Author: WorkCompAcademy

The owner of multiple marijuana clinics admitted Wednesday to forging a doctor’s signature and fraudulently using the doctor’s name and license number to write fake medical marijuana prescriptions. The 72-year-old man, Nelson Leone, will be sentenced September 14, 2015. He faces up to a $250,000 fine and five years in prison.

Prosecutors stated that Leone operated six clinics under the name Green Cross Evaluations throughout San Diego, including locations on Park Boulevard, Mission Valley, Sports Arena, and Pacific Beach. The former doctor purchased advertising touting the clinic’s customer service and amenities such as on-site ATMs, walk-in services, and discounted rates for first-time patients. In the ads he made it clear that his clinics were “consumer friendly.” He also advertised the his clinics offered access to a “licensed physician.”

According to prosecutors, five of the six clinics did not have a licensed doctor on staff. He employed Dr. Arnold Kaplan, a licensed physician, at one of his clinics to meet with customers and issue medical marijuana recommendations. Without Kaplan’s knowledge, Leone also issued medical marijuana recommendations at his five other clinics using Kaplan’s signature and physician license number. Those recommendations falsely stated that the patient was evaluated and suffered from a condition that “may benefit from the use of medical marijuana.”

Leone agreed to shut down all six of his clinics as part of his plea.

Leone was once licensed as a physician in California in 1973. He practiced as a psychiatrist in San Diego for 20 years when misconduct charges were filed against him by four of his former patients. After 38 days of administrative hearings, the Administrative Law Judge recommended that his license be revoked in 1995 for gross negligence, dishonesty, excessive prescribing practices, and aiding and abetting another in the unlicensed practice of psychology. In 2008 he filed a Petition for Penalty Relief claiming he had rehabilitated himself.  The Office of the Attorney General recommended against granting the petition arguing that Leone’s testimony was full of distortion, misrepresentation, and outright fabrication. After a hearing, the Administrative Law Judge denied his Petition in February 2012.

Injured workers are now a step closer to obtaining marijuana for their injuries after the Journal of the American Medical Association published an article that says moderate – or high-quality scientific medical evidence supports the use of marijuana for some medical conditions, but not for others, according to a fresh review of past research. After reviewing 80 randomized trials that included nearly 6,500 people, researchers found moderate support for using marijuana to treat chronic pain and muscle spasms and involuntary movements. The evidence wasn’t as strong to support marijuana’s use for nausea and vomiting due to chemotherapy, sleep disorders, HIV-related weight loss and Tourette syndrome.

The summary in Reuters Health continues to say that any benefits of marijuana or cannabis use must be weighed against the risk of side effects, which include dizziness, dry mouth, nausea, sleepiness and euphoria, according to the study’s lead author. “Individuals considering cannabinoids as a possible treatment for their symptoms should discuss the potential benefits and harms with their doctor,” said Penny Whiting of University Hospitals Bristol NHS Foundation Trust in the UK. She also told Reuters Health by email that other reviews of medical marijuana suggest prolonged use may be tied to an increased risk of psychosis.

The new review, which is published in the Journal of the American Medical Association (JAMA), was commissioned by the Swiss Federal Office of Public Health. The researchers searched medical databases for past randomized controlled trials, which are considered the “gold standard” of medical research. While the researchers found that most trials suggested some improvements in symptoms for the various conditions, not all could suggest the improvement wasn’t just due to chance.

“As systematic reviewers, we have provided a summary of the available evidence which doctors can now use to make decisions regarding whether to prescribe cannabinoids for their patients,” Whiting said.

A second review published in the same journal by Dr. Kevin Hill of McLean Hospital in Belmont, Massachusetts, found similar results. In that review, Hill found high-quality evidence to support the use of marijuana in people with chronic or neuropathic (nerve) pain, and muscle problems related to multiple sclerosis.

“The two reviews have reached similar conclusions, that while there is some evidence to support the use of marijuana for certain conditions . . . for many of the other conditions that various U.S. states have approved medical marijuana, the evidence is of low quality,” said Dr. Deepak Cyril D’Souza of Yale University School of Medicine in New Haven, Connecticut.

“If the primary process by which medications are approved for ‘medical’ use in the U.S. is the (Food and Drug Administration) approval process, then the evidence for many conditions does not meet the existing threshold of evidence,” said D’Souza, who co-authored an editorial accompanying the new reviews.

In another study in the same journal, researchers found poor labeling on medical marijuana. Of 75 edible marijuana products purchased in three metropolitan U.S. areas, less than one in five were labeled correctly, according to Ryan Vandrey of Johns Hopkins University in Baltimore and colleagues. They found the vast majority of products contained more or less of the active ingredients than the label indicated.

Despite some scientific evidence that might get an injured worker’s foot in the door of the UR/IMR process, there remains formidable obstacles before the floodgates are opened in workers’ compensation claim departments. Cannabinoids remain illegal under federal law. Additionally, California Health and Safety code 11362.785(d) says that “nothing in this article (Medical Marijuana Program) shall require… any .. health insurance provider to be liable… for the medical use of marijuana. The WCAB used this provision to support a denial of medical marijuana in the case of Cockrell v Farmers Insurance (March 2013). With that being said, claimants are just a legislative pen stroke away from claiming this as a benefit.

Perspectives on the WCIRB’s 100 year history and its future, success stories from an innovative self-insured employer, and a glimpse at some of the issues that will likely shape the workers’ compensation debate in the years to come are among the highlights of the WCIRB’s Annual Workers’ Compensation Conference held in San Francisco on Thursday, June 11, 2015.

This year’s conference placed special emphasis on the integral role that the WCIRB has played in the workers’ compensation system since its founding in 1915. As part of his welcome message to conference attendees, WCIRB President and CEO Bill Mudge reflected on the organization’s century of service to the California workers’ compensation community and highlighted recent initiatives that have transformed the WCIRB into a more modern enterprise and one that exemplifies its centennial motto of “100 Years Young.”

Watch the Video: The WCIRB: 100 Years Young (12 minutes) Bill Mudge, President and CEO, WCIRB.

This year’s featured guest was California Insurance Commissioner Dave Jones who provided a regulator’s perspective on the California workers’ compensation system and commented on the positive working relationship between the California Department of Insurance and the WCIRB.

Bill Zachry, VP of Risk Management for Safeway Inc. shared some success stories from his work at Safeway – a large self-insured employer with over 2,400 locations and 250,000 employees throughout the United States. In his presentation, Mr. Zachry detailed a number of strategies used by Safeway to lower its cost of workers’ compensation by 40% compared to the overall industry average.

Watch the Video: Insights from an Innovative Self Insurer (42 minutes) – Bill Zachry, VP of Risk Management, Safeway Inc.

Dave Bellusci, the WCIRB’s EVP and chief actuary delivered his presentation in two parts. The first provided an overview of the 100 year old California workers’ compensation system in terms of premiums and market share, claim frequency and severity, overall industry results and SB 863 cost monitoring. In the second half, he compared California to the rest of the country and delved into some of the factors that contribute to California being a high cost workers’ compensation state such as higher permanent disability claim frequency, higher medical costs late in the life of a claim and high benefit delivery costs.

Part I: California Workers’ Compensation System at 100 Years: A WCIRB Perspective. Part II: How Do We Rate? Dave Bellusci, EVP and Chief Actuary, WCIRB

To close the conference, Bill Mudge moderated a panel discussion titled The Beat on the Street: What is Happening Next in California Workers’ Compensation that included representatives from the insurer, medical provider, employer, and legal communities. The wide range of discussion explored issues including medical provider fraud and potential ways in which insurers and medical provider networks can play a role in reducing it; the factors that influence whether an injured worker seeks representation; the incentives that exist in the workers’ compensation system that drive unwanted behaviors; friction forces that drive costs and potentially delay benefit delivery; and the improved outcomes that are possible through proactive, empathetic communication between claims staff and injured workers.

The WCIRB Annual Workers’ Compensation Conference is held each year in June in Northern California. Attendees include senior executives from WCIRB member companies and other California workers’ compensation system stakeholders. Attendance is by invitation only.

The Sacramento County District Attorney announced that former California Department of Corrections and Rehabilitation Officer Alan Lemke pled no contest to felony workers’ compensation insurance fraud. Lemke was charged with failing to disclose his participation in events and activities that, had those events and activities been known, would have affected the benefits to which he was entitled.

Lemke filed a workers’ compensation claim after allegedly injuring his foot while working in the prison. However, investigators in the Office of Internal Affairs, Workers’ Compensation Insurance Fraud Unit at the California Department of Corrections and Rehabilitation discovered Lemke failed to disclose that he engaged in a 50 mile hike over rugged terrain just three weeks after he reported being injured at work. In addition, investigators determined Lemke failed to disclose other activities, including rock climbing, snow shoeing, acting in two plays with multiple performances, and numerous extreme hikes in rugged mountainous terrain during the one year and two months he was off work collecting benefits. Lemke made video recordings and took photos of many of his hikes and other activities, which were discovered in his home when investigators served a search warrant.

Pursuant to the plea, Lemke will be placed on probation and ordered to serve 150 days in county jail, with the sheriff’s work furlough program recommended. Furthermore, he will be ordered to pay to the California Department Corrections and Rehabilitation and State Compensation Insurance Fund a stipulated restitution amount of $33,262.56, with an additional $10,453.68 in discretionary costs to be determined by the court at sentencing. If Lemke pays restitution in full, the charge will be reduced to a misdemeanor.

Sentencing is scheduled for July 17, 2015 in Department 45 before the Honorable Judy Herscher.

Robin Chorn M.D. is a licensed physician and surgeon who provides medical services to workers’ compensation applicants. On November 20, 2013, he filed a class action civil complaint contending that the subdivisions of Labor Code section 4903 imposing medical lien activation and filing fees (§§ 4903.05, 4903.06) and restrictions on payment of awards to assignees (§ 4903.8) violated Article I, sections 3, 7, and 9 and Article XIV, section 4 of the California Constitution. He further alleged that the adoption of emergency regulations to implement the lien activation fee provision violated the California Administrative Procedure Act. (Gov. Code § 11340 et seq.)

The superior court held that it lacked jurisdiction to consider Chorn’s challenge to the statute and denied the motion without considering the merits. Chorn timely appealed. The Court of Appeal sustained the trial court in the unpublished case of Chorn v Brown.

Labor Code 5955 provides, “No court of this state, except the Supreme Court and the courts of appeal to the extent herein specified, has jurisdiction . . . to restrain, enjoin, or interfere with the appeals board in the performance of its duties but a writ of mandate shall lie from the Supreme Court or a court of appeal in all proper cases.” The trial court stated that the California Constitution confers on the Legislature “plenary power, unlimited by any provision of this Constitution,” to establish a system of workers’ compensation: including the power to create a system for trial and resolution of workers’ compensation disputes. The trial court accordingly concluded that the jurisdictional provisions of article VI of the California Constitution, which grant original jurisdiction to superior courts over most cases, were inapplicable to workers’ compensation disputes.

The Court of Appeal agreed saying “In this action, an injunction enjoining respondents from enforcing the challenged provisions of the statute would interfere with the appeals board’s performance of its duties.” The courts of appeal and Supreme Court have exclusive jurisdiction over Chorn’s challenge to the validity of the statute.

The order of the trial court was affirmed