Category: Daily News

A landmark $575 million settlement with Sutter Health has now been given final approval by the court. The settlement agreement was reached in 2019, and resolves allegations by the Attorney General’s office, the United Food and Commercial Workers and Employers Benefit Trust (UEBT), and class action plaintiffs that Sutter’s anticompetitive practices led to higher healthcare costs for consumers in Northern California compared to other places in the state.
Sutter is the largest hospital system in Northern California. The Sutter network consists of some 24 acute care hospitals, 36 ambulatory surgery centers, and 16 cardiac and cancer centers. It also includes some 12,000 physicians and over 53,000 employees. In addition, Sutter negotiates contracts on behalf of the Palo Alto Medical Foundation and many affiliated physician groups.

This settlement is the result of litigation that began in 2014 when UEBT filed a class action lawsuit that challenged Sutter’s practices in rendering services and setting prices. They sought compensation for and an end to what they alleged were unlawful, anticompetitive business practices, which caused them to pay more than necessary for healthcare services and products.

In March 2018, the Attorney General’s office filed a similar lawsuit against Sutter on behalf of the people of California, seeking injunctive relief to compel Sutter to correct its anticompetitive business practices moving forward. The separate lawsuits were combined by the court into one case. In October 2019, one day before the trial, the parties reached an agreement to settle. The settlement was filed with the court on December 19, 2019, and in March, Judge Massullo granted preliminary approval.

Today’s finalized settlement requires Sutter to:

– – Pay $575 million to compensate employers, unions, and others covered under the class action, and to cover costs and fees associated with the legal efforts;
– – Limit what it charges patients for out-of-network services, helping ensure that patients visiting an out-of-network hospital do not face outsized, surprise medical bills;
– – Increase transparency by permitting insurers, employers, and self-funded payers to provide plan members with access to pricing, quality, and cost information, which helps patients make better care decisions;
– – Halt measures that deny patients access to lower-cost plans, thus allowing health insurers, employers, and self-funded payers to offer and direct patients to more affordable health plan options for networks or products;
– – Stop all-or-nothing contracting deals, thus allowing insurers, employers, and self-funded payers to include some but not necessarily all of Sutter’s hospitals, clinics, or other commercial products in their plans’ network.
– – Cease anticompetitive bundling of services and products which forced insurers, employers, and self-funded payers to purchase for their plan offerings more services or products from Sutter than were needed. Sutter must now offer a stand-alone price that must be lower than any bundled package price to give insurers, employers, and self-funded payers more choice;
– – Cooperate with a court-approved compliance monitor to ensure that Sutter is following the terms of the settlement for at least 10 years. The monitor will receive and investigate complaints and may present evidence to the court; and
– – Prevent anticompetitive practices by clearly defining clinical integration to include patient quality of care. The settlement makes clear that for Sutter to claim it has clinically integrated a system, it must meet strict standards beyond regional similarities or the mere sharing of an electronic health record, and must be integrating care in a manner that takes into consideration the quality of care to the patient population. This is important because clinical integration can be used to mask market consolidation efforts by hospital systems, when in fact there is no true integration of a patient’s care. For example, saying that hospitals are regionally close or that hospitals are sharing electronic health records is not enough, there must be close coordination that will lead to less costly, higher quality care for local communities.

A report by the University of California Berkeley showed that over-consolidation drives up prices for consumers. According to the study, outpatient cardiology procedures in Southern California cost nearly $18,000 compared to almost $29,000 in Northern California. For inpatient hospital procedures, the cost in Southern California is nearly $132,000 compared to more than $223,000 in Northern California, a more than $90,000 difference. A 2016 study found that a cesarean delivery in Sacramento, where Sutter is based, costs more than $27,000, nearly double what it costs in Los Angeles or New York, making Northern California one of the most expensive places in the country to have a baby.

A disbarred personal-injury lawyer was found guilty by a federal jury of 22 felonies for stealing the majority of a multimillion-dollar settlement that should have been paid to a car accident victim, as well as cheating on his federal income taxes.

Philip James Layfield, a.k.a. “Philip Samuel Pesin,” 48, of Las Vegas and formerly of Coto de Caza, was found guilty of 19 counts of wire fraud, one count of mail fraud, one count of tax evasion, one count of failure to collect and pay over payroll taxes, and one misdemeanor charge of failure to file a tax return. Following the jury verdicts, Layfield was remanded into federal custody.

According to evidence presented at his 13-day trial, Layfield owned and operated law firms, including Layfield & Barrett (L&B), which, at various times, maintained offices in Irvine; Los Angeles; El Segundo; Park City, Utah; and Scottsdale, Arizona.

After he had misappropriated millions of dollars from clients’ settlements, Layfield relocated to Costa Rica. Just before getting on a flight to Costa Rica, Layfield borrowed $700,000 from a business lender by providing misleading information and failing to disclose material information. Then he used substantial portions of the loan proceeds for personal expenses, including buying a horse and shipping horses to Costa Rica.

In 2016, Layfield entered into an agreement to represent an individual who was struck by an automobile in Orange County and suffered significant injuries. After negotiating a $3.9 million settlement related to the accident, Layfield misappropriated most of the money owed to the victim – approximately $2 million for personal and business uses, including to pay clients whose settlement proceeds Layfield had earlier misappropriated. The car accident victim received only $25,000 of the settlement proceeds.

Layfield also failed to file a federal income tax return for the tax year 2016, despite receiving more than $3 million, including embezzled client settlement money. Layfield also caused his law firm to not pay approximately $120,976 in payroll taxes to the United States government for the second quarter of 2017.

The State Bar of California disbarred Layfield in October 2018. Layfield also was a certified public accountant, but his CPA license expired in July 2019, according to the California Board of Accountancy.

United States District Judge Michael W. Fitzgerald has scheduled a November 8 sentencing hearing, at which time Layfield will face a statutory maximum sentence of more than 200 years in federal prison.

Homeland Security Investigations, IRS Criminal Investigation and the FBI investigated this matter.

Assistant United States Attorneys Mark R. Aveis and Carolyn S. Small of the Major Frauds Section and Ian V. Yanniello of the International Narcotics, Money Laundering and Racketeering Section are prosecuting this case.

American employees say that the number one workplace feature they’ll be searching for post-COVID is the ability to continue working remotely when they please.

That’s according to a new study reported by StudyFinds.org of 2,000 Americans who are still working from home during the pandemic. More than two in five (48%) say a company’s policy on remote work is now their number one desired workplace perk. It’s so important that nearly three in four (72%) claim they wouldn’t even consider working for a company that didn’t offer flexible work-from-home policies.

Although 36 percent think their job is more difficult when working remotely, 71 percent say they have a better work-life balance when working from home. Employees are happiest with the new flexibility in their schedules (45%) and the ability to take breaks anytime (44%), with the average person taking a break around every two and a half hours.

Over half the poll (51%) feel like their workplace contributions have been acknowledged more since they started working from home.

“People are embracing remote work more than ever before. Workplace norms have shifted and employees are expecting to have a more robust work-life balance,” says Dave Landa, CEO of Kintone, in a statement.

Unfortunately, working from home hasn’t been all rainbows and butterflies for employees. From not having the right office equipment (35%), to having difficulty communicating with coworkers (36%), or having too many distractions (34%), working from home isn’t a flawless system for many.

Employees also say they would like to purchase an internet upgrade (48%), a new computer (40%), or a new desk or workstation (38%) to improve their remote work experience. One in five (22%) expressed dissatisfaction with their company meeting employee needs while working from home.

Americans weren’t shy about suggesting ways their company could help improve their work from home experience. Almost half think adjusted company policies, including working hours and expectations (46%) would make a difference in their performance. Other ways that companies can make working from home better is by reimbursing their employees for internet service or other utility bills (43%) or providing a new computer or laptop (41%).

Communication is key for half of respondents (52%) who feel like their company can benefit from communicating more directly with employees. Almost six in 10 (57%) feel work-related communication was more productive in the office and 36 percent feel it has been a strain to effectively communicate with their leadership about career matters.

‘Every major transformation like this comes with hurdles and uncertainties. In the end, the benefits of happier, more satisfied employees will justify the efforts to address these challenges head on. Employers should create policies and find solutions to meet these concerns and strengthen communications so that remote and hybrid work experiences will only improve in the post-pandemic era,’ Landa adds.

Decedent Tara O’Sullivan, worked as a police officer for the City of Sacramento when she died from a gunshot wound on June 19, 2019.

Krista Horvath and Ms. O’Sullivan were sisters. Just prior to her death, decedent and Ms. Horvath agreed to move in together with Ms. Horvath’s fiancé. This would allow Ms. Horvath to save money for her planned wedding. They had signed a lease before the death, and intended to split the utility bills in half.

The Death Without Dependents Unit primarily argued at trial that Ms. Horvath would merely have been a roommate of decedent and that sharing the bills as part of a family pot is insufficient to establish dependency.

A Findings and Order issued which found that competing applicant, Krista Horvath was a partial dependent of deceased employee Tara O’Sullivan, and dismissed the claim of the Death Without Dependents Unit.

The WCAB panel denied the Death Without Dependents Unit Petition for Reconsideration in the panel decision of Krista Horvath for Tara O’Sullivan (Deceased), Death Without Dependents v. City OF Sacramento, (ADJ12601349)

Dependency is determined as of the time of injury, and may be found to be total or partial, depending on the facts established. Dependency may be defined as reliance upon another person for support. Partial dependents are those who at the time of injury have means of support other than the deceased’s contributions.

To prove partial dependency, it is sufficient to show that the claimants looked to the deceased’s contributions to maintain his or her accustomed mode of living and that the same living standard can no longer be maintained. (Atlantic Ricl1field Co. v. WCAB (Arvisu) (1982) (42 Cal.Comp.Cases 369) The contribution must be made in goods or money, and the value of services is not considered. (Great W. Power Co. v. IAC (Savercool) (1923) 192 Cal. 724.)

Death Without Dependents primarily argued at trial that applicant would merely have been a roommate of decedent and that sharing the bills as part of a family pot is insufficient to establish dependency.

While this is true, the facts establish that decedent intended to take on a greater share of the family pot so that applicant could save for her wedding.

If only applicant and decedent lived together, the splitting of rent and utilities would likely be insufficient to establish dependency as it is a true family pot with equal expenses split.

However, here, three people were to occupy the apartment, not two. Decedent agreed, in effect, to subsidize applicant’s rent and utilities. That agreement is sufficient to establish a partial dependency where the applicant is decedent’s sister.

The petition for reconsideration focuses on the undisputed facts that this was a promise for support prior to decedent s passing and that no actual support occurred prior to death. On this point, the argument proffered by DWD was too narrow.

A mere promise of future support is not, as a rule, a basis for a dependency finding, except where circumstances indicate a bona fide assumption of responsibility for support without opportunity to make contributions prior to the injury.” (Wings West Airlines v. Workers’ Comp. Appeals Bd. (1986) 187 Cal. App. 3d 1047, 1052.)

The significant fact here is that they signed a lease together prior to Ms. O’Sullivan’s death. By signing a lease contract, there was a bona fide assumption of responsibility for support, which occurred prior to death. The only reason that Ms. O’Sullivan did not make payments prior to her death was lack of opportunity.

The Workers’ Compensation Appeals Board has issued a notice of public hearing regarding proposed additions and amendments to its Rules of Practice and Procedure.

The online public hearing is scheduled to begin at 9 a.m. on Friday, September 24 via the Zoom meeting platform.

Members of the public may also submit written comments until 4 p.m. that day using this submission form. If written comments are timely submitted, it is not necessary to present oral comments at the public hearing.

The primary purpose of this rulemaking is to formalize the processes for the remote hearings, electronic filing, and electronic service that developed during the novel coronavirus pandemic.

The WCAB’s notice of the proposed rulemaking, the text of the proposed regulations, and the initial statement of reasons can be found on its rulemaking page.

Equal weight will be accorded to oral and written comments. However, the WCAB prefers written comments submitted electronically, which must be submitted using the comment submission form. Electronic comments submitted in any other format will not be accepted or considered.

Written comments may also be submitted by mail to the address below. Hard copy comments should consist only of text-based narratives, should not contain any other formatting such as letterheads or graphics, and should not rely on the use of color or images to convey information not conveyed in the text-based narrative. Improperly formatted hard-copy documents will be subject to rejection and may not be accepted or considered.

Workers’ Compensation Appeals Board
Attention: Julie Podbereski, Regulations Coordinator
455 Golden Gate Avenue
Ninth Floor
San Francisco, CA 94102

The WCAB will consider all properly submitted comments and encourages all interested members of the workers’ compensation community to participate in this important process.

To attend the online public hearing or present statements or arguments orally, please use the following link:

https://dir-ca-gov.zoom.us/j/85768405804?pwd=ckZwdkRrZk82eHk4M2tpTVlvaldwUT09
Password: 211916