Author: WorkCompAcademy

The Department of Industrial Relations has now launched the Return-to-Work Supplement Program for injured workers. This fund – which will get an additional $5,000 to each eligible injured worker who has a disproportionate loss of earnings – is an important component of the workers’ compensation reforms in Senate Bill 863. This program is based on findings of studies done by RAND concerning permanent disability and in particular the study entitled Identifying Permanently Disabled Workers with Disproportionate Earnings Losses for Supplemental Payments.

“This program is another example of the benefits that SB 863 brought about for injured workers,” said DIR Director Christine Baker. “Many workers face economic hardship when they suffer disabling work injuries and this supplement will help them regain some of those lost earnings.”

DIR inaugurated the new program with an online portal as well as kiosks that connect to the portal in its Division of Workers’ Compensation (DWC) offices across the state, allowing injured workers to easily file the application in five steps. Section 17305 of the new regulations state “An application must be submitted by electronic means through the Department of Industrial Relations web site. The Department will make access to this web site available at each Division of Workers’ Compensation Information and Assistance Office location in the state.”

To be eligible for the Return-to-Work Supplement, the individual must have received the Supplemental Job Displacement Benefit (SJDB) Voucher for an injury occurring on or after January 1, 2013. All completed applications will be reviewed for eligibility within 60 days from the date of filing. Payment to workers will be made within 25 days of the eligibility determination.

Regulations for the Return-to-Work Supplement Program were approved by the Office of Administrative Law (OAL) and filed with the Secretary of State on April 6, 2015. These regulations will be implemented on April 13 and are authorized by Labor Code section 139.48.

Commencing 30 days after the effective date of these regulations, and continuing until the Administrative Director of the Division of Workers’ Compensation amends Form DWC-AD 10133.32 to include notice of the Return-to-Work Supplement application process, all Vouchers issued shall be accompanied by a cover sheet, prepared by the claims administrator, containing the following notice: “Because you have received this Voucher and are unable to return to your usual employment you may be eligible for a Return-to-Work Supplement. You must apply within one year from the date this Voucher was served on you. You should make a copy of the Voucher which you will need to apply for the Return-to-Work Supplement. Details about the Return-to-Work supplement program are available from the Department of Industrial Relations on its web site, www.dir.ca.gov, or by calling 510-286-0787.”

An application for the Return-to-Work Supplement must be received by the Return-to-Work Supplement Program within one year from the date the Voucher was served on the individual or within one year from the effective date of these regulations, whichever is later.

The Return- to-Work Supplement Program will provide a supplement of $5,000.00 to each eligible individual who submits a complete application by the deadline. The payment will be made within 25 days of the date the decision of the Director on the application and will be paid in one lump sum. Payment shall be made directly to the individual and is not assignable before payment. The amount of this supplement may be adjusted by the Director based on further studies conducted by the Director in accordance with Labor Code section 139.48.

An individual dissatisfied with any final decision of the Director on his or her application for the Return-to-Work Supplement may, file an appeal at the Workers’ Compensation Appeals Board (WCAB) District Office.

Former State Senator Ron Calderon, a Democrat from Montebello, was indicted in February 2014 on 24 felony charges including bribery, money laundering and tax fraud. They include accepting $88,000 in bribes in exchange for official actions involving bills affecting the film industry and workers’ compensation benefits. He has pleaded not guilty and his trial is now set for August 11. These charges carry a maximum sentence of 400 years in prison.

Capitol sources confirmed the Los Angeles Times report that federal prosecutors have served subpoenas on about 10 staff members in the California Legislature who may be called as witnesses in the trial, It does not appear that any of the subpoenas issued so far are for senators, although Assemblyman Adam Gray’s office confirmed he has been subpoenaed based on his work as a former aide to Calderon. Gray was Sen. Calderon’s legislative director from 2008 to 2011, advising him on bills coming up for votes.

Some elected officials are expected to be called as witnesses, according to Assistant U.S. Atty. Mack E. Jenkins. “We are subpoenaing public officials for the Aug. 11 trial date,” Jenkins said. “They are potentially witnesses. It doesn’t necessarily mean they will testify, but it means they may potentially testify, so we want to make sure they are available during the trial.” Jenkins would not say how many subpoenas have been issued, but Capitol sources who spoke on condition of anonymity because they are not authorized to comment on the case said about 10 had been delivered.

Another former Calderon staffer who has been contacted in the past by federal prosecutors is Assemblyman Adam Gray (D-Merced). A spokesman for Gray said Friday that Gray has been subpoenaed as a former staffer.

Senate President Pro Tem Kevin de León’s office refused to clarify whether the Los Angeles Democrat had been subpoenaed, but in a statement, spokeswoman Claire Conlon said, “Senator de León has been asked to assist the prosecution as a witness in the Calderon trial and, as has been the case from the very beginning of this process, he will readily and fully participate. Since the senator’s been cooperating in this matter for nearly two years, he expected to be called and he’s prepared to serve as needed.” De León’s name is mentioned 56 times in the affidavit laying out the federal government’s allegations that Calderon accepted $88,000 in bribes from an undercover agent and a hospital executive. According to the affidavit, Calderon sought de León’s support for legislation to maintain workers’ compensation rules that aided hospital executive Michael D. Drobot, as well as a bill to give tax credits to low-budget independent films. An undercover federal agent posing as a movie producer gave a $5,000 campaign contribution to de León, which the senator later returned.

The former senator has denied any wrongdoing. A year after his indictment on federal corruption charges, Calderon awaits his day in court, working as an acquisitions manager at Red Hill Real Estate Solutions at 652 Mesa Dr., in Corona. The company specializes in buying distressed properties.  “He is doing very well,” said his attorney, Mark Geragos. “He’s working and he’s got enormous support from his friends and family.” The attorney said Calderon is helping with the 330,000 pages of discovery documents provided by the U.S. attorney’s office, including tapes and transcripts for 2,200 recorded telephone calls and meetings.

Geragos called the case “the definition of entrapment,” saying, “Most of these so-called offenses were completely manufactured by the government at the cost of millions of dollars to the taxpayer.” Assistant U.S. Atty. Mack E. Jenkins said his side is ready with a counter-argument. “The legal standard for entrapment is that there must be no predisposition toward bribery” by the defendant, Jenkins said. “We believe we can meet the legal standard that there was predisposition.”

Geragos, who has represented pop star Michael Jackson, actress Wynona Ryder and singer Chris Brown, has also represented other political figures, including former Rep. Gary Condit, former Los Angeles City Councilman Nate Holden and Whitewater figure Susan McDougal, a former business partner of then-President Clinton. Geragos said Calderon would not be the only state lawmaker called to testify at the trial, which is set for Aug. 11. “I think it’s without question that there will be lawmakers called as witnesses, and not necessarily just by the defense.”

City Attorney Mike Feuer announced that a Los Angeles city crackdown has prompted more than 500 medical marijuana shops to close down in less than two years, According to the report in the Los Angeles Times, that represents a jump from a year ago, when Feuer reported that about a hundred pot shops had been shuttered. The city attorney has also targeted other ways medical marijuana has been distributed, securing court injunctions against a Boyle Heights pot farmers market and a smartphone app used to arrange pot deliveries.”There are a whole bunch of different vehicles that we pursued to close them,” including civil and criminal cases and warning letters, Feuer said. “We’ve made tremendous progress.”

Still, the city doesn’t know how many marijuana businesses continue to operate, raising concerns from critics that the crackdown may amount to a game of whack-a-mole.Under Proposition D, approved by voters two years ago, pot shops and the landlords that lease them space can be prosecuted if the businesses don’t meet a number of requirements. Those include being registered under past L.A. ordinances and operating a specified distance from public parks, schools and other facilities.

When the restrictions were approved, city officials estimated that fewer than 140 medical marijuana dispensaries would be eligible to remain open and avoid prosecution. At the time, police officials said they believed roughly 700 pot shops were operating, although some estimates put the figure more than twice as high. Feuer said neighborhood complaints about the city failing to tackle illegal shops, which he routinely heard when he was first elected two years ago, are now much less frequent. “We are shutting down unlawful dispensaries at a rapidly increasing pace,” he said. That “momentum” will make new, unlawful shops reluctant to open in Los Angeles, he said.

Last year, more than 450 medical marijuana shops filed tax renewals to report their gross receipts, according to the Office of Finance. The number appears to have fallen slightly this year, with 415 businesses renewing around the March deadline. But it isn’t clear if the tax numbers account for all shops. Hundreds more marijuana businesses – more than 1,100 dispensaries – are still registered on the books to pay business taxes, though city officials say many of those may have closed without telling the finance office.

Another estimate by UCLA researchers, who canvassed addresses they found online and through city registrations, found 418 marijuana businesses operating in L.A. last year – more than three times the number supposedly allowed. That was only a slight decrease from two years earlier, when a similar survey found 476 shops. The UCLA Medical Marijuana Research team also found that marijuana shops have been shifting from the San Fernando Valley and East L.A. to South L.A. and San Pedro. Principal investigator Bridget Freisthler said it’s unclear why. It “might be in response to community efforts to close some dispensaries,” she said.

San Diego reports a similar struggle to control the number of shops. In four years, more than 200 of the dispensaries have been shut down, with 40 more awaiting enforcement, according to the city attorney’s office. All opened during the time when the city had no zoning that would permit marijuana dispensaries. The San Diego City Council in July adopted a medical marijuana ordinance allowing no more than four dispensaries in each of the nine council districts. A dozen applications are being reviewed. “Our aggressive enforcement of city zoning regulations is necessary to protect neighborhood standards and safety,” said San Diego City Attorney Jan Goldsmith.

Medical marijuana is an $18 million dollar tax boon for the City of San Jose, but two of the South Bay’s largest dispensaries are now in a conflict with city leaders. In February, the Investigative Unit revealed that some San Jose pot shops owe millions in unpaid marijuana taxes. In that story, San Jose Mayor Sam Liccardo sent a message to the owners of Medimarts in East San Jose and All American Cannabis Club in West San Jose, “Pack up, it’s time to move on and pay up on your way out,” said Liccardo. Dave Armstrong, President and CEO of Medimarts, said the Mayor’s tough talk creates puts him between a rock and a hard place. “The city wants us to do something, but on the other hand it’s illegal,” said Armstrong.

Armstrong argues that by paying the city’s Marijuana Business Tax, he’s also admitting to selling a federally banned substance. “So which of is the worse of the two?” he said. “Breaking federal law or breaking a municipality ordinance?….It’s where we’ve been for three years.” The All American Cannabis Club (A2C2) in San Jose makes the same argument” Founder Dave Hodges said the city is using back door tactics to shut him down.

Many cities have banned cannabis dispensaries, while others tax and regulate collectives operating out of retail storefronts as well as cultivation. The federal government has a history of threatening California city council members, county supervisors, and government staffers with drug trafficking charges if they seek to regulate medical cannabis cultivation or distribution. Federal prosecutors have shut down cultivation regulation programs in Humboldt County and Oakland.

North Hollywood resident Gevorg “George” Kupelian was sentenced to 30 months in custody for his role in a $1 million fraud scheme and was ordered to repay $964,011 in restitution.

According to court documents, Gevorg Kupelian and others operated the El Centro Clinic, located at 485 Broadway Street, Suites C and D, in El Centro, California, as a Medicare-billing mill. Kupelian admitted that he set up the clinic and found a doctor to act as the official physician of record. But, as Kupelian acknowledged, the doctor served primarily as a “front” so that Kupelian could use his Medicare billing number to submit Medicare claims.

Kupelian has further admitted that he recruited and paid “cappers,” individuals whose sole task was to find senior citizens in El Centro and convince them to go to the Clinic. In exchange for providing their Medicare beneficiary numbers, the senior citizens received a free pair of shoes and/or a free buffet lunch. Once they arrived at the Clinic, the beneficiaries were subject to a pre-determined gauntlet of tests, which were not based on the patient’s medical needs and were provided without proper supervision by a physician. In some cases, the clinic billed Medicare despite the fact that the tests were not provided at all.

Kupelian also arranged for a so-called Physician Assistant (“PA”) to see patients (in lieu of the “front” doctor, who was often absent), write progress notes, and order tests. As detailed in today’s court proceedings, the so-called PA hired by Kupelian was, in fact, unlicensed to practice medicine in any capacity in California.

Many of the tests that the Clinic claimed to have administered to beneficiaries required either that a physician administer the test or that a physician be within the Clinic during testing. On over 800 occasions, the Clinic billed Medicare for these tests despite cell phone location records showing that the doctor was not in Imperial County at all during the times these tests were allegedly administered. The Clinic also submitted reimbursement from Medicare for allergy tests despite evidence showing that these tests were never performed in the Clinic by a doctor or anyone else.

The co-conspirators operated the El Centro Clinic in a manner designed to maximize Medicare reimbursements without regard to the medical needs of its patients. For example, they staffed the clinic, either by being personally present or arranging for others to be, in order to give the impression to the recruited Medicare beneficiaries and outside observers that the beneficiaries were being seen by qualified medical professionals. In fact, oftentimes the recruited beneficiaries would never see a doctor or other qualified medical professional during a particular visit to the El Centro Clinic. They also caused tests to be performed on recruited Medicare beneficiaries without regard to their medical necessity, including breathing tests, bladder tests, EKGs, and ultrasounds, for the primary purpose of generating billings to Medicare.

Kupelian also admitted creating “sample” lab sheets and billing forms with certain tests and diagnoses checked. He instructed the clinic’s employees to duplicate the checked boxes from the sample forms on patients’ actual forms, without regard to the patients’ actual medical conditions or what tests they actually needed or received. Moreover, Kupelian instructed the clinic’s employees that all patients were to undergo all of the tests offered by the clinic, without regard to the patients’ actual diagnoses or what tests they actually needed. After the unnecessary tests were conducted, Kupelian inserted false test results into patient files to make it appear that tests had been done and results were appropriately generated, when in fact they had not.

Using these tactics, the El Centro Clinic generated over $2.7 million in claims to Medicare, which resulted in payments of approximately $1.3 million to the doctor, 75% of which the doctor immediately transferred into Kupelian’s bank account. Out of his proceeds, Kupelian paid the other co-conspirators, including the cappers and the fake PA.

Kupelian was ordered to surrender on July 8, 2015.

Physical therapy may work as well as surgery for easing symptoms of lumbar spinal stenosis, a common cause of nerve damage and lower back pain among older people, according to a new study summarized by Reuters Health. Lumbar spinal stenosis, a compression of open spaces in the lower spinal column, can lead to pinched nerves, tingling, weakness and numbness in the back and the lower extremities. The condition becomes more common with age, and an estimated 2.4 million Americans may have it by 2021, according to the American Academy of Orthopedic Surgeons.

“Surgery is a riskier procedure, with about a 15 percent complication rate, and half of those are life-threatening,” said Dr. Anthony Delitto, chair of physical therapy at the School of Health and Rehabilitation Sciences at the University of Pittsburgh. “It isn’t a life-risking procedure to do physical therapy.” Delitto and colleagues set out to see if they could show that physical therapy, long known to be safer than surgery, could work as well as at easing symptoms. Between 2000 and 2005, they asked 481 patients who consented to surgery if they would be willing to join a study where they would be randomly chosen to proceed with the operation or receive physical therapy. Most declined, to avoid being assigned to the non surgical group, but 169 patients agreed to participate in the experiment. Ultimately, 87 patients had surgery and 82 were assigned physical therapy.

At the start of the study, patients were at least 50 years old. They had to be able to walk at least a quarter mile without difficulty and have no underlying medical conditions such as dementia, severe vascular disease, cancer, or a prior heart attack. Most of them were sedentary or only mildly active, and they were typically obese. Patients in the surgery group were slightly younger, about 67 on average, compared with an average age of about 70 for patients receiving physical therapy.

The physical therapy regimen consisted of twice-weekly rehabilitation sessions for six weeks. Participants were allowed to opt out of this regimen in favor of surgery at any point during the study, and over an average two years of follow-up 47 of them, or 57 percent, did just that.

No matter what group they started in, participants achieved similar reduction of pain and other symptoms at two years. “The study demonstrates that both surgery and physical therapy are reasonable choices; the person who goes down either path ends up in the same place a year or two later,” said Dr. Jeffrey Katz, director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston. Katz, who wrote an editorial accompanying the study in Annals of Internal Medicine, noted that there’s still a role for surgery in treating lumbar spinal stenosis. But there’s no harm in trying physical therapy first, he said.

Because so many eligible patients opted not to participate in the study, and so many randomly selected for physical therapy abandoned it to get surgery, more research may still be needed in a larger group of patients to get a complete picture of the relative benefits of each option, said Dr. James Weinstein, chief executive of Dartmouth-Hitchcock health system, who wasn’t involved in the study. Still, “surgery should be the last option,” said Weinstein, lead author of a 2008 paper in the New England Journal of Medicine that found surgery more effective at curbing symptoms than non surgical alternatives.

Despite the small size of the current study and the number of patients who stopped physical therapy early, it still makes sense to try it before surgery, said Dr. Richard Deyo, a researcher in back pain at Oregon Health and Science University, in email to Reuters Health. “If they elect to have surgery at a later time, the results appear to be as good as for patients who choose earlier surgery,” said Deyo, who wasn’t involved in the study. “Some patients are inclined toward surgery because the high tech approach seems more definitive, attractive, and quicker. However, patients should realize they are likely to need physical therapy even after successful surgery, and recovery can be slow.”