Category: Daily News

The Paperwork Reduction Act (H.R. 3797) (“PBRA”), passed by the 118th Congress on December 11, 2024, is legislation aimed at reducing the administrative burden on businesses and individuals.This legislation aims to significantly reduce the administrative burden faced by businesses and individuals.

Here’s a breakdown of the Paperwork Reduction Act key provisions:

– – Focus on Employer Reporting: A central focus of the act is to ease the reporting requirements for employers, particularly those related to health insurance coverage.
– – Simplified 1095-C Forms: The act modifies provisions under the Affordable Care Act. Employers will no longer be obligated to send physical copies of the 1095-C form, which provides employees with information about their health insurance coverage.
– – Alternative Reporting Methods: Employers will have the option to provide employees with clear and accessible instructions on how to request a copy of their 1095-C form. This shift from mandatory physical distribution to an “on-demand” system is intended to streamline the process.
– – Reduced Administrative Costs: By simplifying reporting requirements and eliminating the need for mandatory paper forms, the act aims to reduce administrative costs for businesses of all sizes. This could translate into cost savings that can be reinvested in other areas of their operations.
– – Improved Efficiency: The streamlined reporting process is expected to improve efficiency for both employers and employees. Employers will spend less time on administrative tasks related to health insurance reporting, allowing them to focus on other priorities. Employees will have greater flexibility in accessing their coverage information.

The Paperwork Reduction Act represents a significant step towards reducing the administrative burden on businesses. By simplifying employer reporting requirements related to health insurance coverage, the act aims to create a more efficient and less costly system for both employers and employees.

And employers may benefit from another new federal law.The Employer Reporting Improvement Act (H.R. 3801) (“ERIA”) was passed alongside the Paperwork Reduction Act in December 2024. It focuses on streamlining Affordable Care Act (ACA) reporting requirements for employers, specifically:

– – Codifying Existing IRS Regulations: The ERIA codifies certain IRS regulations designed to simplify ACA reporting for employers. This provides legal certainty and reduces the risk of future regulatory changes that could increase the burden on businesses.
– – Establishing a Statute of Limitations: A crucial provision of the ERIA establishes a six-year statute of limitations for penalty assessments related to ACA coverage failures. This provides much-needed clarity and limits the potential for indefinite liability for employers.
– – Flexibility in Reporting: The ERIA allows employers greater flexibility in fulfilling their reporting obligations. For example, it permits electronic delivery of 1095-B and 1095-C forms to employees who consent to receive them electronically.
– – Alternative Identifier for Social Security Numbers: The ERIA allows employers to use an individual’s date of birth as an identifier in certain situations where the Social Security Number is unavailable. This helps to ensure accurate reporting even in cases where obtaining a Social Security Number may be challenging.
– – Extended Response Time for IRS Notices: The ERIA allows employers more time to respond to Employer Shared Responsibility (ESR) letters from the IRS, giving them additional time to investigate and address any potential issues.

The ERIA complements the Paperwork Reduction Act by providing specific, targeted improvements to ACA reporting requirements. By codifying existing regulations, establishing a statute of limitations, and increasing flexibility for employers, the ERIA aims to significantly reduce the administrative burden associated with ACA compliance. The specific provisions and their impact may vary depending on individual circumstances and the specific requirements of the IRS.

On July 29, 2024, applicant’s attorney, John R. Ramirez, filed a petition for attorney’s fees pursuant to section 5710. He represented that he personally represented applicant at deposition, and requested a fee award of one hour of preparation time and 3.6 hours of actual deposition time. And he requested a fee issue at the hourly rate of $425.00 per hour, or $1,955.00 total.

The workers WCJ issued an orderer that defendant pay $1,840.00 as a reasonable fee after finding that he was entitled to a rate of $400.00 per hour.The order contained a self-destruct clause advising that a timely objection within 20 days would void the order. Attorney Ramirez filed an objection letter along with a declaration of readiness to proceed to a mandatory settlement conference on the issue of 5710 fees.Accordingly, the dispute in this case is over an additional $115.00 fee.

After a hearing on October 3, 2024. The WCJ ordered the matter taken off calendar over the objection of attorney Ramirez, and deferred the issue of the remaining L.C. 5710 attorney fees.

On October 15, 2024 attorney Ramirez and The Ramirez Firm, filed a Petition for Reconsideration objecting to the Order taking the case off calendar. Specifically, in the Petition, Mr. Ramirez alleges that he is entitled to the unpaid portion of attorney’s fees and seeks to proceed to a trial on the issue of attorney’s fees.

The WCAB denied his Petition for Reconsideration, and denied his Petition for Removal, and instead, it Granted Removal on Motion of the Appeals Board, and issued a Notice of Intent to Impose Sanctions against Attorney John R. Ramirez in the panel decision of Armando Amezcua v Milgard Windows Manufacturing – ADJ19104113, ADJ19104112, ADJ19104123, ADJ19104121 (December 2024).

The WCAB noted that “it appears that Mr. Ramirez improperly filed a Petition for Reconsideration in response to a non-final order. It appears that Mr. Ramirez did this in six different cases and he was admonished in five of those cases to review his filings and make necessary corrections.

Moreover on November 5, 2024, just a few months ago, the Appeals Board issued a significant panel decision in Latrice Reed v. County of San Bernardino. (2024 Cal. Wrk. Comp. LEXIS 69.) and admonished Mr. Ramirez who was the applicant attorney in that decision without imposing sanctions. Instead it said “for the purpose of this decision, we will assume that the filing of a petition for reconsideration rather than one for removal was merely a careless error. Accordingly, we do not take up the issue of sanctions at this time.”

However, on this newest case, the WCAB concluded “It does not appear that Mr. Ramirez responded to any of the admonishments given to him. It appears that Mr. Ramirez filed a frivolous petition for reconsideration in this matter and allowed it to proceed on the merits, taking no steps to either withdraw or amend the pleading. It does not appear that our admonishments have had the actual effect of correcting Mr. Ramirez’s conduct”.

“Accordingly, and good cause appearing, pursuant to section 5813 and WCAB Rule 10421 we will issue a notice of intention to impose sanctions against John Ramirez (SBN 201939) in an amount up to $750.00 as he filed a petition for reconsideration from a non-final order, which appears to constitute frivolous conduct, particularly since Mr. Ramirez was admonished on five occasions to correct his conduct, and it appears that he failed to act.”

Blue Cross and Blue Shield of Oklahoma (“BCBSOK”) have filed a civil Racketeering (RICO) action against South Coast Behavioral Health LLC (“SCBH”), Excellence Recovery LLC (“Excellence Recovery”), Everything in Excellence Recovery LLC (“EIE”), Rad Life Recovery, LLC, (“Rad Life”), and individuals involved with those companies, that are California addiction treatment centers mostly located in Orange County. The lawsuit was filed in the United States District Court Central District of California (case 2:24-cv-10683-MWC-AJR).

According to the allegations of the complaint, “Since at least 2020, BCBSOK and hundreds of individuals suffering from Substance Use Disorder (“SUD”) have been victimized by California-based SUD treatment providers and their co-conspirators.”

“California and Oklahoma are separated by over 1,000 miles and multiple states. There are hundreds, if not thousands, of SUD treatment providers between them. And yet, in the last few years alone, thousands of alleged Oklahoma residents have been trafficked across the country to California under the guise of obtaining SUD treatment. The one thing they have in common is that they are members of BCBSOK health benefit plans, most of them having been enrolled right before their arrival in California.”

“This surprising migration is not a result of quality treatment. Rather, it is driven by an army of fraudsters that have overrun certain parts of California’s SUD treatment industry to prey upon alleged Oklahoma residents, many of whom are members of Native American tribes.”

Oklahoma, according to many sources has the fifth highest rate of SUD in the country, at 16.1% of its population.”The combination of a state plan offering robust out-of-state benefits and a large population in need of treatment provided a perfect target for profiteers like Defendants.”

“These SUD providers employ a range of fraudulent tactics. They hire “body brokers” to hunt down potential patients in exchange for kickbacks. Body brokers work with insurance agents to fraudulently enroll individuals in insurance plans. Once enrolled, patients are shipped across the country to receive “treatment,” the main goal of which is to enrich the providers, body brokers, insurance agents, and the others involved in the schemes. There are unlawful kickbacks at every level. In fact, many patients themselves receive cash, free “treatment,” and housing, which unlawfully influences their choice of providers and induces them to stay under the control of a particular provider so that their insurance can continue to be billed. It is becoming exceedingly difficult for good, quality, providers to operate in an industry awash in kickbacks and de facto bribes.”

“When insurance payments run out, the SUD providers kick patients to the curb, leaving these vulnerable individuals to fend for themselves thousands of miles from their homes. Often, these individuals are given no notice of their impending evictions and suddenly find themselves on the streets with no money to afford housing or the necessities of daily life, much less an expensive trip back home. Putting these already-vulnerable individuals in such desperate circumstances only heightens the chances for relapse.”

Plaintiffs go on to allege “the defendants here are among the worst perpetrators of these tactics. Collectively, they have caused BCBSOK plans alone to make over $36 million in wrongful payments.” Last month, Blue Cross and Blue Shield of Oklahoma told the Southern California News Group that it will stop paying for all addiction treatment in California on Jan. 1, with a few exceptions.

Young and associates are being sued by insurer Aetna in a fraud case that echoes this one. Young has countersued Aetna, saying the insurer is just trying to avoid paying what’s owed.

It all echoes the battle between Health Net and now-defunct Sovereign Health that began in 2016. Health Net won big, with $45 million in damages and interest against Sovereign.

Taylor Capito received treatment in the emergency room of San Jose Healthcare System LP dba Regional Medical Center San Jose on two occasions. Regional is a major hospital in San Jose with an emergency room.

Capito filed a class action complaint against Regional under the Consumer Legal Remedies Act (CLRA), challenging Regional’s “unfair, deceptive, and unlawful practice of charging [an EMS fee] without any notification of its intention to charge a prospective emergency room patient such a Fee for the patient’s emergency room visit.”

Regional demurred and moved to strike the class allegations. In doing so, it briefed the legislative history behind the Payers’ Bill of Rights (Health & Saf. Code, § 1339.50 et seq.) and other federal and state regulations governing its pricing disclosures.The trial court sustained the demurrer and dismissed the case.

And the Court of Appeal affirmed the dismissal in the unpublished case of Capito v. San Jose Healthcare System, LP – H049022, – H049646 (April 2023).

However, there are conflicting opinions on this issue in other California courts. In another case, Joshua Naranjo filed a class action lawsuit against the Doctors Medical Center of Modesto Inc., seeking similar relief, however his case resulted in a conflicting opinion. In Naranjo v. Doctors Medical Center of Modesto (2023) 90 Cal.App.5th 1193, a published decision of the Fifth Appellate District in which the court had ruled that the hospital was required to further disclose the EMS fee prior to treating ER patients.

The California Supreme Court agreed to hear the Capito case, and it resolved the conflicting decisions in the case of Capito v. San Jose Healthcare System, LP -S280018 (December 2024)

The question here is whether hospitals have a duty, beyond what is required by the relevant statutory and regulatory scheme, to notify emergency room patients that they will be charged EMS fees.

“Hospitals do not have a duty under the UCL or CLRA, beyond their obligations under the relevant statutory and regulatory scheme, to disclose EMS fees prior to treating emergency room patients. Requiring such disclosure would alter the careful balance of competing interests, including price transparency and provision of emergency care without regard to cost, reflected in the multifaceted scheme developed by state and federal authorities. Capito has not sufficiently alleged facts showing that the lack of such disclosure is “unlawful, unfair or fraudulent” on any theory she presents under the UCL or CLRA.”

Accordingly, the California Supreme Court affirmed the Court of Appeal’s judgment in favor of Regional.

Harold Winston is “an African-American male” with “over 30 years of service” with the County of Los Angeles. Winston worked in the Department of Treasurer and Tax Collector as the supervising deputy public conservator administrator in the public administration branch.

Winston sued his employer L.A. County alleging race-based discrimination, retaliation, and failure to maintain a discrimination free environment under the California Fair Employment and Housing Act (FEHA) (Gov. Code, § 12900 et seq.) and whistleblower retaliation in violation of Labor Code section 1102.5.

While Winston’s case was pending, Labor Code section 1102.5 was amended, effective January 1, 2021, to add a provision – subdivision (j) – authorizing courts to award reasonable attorney fees to whistleblower plaintiffs who prevail against their employer under section 1102.5.

Trial began on November 17, 2021. On November 24, 2021, the jury returned a verdict on the three causes of action submitted to them. It found in favor of L.A. County and against Winston on the causes of action for retaliation under FEHA and failure to prevent discrimination/ harassment under FEHA. The jury found in Winston’s favor on his cause of action for whistleblower retaliation under section 1102.5. It awarded him damages totaling $257,000.

After the jury found in Winston’s favor on his retaliation claim under section 1102.5, Winston filed a motion for attorney fees and requested $1,854,465 as the prevailing party based on section 1102.5’s recently enacted subdivision (j).

The trial court denied the motion, ruling that the fee provision does not apply to Winston’s case because it was not in effect in 2019 when the complaint was filed and because it found no legislative intent supporting retroactive application.

The Court of Appeal reversed in the published case of Winston v. County of Los Angeles – B323392 (December 2024).

On appeal, Winston argued section 1102.5, subdivision (j) applies to his case “because [his] case was still in action at the time the provision became effective.” He contends the trial court erroneously denied his motion based on “no legislative intent demonstrating retroactive application of [the statute].” The Court of Appeal agreed with Winston and reversed.

The law invoked here, section 1102.5, is “California’s general whistleblower statute.” When Winston filed this case, section 1102.5 did not include a one-way fee-shifting provision “authoriz[ing] an award of attorney fees to a worker who prevails on a claim of retaliation for blowing the whistle on workplace legal violations.” The California Legislature amended the law by passing Assembly Bill No. 1947, which allows discretionary recovery of reasonable attorney fees to a prevailing whistleblower plaintiff.

Effective January 1, 2021, section 1102.5, subdivision (j) provides: “The court is authorized to award reasonable attorney’s fees to a plaintiff who brings a successful action for a violation of these provisions.” (§ 1102.5, subd. (j).)

Under California law, the general rule is that absent a clear, contrary indication of legislative intent, courts interpret statutes to apply prospectively. However, “the California Supreme Court and many, many Courts of Appeal have treated legislation affecting the recovery of costs, including attorney fees, as addressing a ‘procedural’ matter that is ‘prospective’ in character and thus not at odds with the general presumption against retroactivity.” (USS-Posco Industries v. Case (2016) 244 Cal.App.4th 197, 217-218)

“Neither party points to a California decision directly addressing the issue of whether section 1102.5, subdivision (j) applies to cases pending at the amendment’s effective date and we have found none.”

“We conclude the statute authorizes an award of attorney fees to Winston because his action was pending when section 1102.5, subdivision (j), became effective. For that reason, we reverse.”