Author: WorkCompAcademy

A criminal complaint has been filed by the Orange County District attorney against a Costa Mesa Police Department (CMPD) officer for allegedly committing insurance fraud by presenting a false insurance claim and making false material statements related to the claim.

Ryan Patrick Natividad, 30, Corona, is charged with one felony count of insurance fraud and one felony count of making a fraudulent statement. If convicted, Natividad faces a maximum sentence of six years in jail. He was expected to be arraigned last Friday in Department C-55, Central Justice Center, Santa Ana.

On Sept. 23, 2014, Natividad is accused of reporting a work-related injury to his employer CMPD. Natividad is accused of falsely claiming earlier in the day, he had struck his fist against a wall when attempting to prevent an arrestee from stumbling into the wall while escorting the arrestee from the patrol vehicle into jail. Natividad is accused of filing a fraudulent workers’ compensation claim. He was subsequently directed by CMPD to seek immediate medical attention.

The City of Costa Mesa internally investigated Natividad’s workers’ compensation claim and uncovered evidence contradicting Natividad’s account of how and when the injury occurred.

Deputy District Attorney Noor Hasan of the Insurance Fraud Unit is prosecuting this case.

In 2011 Gregory Thompson, was working at High Desert State Prison as a guard. An inmate stabbed him eight times. He was awarded workers compensation benefits. As a result of his injuries, he accepted a medical demotion to an entry-level computer analyst position in the information technology department of the prison’s medical unit, forfeiting his peace officer status. He had a troubled relationship with his supervisor, who told him he was not passing probation.

In March 2013, he committed suicide by means of a self-inflicted gunshot wound. The widow filed her application for workers’ compensation death benefits in April 2013. The Department did not contest the finding that the death of Gregory Thompson was causally related to the industrial injury.

In August 2013, she petitioned for a finding of fact pursuant to GC 21537 that the death was industrial, qualifying her for a PERS special death benefit for peace officers. Labor Code section 4708 expressly provides that the PERS Board “shall be joined as a defendant, and the [WCAB] shall determine whether the death resulted from injury.A surviving dependent is precluded from seeking the workers’ compensation death benefit in lieu of the PERS special death benefit. (Gov. Code, § 21542). Nevertheless, the WCJ never joined the PERS Board as a defendant.

At the conclusion of the WCAB trial, the widow testified she was indeed receiving PERS death benefits. Yet the decision did not include any findings on the petition for finding of fact pursuant to section 21537. It simply awarded a workers’ compensation death benefit of $250,000 and set legal fees at $30,000. The employer’s petition for reconsideration was denied with the WCAB simply saying the PERS issue “is not before us on reconsideration. CalPERS will determine the issue of any duplicate payments.”

The Court of Appeal had a difficult time determining from the WCAB record exactly what happened to the PERS issue. It nonetheless reversed in the published opinion of Department of Corrections and Rehabilitation v WCAB (Thompson).

The Court of Appeal concluded “These statutory directives would seem to be straightforward. Indeed, we have not found a case, treatise, or encyclopedia on this issue that suggests there is any alternative procedure to the two boards making a joint calculation of workers’ compensation and PERS death benefits in a single proceeding after the WCAB resolves the issue of industrial causation for a death.”

“As a result of the WCAB’s insouciant deferral of the computation issue to the PERS Board, its order awarding the full workers’ compensation death benefit to the widow – without crediting the PERS special death benefit against it – is accordingly unauthorized under Labor Code section 4707 and cannot stand.”

The Department of Justice Office of the Inspector General is conducting an audit of the Drug Enforcement Administration’s Confidential Source Program. The OIG initiated the audit as a result of the OIG’s receipt of numerous allegations regarding the DEA’s handling and use of confidential sources. Its audit work thus far has been seriously delayed by numerous instances of uncooperativeness from the DEA. Nevertheless, it has uncovered several significant issues.

Among other matters, the audit learned that the DEA was providing Federal Employees’ Compensation Act (FECA) benefits to confidential informants, yet had not established a process or any controls regarding the awarding of them. The DEA lacked a process for thoroughly reviewing FECA claims for confidential sources or determining eligibility for these benefits. In addition, the DEA did not oversee and ensure that the established pay rate for these sources was proper and inappropriately continued using and paying confidential sources who were also receiving full disability payments through FECA.

In one case, the Inspector General wrote, the DEA paid out more than $1.3 million between 1989 and 2012 to the widow of a killed informant. Payments have been ongoing in other cases since 1974.

In addition, the Inspector General says there is no legal basis for extending compensation benefits intended for federal employees to confidential informants. The law cited by the DEA as justification for the payments, the Inspector General wrote, “does not provide a legal basis for the DEA’s position that its confidential sources were appropriately categorized as non-federal law enforcement officers eligible for FECA benefits.”

In a statement, a Justice Department spokesperson said the DEA “has placed a moratorium on submitting new FECA claims for confidential sources to the Department of Labor.” “DEA has also determined that, although a determination should be based on the facts of each individual case, the presumption should be confidential sources are not ‘employees’ pursuant to FECA and should not be eligible for benefits,” the spokesperson said.

Hospitals, health insurance companies, and universities have all become a frequent target for hackers seeking massive databases of personal information. Profile data, Social Security numbers and health records sell quickly on the black market and are now more profitable in that marketplace than is credit card information. Illegal data brokers amass large databases of this stolen information, then sell access to identity thieves.

An now hackers reportedly broke into the massive hospital network of the University of California, Los Angeles, accessing computers with sensitive records of 4.5 million people. According to the story on Fox2Now, names, medical information, Social Security numbers, Medicare numbers, health plan IDs, birthdays and physical addresses – all were potentially stolen. That could affect anyone who has visited – or works – at the university’s medical network, UCLA Health, which includes four hospitals and 150 offices across Southern California. UCLA Health made this announcement on Friday – two months after it discovered the extent of the data breach.

Evidence collected by UCLA Health indicates hackers slipped into computers in September 2014. The next month, university network alarms “detected suspicious activity,” and UCLA Health called in the FBI for help. “At that time, it did not appear that the attackers had gained access to the parts of the network that contain personal and medical information,” UCLA Health said in a statement.

That changed on May 5, when UCLA claims it discovered hackers actually accessed computers with sensitive records. The hospital group is now notifying staff and patients, offering them one year of identity theft recovery services. However, UCLA Health stresses it can’t yet be sure that hackers actually accessed – or stole – the records themselves. The FBI is currently trying to determine “the nature and scope” of the incident.

The UCLA Hospital System’s president, Dr. James Atkinson, apologized to the public in a statement. The hospital group also noted it is under “near-constant attack” by hackers – blocking “millions of known hacker attempts each year.” UCLA Health said the hack forced it to employ more cybersecurity experts on its internal security team, and to hire an outside cybersecurity firm to guard its network.

Health care tends to lose larger numbers of records. When insurance giant Anthem was hacked, up to 80 million records were stolen. The Premera health insurance hack hit 11 million people. Hackers also stole data on 4.5 million Community Health System patients.

Universities get slammed as well. Last year, hackers stole 310,000 University of Maryland records. This year, Auburn University exposed its students’ Social Security numbers. North Dakota University, Butler University, and Indiana University have all exposed the private information of hundreds of thousands of students.

The DWC will implement a new online panel process for represented initial panel requests on October 1, 2015. DWC will no longer accept or process paper submissions postmarked after September 3, 2015. The new process requires parties in a represented case to submit initial QME panel requests online and immediately receive a QME panel. The requesting party will then serve the panel request form, any required documentation and the QME panel on all parties with a proof of service.

“Our goal for the new online process is to further reduce delays. In most cases the QME panel will issue immediately, allowing the injured worker to schedule an exam with a QME more quickly,” said Christine Baker, Director of the Department of Industrial Relations (DIR). DWC is a division of DIR.

The DWC has posted an online QME Form 106 Panel Request training video and FAQs on the Medical Unit website. The video demonstration details the way in which represented initial panel requests will be submitted using the new online system.

“I encourage attorneys and claims administrators to view the training video to see how easy the new system will be to use and to become familiar with the process before October 1, 2015,” said Destie Overpeck, Administrative Director of DWC.

The notices of rulemaking, text of the regulations, and the initial statements of reasons can be found at on the DWC rulemaking page. The regulations are pending final review with the Office of Administrative Law (OAL).

Continuous updates about the division’s activities are available by subscribing to the DWC Newsline. QME specific information, which includes new training materials, is also available on the DWC Medical Unit website.