Author: WorkCompAcademy

A West Los Angeles man who was the owner of a medical supply company has been sentenced to five years in federal prison for his role in a scheme that fraudulently billed more than $4 million to Medicare.

Valery Bogomolny, 44, of Westwood, was sentenced by United States District Judge S. James Otero, who also ordered the defendant to pay $1,266,860 in restitution.

The sentencing of Bogomolny was announced by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division; United States Attorney Eileen M. Decker; Assistant Director in Charge Deirdre L. Fike of the FBI’s Los Angeles Field Office; and Special Agent in Charge Christian Schrank of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Los Angeles Region.

Bogomolny was found guilty by a federal jury in November 2015 of six counts of health care fraud. According to evidence presented at trial, between January 2006 and October 2009, Bogomolny used his company, Royal Medical Supply in the Beverly Grove district of Los Angeles, to bill Medicare $4 million for power wheelchairs, back braces and knee braces that were medically unnecessary, not provided to beneficiaries or both.

The evidence further showed that Bogomolny created false documentation to support his false billing claims, including creating fake reports of home assessments that never occurred. Power wheelchairs were delivered to beneficiaries who were able to walk without assistance. In other cases, Bogomolny signed documents stating that he had delivered equipment when, in fact, the equipment was not actually delivered.

“Royal Medical Supply was a complete fraud,” said United States Attorney Eileen M. Decker. “Many purported patients lived over 100 miles away from the storefront, most of the prescriptions were issued under the names of doctors either associated with or the victims of fraud, and most of the patients never received the equipment paid for by Medicare. Mr. Bogomolny supervised this scheme victimizing U.S. taxpayers, warranting this significant sentence.”

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Central District of California. DOJ Fraud Section Trial Attorneys Ritesh Srivastava and Claire Yan prosecuted the case.

Since its inception in March 2007, the Medicare Fraud Strike Force, which now operates in nine cities across the country, has charged over 2,900 defendants who collectively have billed the Medicare program for more than $10 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

If the previous occupant of a hospital bed received antibiotics, the next patient who uses that bed may be at higher risk for a severe form of infectious diarrhea, according to a new study reviewed in Reuters Health.

Clostridium difficile (C. diff) diarrhea causes 27,000 deaths each year in the U.S. Hospital patients taking antibiotics are particularly at risk for it, say the authors of the study. Antibiotics disturb the normal healthy bacteria of the gut so a C. diff infection can take hold.

The new study shows that “antibiotics given to one patient may alter the local microenvironment to influence a different patient’s risk” for C. diff infection, the researchers wrote in JAMA Internal Medicine.

“Other studies have also demonstrated that antibiotics can have a ‘herd’ effect – in other words, that antibiotics can affect people who do not themselves receive the antibiotics,” said lead author Dr. Daniel Freedberg of Columbia University Medical Center in New York.

Freedberg and his colleagues studied more than 100,000 pairs of patients who sequentially occupied a given hospital bed in four institutions between 2010 and 2015, not including those who had recent C. diff infection or whose prior bed occupant was in the bed for less than 24 hours.

More than 500 patients, or less than 1 percent of the total group, developed a C. diff infection as the second bed occupant.

The infections were 22 percent more likely when then previous occupant had received antibiotics.

Other factors about the previous bed occupant were not associated with C. diff risk.

People can be carrying C. diff organisms without having any symptoms, Freedberg told Reuters Health by email. When these colonized patients receive antibiotics, C. diff may expand within their gut microbiome and start shedding more spores, which means more spores on the bed, the bedside table, the floor, and other areas, he said.

“The next patient who enters the room is thus more likely to be exposed to C. diff spores,” he said. “It’s not easy to sterilize the room/bed between patients because C. diff spores are extremely hardy. To be killed, they need to be soaked in a bleach-containing cleaning agent for an adequate amount of time.”

About half of patients in acute care facilities take antibiotics on any given day, said Kevin Brown of the University of Toronto Dalla Lana School of Public Health, who was not part of the new study.

“That’s a huge portion of patients that could be involved in spreading the infection,” Brown told Reuters Health by email.

But the increased risk is modest, Freedberg added.

“There was a 22 percent relative increase in risk for C. diff with the prior patient’s antibiotics but there was a four-fold increase in risk related to the antibiotics received by the patient him- or herself,” he said.

Other patients, such as other antibiotic user patients within the ward, could have contributed increased risk as well, Brown said.

“Doctors (and patients) should avoid antibiotics in situations where they are not necessary,” Freedberg said. “Too often, antibiotics are prescribed without clear indications.”

“I think this evidence needs to be taken just as an association that needs further exploration,” said Jack A. Gilbert of Argonne National Laboratory in Argonne, Illinois, who was not part of the new study. “While it would be tempting to use these results to change policy, there are so many uncertainties here that such a move would not be advisable.”

Workers’ compensation benefits as a share of payroll are reaching historically low levels, even as employers shoulder more costs, according to a new report from the National Academy of Social Insurance

Until 1995, the U.S. Social Security Administration (SSA) produced the only comprehensive national data on workers’ compensation benefits, coverage, and costs with annual estimates dating back to 1946. SSA discontinued the series in 1995 after publishing data for 1992 -1993. The National Academy of Social Insurance assumed the task of reporting national data on workers’ compensation in 1997. The Academy published its first report that year, extending the data series from 1993 through 1995, and has produced the report annually ever since.

The 19th annual report of the National Academy of Social Insurance on workers’ compensation benefits, coverage, and costs is now available. This report presents new data on workers’ compensation programs for 2014 and updated estimates for 2010 – 2013 with newly available data. The revised estimates in this report replace estimates in the Academy’s prior reports.

The Academy’s measures of benefits and costs are designed to reflect the aggregate experience of two stakeholder groups: workers who rely on compensation for workplace injuries and employers who pay the bills.

Despite growth in employment during the economic recovery – and the corresponding uptick in employees covered by workers’ compensation – benefits per $100 of payroll fell from $0.97 in 2013 to $0.91 in 2014, the lowest level since 1980. Benefits as a percent of payroll declined in 46 states between 2010 and 2014, continuing a national trend in lower benefits relative to payroll that began in the 1990s.

Costs to employers, on the other hand, continue to climb. Between 2010 and 2014, employer costs associated with workers’ compensation – such as insurance premiums, reimbursement payments, and administrative costs – grew at a rate nearly 5 times faster than benefits. Nationally, employer costs exceeded total benefits in 2014 by $29.5 billion while costs per $100 of payroll reached $1.35, according to the report, Workers’ Compensation: Benefits, Coverage, and Costs (PDF).

“What we are seeing in these data are still the effects of the economy gradually coming out of the recession of 2008-10,” said Marjorie Baldwin, Chair of the Academy’s Study Panel on Workers’ Compensation Data and Professor of Economics in the W. P. Carey School of Business at Arizona State University. “As more workers are hired, employers immediately incur higher costs for workers’ compensation insurance – the increase in benefits paid comes with a lag, especially for the most costly long-term injuries.”

The ratio of benefits paid per $1 of employer cost has varied over the last 20 years from a high of $0.82 in 1999 to a low of $0.63 in 2006. The ratio has declined from $0.81 in 2010 to $0.68 in 2014, but it is still greater than in the five years leading up to the recession of 2008.

“Declining levels of workers’ compensation benefits could mean that workers are getting injured less frequently and/or that they are returning to work sooner when they do get injured,” said Christopher McLaren, Workers’ Compensation Senior Research Associate at the Academy. “But there have been a number of changes in state laws in recent years limiting access to workers’ compensation benefits, which may also be a factor.”

Nearly three-quarters of U.S. dermatologists received payments worth a collective $34 million from drug companies in 2014, according to a new analysis of a public database reported by Reuters Health.

In most cases, the payments were worth less than $50, researchers found. But a few doctors were taking industry payments worth at least $93,622.

“Most dermatologist in the U.S. – about 73 percent according to this database – received some form of payment from industry,” said lead author Dr. Marie Leger, a dermatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City. “That being said, most dermatologists get a modest amount from industry.”

It’s difficult to know what these payments mean, but seeing how money flows from industry to the dermatology profession is important to understanding the relationship between those two groups, Leger told Reuters Health.

She and her colleagues analyzed data from the Centers for Medicare and Medicaid Services Sunshine Act Open Payment database, which records payments made to doctors from U.S. medical manufacturers and group-purchasing organizations.

They found that in 2014, 8,333 dermatologists received 208,613 different payments totaling about $34 million. Those payments could take a number of forms, including gifts, grants, education, consulting and food and beverages.

That $34 million, however, represents less than 1 percent of the roughly $6.5 billion paid to doctors in 2014, the researchers report in JAMA Dermatology.

A quarter of dermatologists received less than $100, 63 percent received less than $500 and 78 percent received less than $1,000. The top 10 percent of doctors received at least $3,940, which represented 90 percent of the total paid to dermatologists.

“I think we knew there were interactions, but we didn’t know how many interactions there were,” said lead author Dr. Hao Feng, of NYU Langone Medical Center in New York City. “We were surprised that in general it was a modest amount of money.”

The top 1 percent of dermatologists received at least $93,622, which accounted for 44 percent of the total.

About 81 percent of the compensation to the dermatologists came from drug companies.

Almost a third of payments were listed as speaking fees, about 22 percent were listed as consulting fees and about 17 percent were listed as research payments.

Dr. Jack Resneck, of the University of California, San Francisco School of Medicine, points out in an accompanying editorial that the payment database is limited.

He wrote that it can be improved if providers are allowed to see what payments industry submit and by the categories better describing interactions.

“Some straightforward changes would substantially improve the situation,” he wrote.

Since the database is missing information about the context of these payments, it’s difficult to get a better understanding of the interaction between industry and doctors, Feng told Reuters Health.

“That’s something that is really difficult – if not impossible – to get from this database,” said Feng.

For example, Leger wondered if the financial connection between industry and dermatology may affect how the specialty advocates for patients in terms of drug costs.

“I think this study maps points of contact in an important way and I think there’s more to explore for what those points of contact mean,” she said.

A new report from the Labor Department had harsh words for the current condition of various state workers’ compensation systems.

For example, the DOL says “Despite the sizable cost of workers’ compensation, only a small portion of the overall costs of occupational injury and illness is borne by employers. Costs are instead shifted away from employers, often to workers, their families and communities. Other social benefit systems – including Social Security retirement benefits, Social Security Disability Insurance (SSDI), Medicare, and, most recently, health care provided under the Affordable Care Act – have expanded our social safety net, while the workers’ compensation safety net has been shrinking. There is growing evidence that costs of workplace-related disability are being transferred to other benefit programs, placing additional strains on these programs at a time when they are already under considerable stress.

The report calls for “exploration” of “the establishment of standards that would trigger increased federal oversight if workers’ compensation programs fail to meet those standards.”

Not unexpectedly, the report caused a firestorm of controversy, and industry rebuttal.

The Property and Casualty Insurers Association of America is composed of nearly 1,000 member companies, representing the broadest cross section of insurers of any national trade association.

PCI members write more than $183 billion in annual premium, 35 percent of the nation’s property casualty insurance. Member companies write 42 percent of the U.S. automobile insurance market, 27 percent of the homeowners market, 32 percent of the commercial property and liability market and 34 percent of the private workers compensation market. It is one of the major industry organizations that has formulated a response.

PCI says that “while the Department of Labor report highlights some of the challenges state workers compensation systems are facing, in many sections it provides an inaccurate assessment of how the system really works for the vast majority of injured workers.”

“Overall, today’s work environment is safer which means fewer workplace accidents. When workers are injured, on average they are receiving higher benefits than in the past, and health outcomes for injured workers have improved. This means workers are able to return to work sooner and resume productive employment. These improvements to the state workers compensation system have all been achieved without federal involvement.”

“While no system is perfect, the state-based system has significantly evolved and will continue to evolve. For over a century, state workers compensation laws have successfully sought to strike a balance between the interests of employers and their employees while promoting safe workplaces. State workers compensation systems guarantee that injured workers receive medical treatment at no cost to the worker and compensation for lost wages and permanent injury, while avoiding cost shifting to families and public assistance programs.”

“Employers and insurers are dedicated to supporting reforms that will improve the effectiveness of the state workers compensation system for all stakeholders. PCI and its members will continue to support reforms at the state level that are targeted to maintain an effective and balanced system for all stakeholders.”