemen in the health-care supply chain.

The announcement was enough to sink health-care stocks. Express Scripts Holding Co. and CVS Health Corp., which manage pharmacy benefits, slumped 6.9 percent and 4.9 percent, respectively. Health insurers such as Cigna Corp. and Anthem Inc. and biotechnology companies also dropped.

The three companies, which bring their scale and complementary expertise to this long-term effort, will pursue this objective through an independent company that is free from profit-making incentives and constraints.

The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost.

The group plans to hire a CEO and start partnering with other organizations, according to a person familiar with the matter. The effort would be focused internally first, and the companies would bring their data and bargaining power to bear on lowering health-care costs, the person said. Potential ways to bring down costs include providing more transparency over the prices for doctor visits and lab tests, as well as by enabling direct purchasing of some medical items, the person said.

The the company jointly will be spearheaded by Todd Combs, an investment officer of Berkshire Hathaway; Marvelle Sullivan Berchtold, a Managing Director of JPMorgan Chase; and Beth Galetti, a Senior Vice President at Amazon.

The longer-term management team, headquarters location and key operational details will be communicated in due course.

Court of Appeal Reviews Automatic Disqualification of Law Firm

The California Self-Insurers’ Security Fund is a nonprofit organization charged by the state Legislature with continuing payment of workers’ compensation claims when a self-insured entity is unable to do so. When the Fund steps in to provide such payments, it is required by law to seek reimbursement from the employer. The law permits groups of employers to band together into self-insurance groups, and the Fund is also responsible for paying workers’ compensation claims when such groups cannot.

The Healthcare Industry Self-Insurance Program is one such group. In 2013, the California Department of Industrial Relations ordered the Fund to assume the Program’s workers’ compensation claims.

The Fund hired the law firm of Nixon Peabody to represent it in order to seek reimbursement from the employer group. In November 2013, the Fund filed a lawsuit naming 304 members of the Program as defendants, approximately 170 of which have since settled.

Attorney Andrew Selesnick served as Chair of the Health Care Department at Michelman & Robinson, LLP (M&R), overseeing and managing a team of attorneys who represented clients in the healthcare industry. Since 2014, M&R served as attorneys for employer defendants in this collection case. The representation of those parties was handled primarily by four attorneys at M&R, including Selesnick. Selesnick was actively involved in the case, including participation in a confidential discussion pertaining to moving parties’ liability and damages.

In February 2017, Selesnick left M&R and joined the Nixon Peabody law firm. Nixon Peabody was promptly advised of the potential conflict issue by M&R. On or about March 8, Selesnick “parted ways” with Nixon Peabody.

On March 15, moving parties filed a motion to disqualify Nixon Peabody. They argued that Selesnick had done prior work for the moving parties in the same action, and as a result, Nixon Peabody and all its attorneys had a conflict of interest as a matter of law. M&R claimed that Selesnick had not shared confidential information with them, and the firm had put an “ethical wall” in place. The trial court granted the motion and M&R appealed. The Court of Appeal reversed in the published case of California Self-Insurers Security Fund v Superior Court, concluding that “automatic disqualification was not required under the facts.”

There “is no question that if Selesnick were seeking to represent the Fund, he could not do so. There is also no question that if Selesnick continued to work at Nixon Peabody, the entire firm would be disqualified. The question that is left is whether Nixon Peabody and all its attorneys are also prohibited from representing the Fund given all the relevant facts, including that Selesnick no longer works at Nixon Peabody, and was only there for a very brief period.”

“We conclude the trial court must perform an analysis regarding whether confidential information was, indeed, transmitted from Selesnick to the attorneys working on the matter at Nixon Peabody.” The question, then, is whether Selesnick’s tenure at the firm endangers the duty of confidentiality he owes to real parties; if it does, disqualification is required. If it does not, then the court must exercise its discretion to determine whether other reasons compel disqualification.