Author: WorkCompAcademy

A new study published in the Journal of Occupational and Environmental Medicine concluded that employers can make a business case for expanding access to pharmacotherapy treatment for Opioid Use Disorder (OUD) based on its finding that receipt of pharmacotherapy significantly reduces overall health care costs.

Prior research has measured the impact of employee opioid use disorder (OUD) on employer costs. One study found that employees who are dependent on opioids but have not been diagnosed with OUD have lower at-work productivity, which costs employers approximately $16 million a year.

Another study using 2006 to 2012 data reported that individuals with OUD had seven more medically related absenteeism days annually relative to matched controls.

A third study found that US adults who misuse prescription pain relievers have higher work absenteeism than do employees who do not.

Studies focusing on health care costs have found that individuals who misuse opioids have more than $10,000 more in annual expenditures.

However, employers do not have a recent or full picture of costs related to OUD. Employees who have a spouse or dependent with an OUD may have additional lost productivity days and days absent because of family member health concerns. Employees may have to help their family member navigate health care benefits during business hours, including identifying appropriate and available providers for substance use disorder (SUD).

Employees also may assume a caregiving role, particularly during relapse or potential relapse. A cross-sectional study of caregivers of individuals with advanced cancer found a 23% drop in average productivity. Another study that looked at caregivers of patients with poststroke spasticity found that lost-productivity cost per employed caregiver was $835 per month, with 72% attributable to presenteeism.

To update this information, ACOEM researchers conducted a cross-sectional analysis of 2016 to 2017 commercial enrollment, health care, and pharmacy claims and health risk assessment data using the IBM® MarketScan® Databases (Ann Arbor, MI).

The results of the new study were consistent with previous research that found that employers incur significant costs from OUD. The findings add to the literature by providing evidence that employers would benefit financially from expanding access to pharmacotherapy for their employees with OUD.

Employers should work with other payers to tackle important barriers to treatment for OUD by supporting efforts to expand provider education and licensure requirements to include MAT and increasing insurance coverage for these treatments.

3M’s legal battle to keep price gougers from profiting on sales of its N95 face masks during the coronavirus pandemic grew on new fronts.

The Star Tribune reports that on Monday, 3M targeted a third-party seller on Amazon.com for using its trademark to sell $350,000 worth of masks at up to 20 times list prices.

KM Brothers Inc., a California company trading under several different business names, “claimed to be reselling authentic N95 respirators, while actually selling damaged and fake goods at highly inflated prices,” 3M said.

After customer complaints, Amazon pulled the KM Brothers ads from its online shopping forum.

3M’s federal court lawsuit against Mao Yu, the owner and operator of KM Brothers, explains a strategy that uses multiple business names to carry on selling if a single business gets taken down.

3M said that on Feb. 20, various business under KM Brothers control began selling “what were purported to be 3M-branded N95 respirators across three connected accounts on Amazon.com.”

The company also “maintained at least 45 different Amazon Standard Identification Numbers.”

The new lawsuits offer a glimpse into the depth and breadth of attempts to profit from a national shortage of N95 masks, said to be among the most effective in blocking airborne COVID-19 molecules.

The new legal actions bring to 14 the number of suits 3M has filed since January to try to control price gouging for its product by what the company calls “pandemic profiteers.”

3M said it “has won five temporary restraining orders and three preliminary injunction orders from courts across the country that put a stop to other defendants’ unlawful and unethical profiteering from the pandemic.”

It has shut down more than 3,000 websites and 4,000 social media posts that try to expropriate the 3M brand for profit, the company explained.

3M asks the court to shut down KM Brothers’ mask-selling operations and to force the company to repay any profits derived from by claiming the resale of 3M masks when it was instead “selling counterfeit, damaged, deficient, or otherwise altered masks.”

The seller charged Amazon customers up to $23.21 for a single mask that normally listed for prices ranging from 60 cents to $3.40 each. Customer complaints tipped off Amazon.

The California Public Utilities Commission said in an order Tuesday that drivers for Transportation Network Companies (TNCs), which include services like Uber and Lyft, are considered employees under AB-5, the state’s hotly debated new gig work law.

“For now, TNC drivers are presumed to be employees and the Commission must ensure that TNCs comply with those requirements that are applicable to the employees of an entity subject to the Commission’s jurisdiction,” wrote commissioner Genevieve Shiroma.

The ruling from CPUC, the agency in charge of regulating ride-hail companies, marks a significant development in the battle over the employment status of tens of thousands of gig workers in California.

According to the report in Business Insider, both companies criticized the ruling, saying it could hurt drivers’ wages and pointing to a ballot measure they support that would revoke the law.

“CPUC’s presumption is flawed; drivers are correctly classified as independent contractors and overwhelmingly want to remain independent contractors,” a Lyft spokesperson told Business Insider. “Forcing them to be employees will have horrible economic consequences for California at the worst possible time.”

“Uber remains committed to expanded benefits and protections to drivers,” a company spokesperson told Business Insider. “If California regulators force rideshare companies to change their business model it could potentially risk our ability to provide reliable and affordable services along with threatening access to this essential work Californians depend on.”

Ride-hailing companies like Uber and Lyft have been at the center of AB-5, which went into effect this year and made it more difficult for companies to classify employees as independent contractors.

While many drivers and labor groups have praised AB-5, it has also received intense pushback from some corners. Beauticians, truckers, freelance writers and workers in industries long dominated by contractors have said the law is too far-reaching, for example.

AB-5’s most ardent opponents, however, have been its intended targets: gig work companies.

Last year, Uber sued California, seeking an exemption from AB-5, and along with Lyft and various food delivery apps, has publicly argued that its drivers should not be classified as employees, called on taxpayers to foot the bill for drivers’ unemployment insurance, and poured millions into a ballot measure aimed at revoking the law.

Uber and Lyft have so far refused to reclassify drivers under AB-5, leading city attorneys general from Los Angeles, San Francisco, and San Diego to sue the companies to force them to comply with the law. More than 4,000 drivers across the state have also taken action by filing $1 billion worth of back wage claims, driver group Rideshare Drivers United said in a statement.

The COVID-19 pandemic has brought new scrutiny to the labor practices of gig work companies like Uber and Lyft, with drivers facing a steep drop in income, struggling without healthcare or paid time off, and unable to claim unemployment insurance.

The president of a California-based medical technology company was charged for his alleged participation in schemes to mislead investors, to manipulate the company’s stock price and to conspire to commit health care fraud in connection with the submission of over $69 million in false and fraudulent claims for allergy and COVID-19 testing.

The complaint against Mark Schena, 57, of Los Gatos, California, the president of Arrayit Corporation, is the first criminal securities fraud prosecution related to the COVID-19 pandemic that has been brought by the Department of Justice and charges one count of securities fraud and one count of conspiracy to commit health care fraud.

According to the affidavit in support of the complaint, Schena touted that Arrayit is the “only laboratory in the world that offers” revolutionary “microarray technology” that allows Arrayit to test for allergy and COVID-19 based on a drop of blood that is 250,000 times smaller than the technology touted by Theranos.

Beginning in or around 2018 and continuing to in or around February 2020, Schena and others paid kickbacks and bribes to recruiters and doctors to run an allergy screening test for 120 allergens (including things ranging from stinging insects to food allergens) on every patient regardless of medical necessity, and then made numerous misrepresentations to potential investors about Arrayit’s allergy test sales, financial condition, and its future prospects.

Schena and others issued press releases and tweeted about partnerships with Fortune 500 companies, government agencies and public institutions, without disclosing that such partnerships either did not exist or were of de minimis value.

As the COVID-19 crisis began to escalate in March 2020, Schena and others made false claims concerning Arrayit’s ability to provide accurate, fast, reliable and cheap COVID-19 tests in compliance with state and federal regulations, and made numerous misrepresentations to potential investors about the COVID-19 tests and Arrayit’s future prospects for COVID-19 testing.

Schena stated that it was simple to develop a test for COVID-19 because the switch from testing for allergies to testing for COVID-19 was “like a pastry chef” who switches from selling “strawberry pies” to selling “rhubarb and strawberry pies.” Arrayit’s stock price doubled in mid-March, but Schena and others never disclosed that there were questions about the validity of its data and the accuracy of its COVID-19 test.

“The scheme described in the complaint, in which the defendant allegedly leveraged this allure by appending the fear of the Covid 19 pandemic, amounts to a cynical multi-million dollar hoax,” said U.S. Attorney David L. Anderson of the Northern District of California.

“This defendant allegedly defrauded Medicare through illegal kickbacks and bribes, and then turned to exploiting the pandemic by fraudulently promoting an unproven COVID-19 test to the market,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division.

Michael Perani was a computer software engineer from 1988 until 1995, who sustained an injury to his “upper extremities” while employed by Island Graphics.

In 1994, he filed a workers’ compensation claim after he began suffering from pain, inflammation, swelling and impaired range of motion in his hands, wrists and arms. He was not specifically diagnosed as having a condition known as “thoracic outlet syndrome” (TOS), but his medical records describe symptoms consistent with TOS in the year following his claim.

TOS refers to a constellation of symptoms which arise due to compression of blood vessels or brachial plexus nerves in the space between the clavicle and the first rib (i.e., the thoracic outlet). Compression of the brachial plexus nerves causes a variety of symptoms, including pain in the shoulder and scapula area, pain, numbness, swelling and tingling in the arm or hand, reduced grip strength, and weakness when raising the arm. Thoracic outlet syndrome commonly arises in patients whose occupation requires repetitive motion, which causes inflammation, which in turn results in compression of the brachial plexus nerves.” (Borrayo v. Avery (2016) 2 Cal.App.5th 304, 307.)

In 1998, Perani entered into a stipulated award which stated he “. . . sustained injury arising out of and in the course of employment.” In the space labeled “(Parts of body injured),” the award stated, “bilateral upper extremities.”

The WCAB upheld a decision by the WCJ that thoracic outlet syndrome involves a different part of the body than did the award. It consequently denied Perani’s application for expenses incurred to treat that condition. The court of appeal annulled the decision in the unpublished decision of Perani v WCAB, Island Graphics.

The question presented was whether thoracic outlet syndrome is encompassed within the award.

“Upper extremity” includes the hand, wrist, elbow and the shoulder – in other words the entirety of the arm. (See Smith v. Empire Pencil Company (Tenn. S.C. 1989) 781 S.W.2d 833, 837.) The term can be defined even more expansively, to include the neck and shoulders; essentially, everything from the base of the skull down. (M.C. Dean, Inc. v. District of Columbia Employment Services (D.C. App. 2016) 146 A.3d 67, 72-73.

The 1998 stipulated award did not specify that future medical treatment was authorized only for a particular medical condition such as repetitive strain injury or carpal tunnel syndrome, which can be distinguished from TOS even when the symptoms overlap. Instead, the award broadly stated that the body parts injured were the “bilateral upper extremities,” without specifying a particular medical condition, and that there was a need for further medical treatment of that injury.

Had the parties wished to limit future medical treatment to treatment for particular conditions, they could have done so.