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New MPN Regulations Now in Effect

The Office of Administrative Law (OAL) has approved the Division of Workers’ Compensation’s final version of Medical Provider Networks (MPN) regulations, one of the sections that implemented major reform provisions of Senate Bill 863. The MPN regulations went into effect August 27, 2014.

“We’re pleased to announce that the MPN regulations have been approved and are immediately effective,” said Christine Baker, Director of the Department of Industrial Relations (DIR). DWC is a division of DIR. “These regulations will help improve patient access to physicians within MPNs.”

The MPN regulations include:
1) A streamlined application process that allows electronic submission of MPN applications, modifications and reapprovals
2) Unique MPN Identification numbers to be assigned to each MPN in order to identify a specific MPN
3)The requirements for an MPN applicant to qualify as an entity that provides physician network services. Allowing these entities to qualify as an MPN applicant better aligns legal responsibility with operational responsibility
4) Improved access to medical care with the introduction of MPN Medical Access Assistants and the regulatory standards that they must meet to properly assist injured workers to find and schedule medical appointment with MPN physicians
5) Clarified access standards that require an MPN to have at least 3 available physicians from which an injured worker can choose from, and if the time and location access standards are not met, MPNs shall have a written policy permitting out-of-network treatment
6) Sets forth the physician acknowledgment requirements to ensure that physicians in the MPN have affirmatively elected to be a member of the network and a streamlined process for obtaining acknowledgments from medical groups
7) Greater accountability with the requirement that MPNs are approved for a period of four years and the procedural timelines for MPN re-approval
8) Oversight of MPNs is strengthened with the formal complaint process
9) DWC’s ability to enforce MPN statutory and regulatory compliance is improved with the regulations that set forth the petition for suspension or revocation of MPN process. In addition, the regulations establish additional grounds for the probation, suspension, or revocation of an MPN and the procedures by which MPNs are reviewed by DWC and assessed administrative penalties.

The final regulations are posted on the DWC website.The fillable MPN forms will be posted next week.

Reclassification of Opioid Painkillers May Increase Comp Costs

Tighter controls on opioid prescription painkillers issued by the U.S. Drug Enforcement Administration last month may increase workers compensation costs in the short term, but over the long term they could help reduce overuse of opioids according to an article in Business Insurance. The new regulations may drive up the price of some drugs and will force some workers comp claimants to visit their doctors more frequently to obtain prescription painkillers, increasing employer costs, but closer monitoring by medical professionals may lead to alternative therapies that don’t rely on potentially addictive drugs, experts say. Despite the tighter controls, opioid use by workers remains a critical workplace safety concern, they say.

Last month, the DEA said that effective Oct. 6, hydrocodone combination drugs – powerful opioids that have been prescribed increasingly over the past several years to treat injured workers – would be classified as Schedule II controlled substances under the federal Controlled Substances Act. Previously, they had been classified as Schedule III. Pure hydrocodone already was considered a Schedule II controlled substance, along with opioids such as oxycodone and morphine. In addition, the DEA classified tramadol, another opioid painkiller but one that is generally viewed as less powerful than some others, as a Schedule IV drug last month. Previously, tramadol, which is sold under the names Ultram and Ryzolt, was unregulated by the DEA.

Under DEA rules, Schedule II drugs cannot be refilled under the same prescription, whereas Schedule III and Schedule IV drugs can be refilled up to five times, with prescriptions expiring after six months. As an unregulated substance, patients had access to unlimited refills of tramadol over the course of one year in most states, said Paul Peak, pharmacist on the complex pharmacy management team at Sedgwick Claims Management Services Inc. in Memphis, Tennessee. However, at least 10 states treated products containing tramadol as controlled substances prior to the DEA’s classification, Mr. Peak said.

As a result of the changes for both classes of drugs, some injured workers may have to make more frequent physician visits to be monitored or to obtain new written prescriptions, said Dr. Robert Hall, medical director at pharmacy benefit manager Helios, which formed from the merger of PMSI Inc. and Progressive Medical Inc., in Tampa, Florida. “We are increasing costs to the system” by having injured workers visit physicians more often, but there’s also a chance that those visits could lead to better care, said Brian Carpenter, senior vice president of pharmacy product development and clinical management at Healthcare Solutions in Atlanta. “As long as the physician is … checking to see if optimal capacity is increasing with the use of the drug, making sure there isn’t aberrant behavior” and doing drug screenings, costs could actually decrease in the long run, Mr. Carpenter said. However, if more claimants begin taking tramadol as a result of hydrocodone combination products becoming more controlled, the average wholesale price of tramadol products could increase, Dr. Hall said.

The DEA is “adding a lot more control,” but the controls are not as restrictive as those imposed on hydrocodone combination products, such as Vicodin and Norco, that can no longer be refilled under Schedule II, Mr. Carpenter said. As tramadol is less tightly controlled than other popular opioids, its use may increase despite the tighter controls imposed on the drug because the alternatives are even more tightly controlled, experts say.

In October, claimants who were taking hydrocodone products may switch to tramadol or codeine, Mr. Carpenter said, although “a lot of users don’t like codeine because it has more side effects.” “It will be interesting now to see if codeine will be on the uptick because of the conditions that are being placed on the hydrocodone combo products,” Mr. Carpenter said.

Even though the DEA has tightened controls on tramadol and hydrocodone combination products, employers and third-party administrators “can’t, in most situations, prevent someone from taking it unless an outside peer reviewer comes along and says it’s not necessary,” Mr. Peak said.

WCAB Gives Applicants Second Chance at IMR Appeal

Christopher Torres suffered industrial injury to his left knee while working for Contra Costa Schools Insurance Group as a claims examiner in 1998, causing 27% permanent disability and need for future medical treatment. It in 2000, he also sustained industrial injury to his neck and spine causing a need for medical treatment.

For a period of time, defendant authorized the Duragesic patches and Norco prescribed by applicant’s primary treating physician, Douglas Grant, M.D., to relieve the pain caused by applicant’s industrial injuries. However, after Dr. Grant requested authorization to refill additional prescriptions for Duragesic patches and Norco in June 2013, defendant’s UR physician Claudio Palma, M.D., issued a UR determination certifying the request for Norco, but conditionally denying certification of the request for Duragesic patches.

Applicant disagreed with the UR determination and submitted an application for IMR on August 2, 2013. On August 15, 2013, applicant’s attorney sent the IMR organization an additional report by Dr. Grant concerning applicant’s history and use of Duragesic patches.

An IMR determination dated November 12, 2013 was sent to applicant’s attorney, stating without further explanation that Duragesic patches were “not medically necessary and appropriate.” On December 18, 2013, applicant’s attorney filed an appeal of the IMR determination regarding the Duragesic patches, writing that the “reviewer failed to review documents submitted by applicant and applicant’s representative before making the determination,” contrary to applicant’s right to due process. Although the IMR appeal was signed by the attorney, it was not verified. Following submission of the matter the WCJ issued his February 18, 2014 decision dismissing the IMR appeal for lack of verification.

The WCAB reversed the dismissal and remanded the case to allow applicant a second chance to file a verified appeal in the panel decision of Torres v Contra Costa Schools Insurance Group and SCIF.

Labor Code section 4610.6(h) provides that a determination of the administrative director pursuant to that section “may be reviewed only by a verified appeal from the medical review determination of the administrative director.” That statutory verification requirement is consistent with Workers’ Compensation Appeals Board Rules of Practice and Procedure, Rule 10450(a), which addresses the form of requests for action filed with the Workers’ Compensation Appeals Board (WCAB), and provides that all such requests “shall be made by petition.” (Cal. Code Regs., tit. 8, § 10450(a).) Rule 10450(e) in turn requires that all such petitions be verified under penalty of perjury. Applicant’s December 13, 2013 IMR appeal includes no affidavit by either the applicant or his attorney verifying the contents of the appeal under penalty of perjury as required by section 4610.6(h) and Rule 10450.7 Rule 10450(e) plainly provides that an unverified petition filed with the WCAB may be summarily dismissed.

However, it has long been recognized that lack of verification does not necessitate automatic dismissal of a nonconforming pleading. (United Farm Workers v. Agricultural Labor Relations Bd. (1985) 37 Cal.3d 912, 915; Mullane v. Industrial Acc. Com. (1931) 118 Cal.App. 283, 286 [17 I.A.C. 328, 330]; Wings West Airlines v. Workers’ Comp. Appeals Bd. (Nebelon) (1986) 187 Cal.App.3d 1047 [51 Cal.Comp.Cases 609]; Katzin v. Workers’ Comp. Appeals Bd. (1992) 5 Cal.App.4th 703, 712, fn.3 [57 Cal.Comp.Cases 230].). Failure to correct a lack of verification within a reasonable time after receiving notice of the defect allows dismissal of the nonconforming petition. (Lucena v. Diablo Auto Body (2000) 65 Cal.Comp.Cases 1425 [significant panel decision]; Smith v. Workers’ Comp. Appeals Bd. (2001) 66 Cal.Comp.Cases 788 (writ den.); see also Connor v. Workers’ Comp. Appeals Bd. (1980) 45 Cal.Comp.Cases 370 (writ den.).).

In this case, defendant raised the issue of lack of verification of the IMR appeal as an issue at the expedited hearing on January 9, 2014. However, applicant did not seek to cure the defect before the appeal was dismissed by the WCJ for lack of verification or at anytime thereafter. Applicant’s failure to timely cure the verification defect after receiving notice of it supports the WCJ’s dismissal of the IMR appeal. However, the WCAB also recognized that the verification requirement in section 4610.6(h) is relatively new, and that there is a strong public policy favoring the disposition of cases on their merits that is consistent with our mandate under Article XIV, section 4 of the California constitution to “accomplish substantial justice in all cases.” If applicant cures the procedural defect in the IMR appeal within 20 days after service of this decision by filing an appropriate verification or amended appeal with the necessary verification, the WCJ should address the substance of the IMR appeal.

Task Force Issues 81 Citations and $135K in Penalties for Labor Law Violations

The Labor Enforcement Task Force (LETF), a multi-agency team of inspectors, yesterday participated in Operation Underground, a statewide enforcement action at construction worksites throughout California. Ten investigators from Cal/OSHA and the California Labor Commissioner’s offices were deployed in Los Angeles, the Silicon Valley, Fresno and the Inland Empire.The enforcement effort is focused on curbing practices common in the underground economy that harm legitimate businesses and workers, including wage theft, tax evasion and fraud.

As a result of inspections, 81citations with penalties of over $135,000 were issued for various labor law and workplace safety violations, including four work stop-orders for failure to maintain workers’ compensation coverage in Fresno, Chino Hills and Uplands. Inspectors found serious safety hazards such as saws without safety guards, scaffolding, stairways, and an open skylight on a roof with no guard rails.

Inspectors also found wage theft violations including inadequate workers’ compensation coverage, failure to pay overtime and failure to provide pay stubs.

Officials claims that not only do these practices provide a competitive edge over compliant establishments, they also compromise the well-being of employees and increase taxpayer burden. “These citations serve as a reminder that underground employers who commit wage theft and intentionally put their workers at risk will not be tolerated,” said Christine Baker, Director of the Department of Industrial Relations (DIR), which administers LETF, and oversees both Cal/OSHA and the California Labor Commissioner’s offices. “LETF focused its resources on construction businesses yesterday due to the inherent danger and potential for labor violations.”

The Labor Enforcement Task Force was formed in January 2012 to combat all industries that operate in the underground economy. The goal of LETF is to ensure safe working conditions, proper payment of wages, and create an environment where legitimate businesses can thrive as well as support the collection of taxes, fees and penalties due to the State of California.

The Labor and Workforce Development Agency, the first cabinet-level agency coordinating workforce programs, oversees both LETF, led by DIR, and the Joint Enforcement Strike Force (JESF), headed by the Employment Development Department. LETF and JESF both participated in today’s enforcement efforts, which were coordinated by the California Department of Insurance.

Additional information on the underground economy, the Labor Enforcement Task Force and DIR is posted online and on DIR’s Facebook and Twitter pages. California workers and employers can contact the task force hotline at 855-297-5322 to report documented complaints and enforcement tips.

Convicted DME Owners Sentenced for Fraud and Kickbacks

Edna Calaustro was sentenced to 24 months in prison and Mele Saavedra was sentenced to three years’ probation for conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks involving the Medicare program, and health care fraud. , The announcement was made by United States Attorney Melinda Haag, FBI Special Agent in Charge David J. Johnson, and Special Agent in Charge for the Los Angeles Regional Office of Inspector General of the Department of Health and Human Services Glenn R. Ferry.

The evidence at trial showed that beginning in approximately December 2006 and continuing through July 2011, Patrick Sogbein, the owner of Debs Medical Distributors, a Van Nuys durable medical equipment company, and his wife, Adebola Adefunke Adebimpe, the owner of Dignity Medical Supply, a Santa Clarita durable medical equipment company, submitted over 400 false and fraudulent claims to Medicare using fraudulent prescriptions and medical records prepared by Calaustro. The evidence also showed that Sogbein and Adebimpe worked with Calaustro, then a San Francisco-based physician, and street level recruiters, including Eduardo Abad and Saavedra.

Abad and Saavedra recruited beneficiaries at locations in the Tenderloin and South of Market neighborhoods in San Francisco, including a fast food restaurant at the Powell Street cable car turnaround and a Tenderloin neighborhood senior center. After identifying beneficiaries, Calaustro, with Abad or Saavedra, went to the beneficiaries’ homes with a portable copy machine, copied their Medicare cards, and conducted sham examinations to obtain background information for the required Medicare paperwork. Calaustro gave the fraudulent paperwork and bogus prescriptions to Sogbein and Adebimpe. Sogbein and Adebimpe, in turn, created additional fraudulent paperwork in the names of their respective companies and submitted the claims to Medicare. Sogbein paid Calaustro a $100 kickback for each power wheelchair prescription. Sogbein paid Abad and Saavedra a $100 and $50 kickback, respectively, for each beneficiary they identified. From December 2006 through July 2011, Sogbein and Adebimpe were paid more than $1.6 million for over 400 fraudulent power wheelchair claims submitted to Medicare using the fraudulent prescriptions written by Calaustro. In mid-2011, Calaustro began working as a physician in Los Banos.

Calaustro, 71, of Daly City and Los Banos, and Saavedra, 49, of San Francisco, respectively, along with co-defendants Sogbein, Adebimpe, and Abad, were indicted by a federal grand jury on Jan. 26, 2012, for conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349, and health care fraud, in violation of 18 U.S.C. § 1343. Calaustro and Saavedra were arrested on Feb. 9, 2012, in Los Banos and San Francisco, respectively. After their initial appearances, Calaustro and Saavedra were released on bail. On Sept. 19, 2013, a grand jury returned a superseding indictment, charging Sogbein, Adebimpe, Calaustro, Abad, and Saavedra with conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349, and health care fraud, in violation of 18 U.S.C. § 1343. The indictment also charged Sogbein, Calaustro, Abad, and Saavedra with conspiracy to pay and received kickbacks involving the Medicare program, in violation of 18 U.S.C. § 371.

On Sept. 30, 2013 and Oct. 21, 2013, respectively, Calaustro and Saavedra pleaded guilty to conspiracy to commit health care fraud, conspiracy to receive kickbacks involving the Medicare program, and health care fraud. Calaustro and Saavedra both testified in November 2013 at the trial of co-defendants Sogbein, Adebimpe, and Abad.

The sentences for Calaustro and Saavedra were handed down by the Honorable Jeffrey S. White, United States District Court Judge. Judge White also sentenced Calaustro to a 3 year period of supervised release following her 24 month prison term and ordered forfeiture of $1,577,426 and restitution of the same amount to Medicare. Calaustro remains out of custody and is scheduled to begin serving her sentence on Nov. 17, 2014. Judge White sentenced Saavedra to perform 500 hours of community service during her 3 year term of probation and ordered forfeiture of $275,338 and restitution of the same amount to Medicare.

On June 17, 2014, co-defendants Sogbein, Adebimpe, and Abad, who were all convicted after trial, were sentenced to prison terms of 144 months, 51 months, and 12 months and 1 day, respectively. Sogbein is in custody. Adebimpe began serving her sentence. Abad remains out of custody pending his appeal.

Denise Marie Barton and Randy Luskey are the Assistant U.S. Attorneys who are prosecuting the case with the assistance of Assistant U.S. Attorney David Countryman, Beth Margen, and Bridget Kilkenny. The prosecution is the result of an investigation by the Federal Bureau of Investigation in San Francisco and Office of Inspector General, Department of Health and Human Services in Los Angeles.

Southern California Physician Pleads Guilty in Fraud Case

A Los Angeles County physician whose referrals led to more than $1.7 million in fraudulent Medicare billing pleaded guilty this to participating in a conspiracy to defraud Medicare by writing prescriptions for unneeded durable medical equipment (DME), such as power wheelchairs. Charles Okoye, a 52-year-old Carson resident, pleaded guilty to one count of conspiracy to commit health care fraud.

Appearing before United States District Judge Michael W. Fitzgerald, Okoye admitted that he wrote prescriptions for medically unnecessary DME for patients referred to him through Adelco Medical Distributors, Inc., a Gardena-based DME supply company.

Between November 2008 and November 2011, Adelco recruited Medicare beneficiaries and took them to see Okoye, who would issue DME prescriptions – primarily for power wheelchairs -after giving the “patients” a single, cursory examination. Adelco then billed Medicare for providing the DME, which the beneficiaries did not want and often never used. In return for these referrals, Okoye received illegal kickbacks for every DME prescription from Adelco’s owner, Adeline Ekwebelem. Okoye’s referrals led Adelco to submit approximately $1.7 million in fraudulent claims to Medicare, and Medicare paid Adelco more than $820,000. Okoye also fraudulently billed Medicare more than $50,000 for services he claimed to have provided to the “patients” who received unnecessary prescriptions.

Ekwebelem, 51, of Hawthorne, is also charged in the case, and she is scheduled to go on trial before Judge Fitzgerald on September 9. The Adleco indictment charges four other defendants, three of whom have previously pleaded guilty. The final defendant is currently a fugitive.

In his plea agreement, Okoye also admitted that he engaged in a similar unlawful arrangement with another DME company, Esteem Medical Supply in Inglewood.

Okoye is scheduled to be sentenced by Judge Fitzgerald on December 8. At sentencing, Okoye faces a statutory maximum sentence of 10 years in federal prison. As part of his guilty plea, Okoye has agreed that the California Medical Board can revoke his license to practice medicine.

The investigation into Okoye, Ekwebelem, and the others involved in Adelco’s fraudulent scheme to defraud Medicare was conducted by the U.S. Department of Health and Human Services, Office of the Inspector General, and the Federal Bureau of Investigation.

Two More Deaths Reported in Southern California Comp Community

After the report yesterday of the passing of Retired Workers’ Compensation Judge Samuel L. Sosna Jr. we are saddened to learn of the passing of yet two additional members of our Southern California Workers’ Compensation community.

Jack Paul Koszdin, the founding partner of the applicant’s firm of Koszdin, Fields Sherry and Katz in Van Nuys California passed away on Sunday, August 24, 2014. There will be a memorial service this Wednesday, August 27, 2014 at 10:00 a.m. at Mt. Sinai Cemetery in the Chapel Tanach. The California State Bar website provides the following tribute to Jack.

Born in 1931, Jack Koszdin grew up in Chicago, a child of Russian Jewish immigrants. As a young man, he moved to California and attended UCLA for his undergraduate degree and his J.D. Admitted to the California State Bar in 1955, Jack Koszdin dedicated his professional life to securing the rights of injured workers throughout California, which he championed through the law, through the classroom and through broadcast media.

Jack strongly supported workers’ union rights, serving as a founding member of VELPEC. He was legal advisor to the Valley Labor Political Education Council and co-hosted the Union Voice radio program.

Jack’s passion for politics lead him to work on numerous political campaigns for democratic candidates throughout his career. He supported such notable leaders as Tom Bradley, Bill Lockyer, Hilda Solis, Loretta Sanchez, and Richard Katz, among many others.

Service to the community has always been a priority to Jack. He has served in leadership positions for such organizations as Red Cross, Child Guidance Clinic, and Valley Hillel. Jack lectured in law at UCLA, the University of West Los Angeles and L.A. Trade Tech. He was a partner in the firm of Levy, Koszdin and Woods before heading the firm of Koszdin and Siegel, which later became Koszdin, Fields, Sherry and Katz, where he remained senior partner until his recent retirement.

It is through the efforts of Jack P. Koszdin and the powerhouse attorneys like him, who over the years have zealously protected some of our state’s most important yet vulnerable members — the laborers — that such landmark cases as Zemke v. Workmen’s Comp. App. Bd. 68 Cal. 2d 794 and Franklin v. Workers’ Comp. Appeals Bd., supra, 79 Cal.App.3d at pp. 237-238 came to be. After almost 60 years in the field of workers’ compensation law, Jack cared deeply for the plight of the injured worker, whose rights and benefits need defending now more than ever.

While Jack’s professional achievements are many, his greatest pride comes in the successes of his children, Shelli, Kari, Kenton, David and Frank, who are all accomplished professionals in their own right. He lived in Burbank, California with his beloved wife of years, Helen Griffin.

We must also report that Workers Compensation Judge Dennis Stach from the Riverside WCAB Passed away on August 7, 2014 in Norco, CA.

Judge Stach graduated from Elmwood Park High School in 1962. He enlisted in the US Air Force where he served as a Pararescue Specialist during the Vietnam era. He went on to undergraduate studies at California State Polytechnic University and then law school at the University of La Verne and became an attorney in 1979 and later served as a Workers’ Compensation judge in Southern California. He retired in 2010 after 25 years of service.

Judge Stach is survived by his sister, Mary Ann Carr, from San Diego; and brother, William Stach, of Streamwood, IL.

The Southern California Workers’ Compensation community will surly miss both of these fine professionals who were well respected and well liked by colleagues.

Medical Marijuana States Report 25% Reduction in Opioid Fatalities

Researchers aren’t sure why, but in the 23 U.S. states where medical marijuana has been legalized, deaths from opioid overdoses have decreased by almost 25 percent, according to a new analysis reported by Reuters Health.

California, Oregon and Washington first legalized medical marijuana before 1999, with 10 more following suit between then and 2010, the time period of the analysis. Another 10 states and Washington, D.C. adopted similar laws since 2010.

For the study reported in JAMA Internal Medicine, August 25, 2014,, Marcus A. Bachhuber, MD of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and his colleagues used state-level death certificate data for all 50 states between 1999 and 2010. In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected, according to results in JAMA Internal Medicine.

Meanwhile, opioid overdose deaths across the country increased dramatically, from 4,030 in 1999 to 16,651 in 2010, according to the Centers for Disease Control and Prevention (CDC). Three of every four of those deaths involved prescription pain medications. Of those who die from prescription opioid overdoses, 60 percent have a legitimate prescription from a single doctor, the CDC also reports.

Medical marijuana, where legal, is most often approved for treating pain conditions, making it an option in addition to or instead of prescription painkillers, Bachhuber and his coauthors wrote. But the full scope of risks, and benefits, of medical marijuana is still unknown. “I think medical providers struggle in figuring out what conditions medical marijuana could be used for, who would benefit from it, how effective it is and who might have side effects; some doctors would even say there is no scientifically proven, valid, medical use of marijuana,” Bachhuber said. “More studies about the risks and benefits of medical marijuana are needed to help guide us in clinical practice.”

Marie J. Hayes of the University of Maine in Orno co-wrote an accompanying commentary in the journal. “Generally healthcare providers feel very strongly that medical marijuana may not be the way to go,” she told Reuters Health. “There is the risk of smoke, the worry about whether that is carcinogenic but people so far haven’t been able to prove that.” There may be a risk that legal medical marijuana will make the drug more accessible for kids and smoking may impair driving or carry other risks, she said. “But we’re already developing Oxycontin and Vicodin and teens are getting their hands on it,” she said. If legalizing medical marijuana does help tackle the problem of painkiller deaths, that will be very significant, she said. “Because opioid mortality is such a tremendously significant health crisis now, we have to do something and figure out what’s going on,” Hayes said.

The efforts states currently make to combat these deaths, like prescription monitoring programs, have been relatively ineffectual, she said. “Everything we’re doing is having no effect, except for in the states that have implemented medical marijuana laws,” Hayes said. People who overdose on opioids likely became addicted to it and are also battling other psychological problems, she said. Marijuana, which is not itself without risks, is arguably less addictive and almost impossible to overdose on compared to opioids, Hayes said.

Claimant/Restaurant Owner Gets 120 Days For Collecting TTD While Working

A former San Mateo County files clerk caught on video working at restaurants she owned while collecting disability for a supposed back injury was sentenced Thursday to 120 days in jail, according to District Attorney Steve Wagstaffe. and the story in Insurance News Net.

But Superior Court Judge Craig Parsons recommended that sheriff’s officials instead confine and electronically monitor Sunita Sagar, 46, inside her home over that period. Parsons also placed Sagar on probation for three years, but defense attorney Lauren Kramer said the felony fraud charge will be reduced to a misdemeanor after 18 months if she behaves.

Sagar and her husband own multiple restaurant franchises in the Bay Area, including several Denny’s, a Baja Fresh and a Jack in the Box, although none in San Mateo County, Wagstaffe said. They also own a computer equipment store in Fremont.

According to prosecutors, Sagar collected disability benefits from 2008 to 2012 for a back injury she reportedly sustained while working. She convinced doctors she was “completely sedentary and could not conduct her daily activities,” and requested in-home care, according to Wagstaffe.

But insurance fraud investigators caught Sagar on hidden video “engaged in a very active lifestyle” that included working at her businesses, walking and bending without sign of discomfort, according to Wagstaffe. When her doctors were shown the video, they confirmed that Sagar had misrepresented her disability and was able to work, the district attorney said.

Despite her client’s no-contest plea, Kramer said the videos don’t prove Sagar was working. The allegations “weren’t ever tested,” she added, because the case didn’t go to trial. “Obviously we have a very different perspective,” Kramer said in a phone interview Thursday. “She indisputably spent time at the restaurants they owned, but she was not involved in the day- to-day operations.”

Sagar received approximately $22,000 in undeserved benefits, according to the district attorney’s office. On Thursday, she was also ordered to pay restitution to the county totaling $54,773, which include the costs of the investigation, according to Wagstaffe.

Retired Workers’ Compensation Judge Samuel L. Sosna Jr. Dies of Cancer

Retired Workers’ Compensation Judge Samuel L. Sosna, Jr. passed last week after a long battle with cancer.

Hon. Samuel L. Sosna, Jr. was retired as a Workers’ Compensation Administrative Law Judge in the Van Nuys District Office of the California Division of Workers’ Compensation. His retirement was announced in April, 2009. He was the past Presiding Judge of the Pasadena District Office from 1990 to 1996. He was well liked and well respected during his tenure as an attorney and as a Worker’s Compensation Judge.

He received his undergraduate degree from Stanford University and his law degree from the University of California Los Angeles. He was admitted to the California Bar on January 14, 1959.

There has not been any public announcement of funeral arrangements.