Category: Daily News

Anita Vijay, 50, of Sacramento, pleaded guilty to conspiring to pay and receive illegal kickbacks in exchange for Medicare beneficiary referrals and to soliciting kickbacks in exchange for Medicare beneficiary referrals, United States Attorney McGregor W. Scott announced.

According to court documents, Anita Vijay worked as the Social Services Director at a skilled nursing and assisted living facility in Sacramento. In her role, Vijay assisted Medicare beneficiaries in selecting home health care and hospice agencies following their discharge from the facility.

Vijay used her position to steer Medicare beneficiaries to home health agencies in Folsom and El Dorado Hills and a hospice agency in Folsom. In exchange for the referrals, the agencies’ owners paid her and her husband, Jai Vijay, illegal cash kickbacks.

In her plea agreement, Vijay admitted that the agencies’ owners paid her and her husband kickbacks in exchange for the referral of approximately 60 beneficiaries. Medicare paid the agencies approximately $400,000 for services they purportedly provided to the beneficiaries. Because the agencies obtained the referrals by paying kickbacks, they should not have received any reimbursement from Medicare.

This case is a product of an investigation by the Federal Bureau of Investigation and the Department of Health and Human Services’ Office of Inspector General. Assistant United States Attorney Matthew Thuesen is prosecuting the case.

U.S. District Judge Troy L. Nunley is scheduled to sentence Anita Vijay on December 3, 2020.

She faces maximum statutory penalties of five years in prison for the conspiracy charge and ten years in prison for the kickback charge. Anita Vijay also faces a maximum fine of $250,000 or twice the gross loss or gain.

On February 6, 2020, Jai Vijay pled guilty to conspiracy to pay and receive kickbacks in exchange for Medicare beneficiary referrals.

The Division of Workers’ Compensation and Workers’ Compensation Appeals Board continue to improve their ability to hold hearings during the COVID-19 pandemic.

The following changes are effective September 14.

DWC will continue to hear all mandatory settlement conferences, priority conferences, status conferences, case-in-chief trials, lien conferences, Special Adjudication Unit (SAU) trials and expedited hearings telephonically via the individually assigned judges’ conference lines as announced in newslines issued on April 3, April 28, May 28 and August 12.

Beginning September 14, DWC will resume holding lien trials. Lien trials will be limited to one per judge per day to start.

Parties will continue to use individually assigned judges’ conference lines on the day of trial. However, judges will have the option of conducting any trial or expedited hearing through the judge’s LifeSize virtual courtroom if needed. If that is required, the judge will provide a link to the parties allowing them to log into the video platform.

Stakeholders should download the software prior to a hearing where a video option may become necessary. Neither DWC nor LifeSize will charge for participants to use the platform.

However, parties will need to have certain system requirements to fully participate in the video option. Parties will also need to have a web camera. Participants without access to a web camera may use a smart phone with the program, although it is not recommended. Additional information on LifeSize and how to use the program may be found on the DWC website.

All parties scheduled for a hearing should continue to call the conference line for the judge in front of whom the case is set, at the designated time listed on the hearing notice. When prompted, the parties should enter the access code assigned to that line. DWC staff will instruct participants as to the procedure to follow during the call.

District offices will not hold in-person hearings.

DWC will not accept walk-in filings, walk-through documents or in-person requests at this time. DWC will only accept electronic filing via EAMS and JET File, and paper filing by U.S. mail.

DWC will accept limited email filings pursuant to WCAB’s en banc decision dated April 6 and its newsline issued on April 23. Email filings are limited to documents that are subject to a statute of limitations that cannot otherwise be efiled, JET filed or filed by U.S. mail.

DWC will continue to accept an electronic signature on any settlement documents, applications, pleadings, petitions or motions that are sent to the district offices or filed in EAMS. For all e-forms, parties should utilize “S signature” as shown in the E-forms Filing Reference Guide and the JET File Business Rules.

Injured workers who are unable to file utilizing the available options or need assistance may contact DWC’s call center at 909-383-4522.

The WCAB office in San Francisco is operating with limited in-office staff. The WCAB commissioners and staff continue to work remotely. All practitioners are encouraged to regularly check the WCAB and DWC websites for updates about the district offices’ and the WCAB’s operations during this period.

According to a new public policy report, .AARP finances its operations by overcharging members for health care policies and through its billion-dollar relationship with UnitedHealth Group.

Despite its “non-profit” status, AARP’s profits have been increasing for years largely due to the organization’s practices of marketing of products and services. The report, published by public policy think tank American Commitment, mainly examined AARP’s source of revenue since the passage of The Affordable Care Act in 2010.

AARP reported $1.6 billion of revenue and $246.4 million of profit in 2018, the most recent year in which data was available. In total, AARP received more than $5.3 billion tax free from UnitedHealthGroup from 2007 through 2017.21 Between the year of Obamacare’s passage and 2017, the organization made nearly $4.2 billion in those eight short years.

AARP not only makes money from UnitedHealth- Group – and its members – directly, it does so indirectly as well. The Report claims the organization has established a grantor trust, through which it funnels payments for insurance policies issued by UnitedHealth and other insurers, including MetLife, Genworth, and Aetna.

In the past four years, AARP has been sued three times by its own members over its royalty fee policy, which they argued was deceptive, according to court filings. However, AARP ultimately won each of the cases.

U.S. District Court of Washington D.C. Judge Beryl Howell ruled in favor of AARP in May dismissing the plaintiffs’ class action lawsuit. The plaintiffs, led by AARP member Helen Krukas, argued that the organization misrepresented its Medigap royalty fee structure, according to Forbes.

The plaintiffs specifically argued that AARP was “micromanaging the sale of Medigap and therefore [the 4.95% fee] is not really a royalty fee for its intellectual property. They are a salesman. This is a commission and it’s taxable,” Jacobs said.

Howell originally rejected AARP’s motion to dismiss the case in March 2019 giving credence to Krukas’ argument. Krukas “sufficiently and plausibly alleged that the defendants engaged in unfair trade practices – by materially misrepresenting information about the 4.95% charge,” Howell wrote.

But, in May Howell ruled that Krukas’ argument misses the mark. She said Krukas failed to prove that AARP has a fiduciary relationship with its members.

Similarly, U.S. District Judge Dean D. Pregerson of Los Angeles dismissed two separate AARP class action lawsuits, Forbes reported. Pregerson ruled against plaintiff Simon Levay in November 2018 and against Jerald Friedman in November 2019.

The second dismissal came after the three-judge panel Ninth Circuit Court of Appeals ruled in favor of the plaintiffs. The panel ruled that AARP “transacts” and “solicits” insurance without a license and engaged in fraud by calling the 4.95% commission a “royalty,” according to Forbes.

Pregerson didn’t agree, however, saying the plaintiffs failed to prove they suffered economic harm, Forbes reported

The House Ways and Means Committee investigated AARP in 2011. The investigation pointed out several potential issues with AARP’s structure including its royalty fee practices and concluded with a series of suggestions for the Internal Revenue Service to consider.

A major complaint among Californians affected by the state’s anti-freelancing law, AB5, is that the labor unions wrote it and essentially paid for its passage and that the purpose was to enrich unions by creating millions of new “employees” to “organize.”

The bill’s author, Asm. Lorena Gonzalez-Fletcher has admitted that the California Labor Federation sponsored the bill but denies that the unions ensured its passage, saying that its purpose was to provide benefits and a guaranteed minimum wage.

Newsom had up to 30 days to sign AB-2257, the AB-5 walk back, so it’s significant that he signed it only three days after passage. And that the new law was deemed an “urgency statute” so that it take effect immediately.

There’s bad blood between San Francisco Democrats and Los Angeles/San Diego Democrats, and Gonzalez-Fletcher’s already made Gavin Newsom’s life more difficult this year by failing to negotiate clean-up provisions for AB-5, and by publicly battling with Elon Musk, a long-time friend of Newsom and major job creator in the state.

Entering stage left, is Willie Brown, who perhaps put his thumb on the scales of legislation once again. For those not familiar, Willie Brown is not only one of the most powerful politicians to have ever graced the floor of the California State Assembly; he’s been the most powerful Democrat in the state since the 1960s.

At age 86, he still wields considerable power as a “kingmaker” in the state. After serving 32 years in the Assembly, Brown was Mayor of San Francisco for eight years and was succeeded by his protege, Gavin Newsom. Kamala Harris’ political career started when Brown appointed her to a state commission then helped her become the elected District Attorney of San Francisco.

Brown wanted AB2257 signed immediately because, as a weekly columnist for the San Francisco Chronicle, he had hit his 35 story limit under AB-5, and they were prohibited from publishing additional columns until AB2257 was signed.

Brown fumed of the move by Hearst Newspapers’ flagship publication. “For 12-plus years, every Sunday, I’ve written that column in the paper and never taken a vacation. And this is the most important year. This is a campaign year, when there’s really a contest.”

“I signed the bill, write the damn column!”’ Newsom wrote to Brown in a text message that Brown shared with POLITICO.

Earlier in the day, some of Brown’s powerful friends in politics, including attorney Joe Cotchett, contacted Newsom in an effort to get him to move quickly on the bill to get Brown’s Sunday column back in the paper as soon as possible, sources said.

“If there was a place to picket organized labor, I’d do it today,” Brown said. “If there was a place to picket a legislator, I’d do it,” he said. As Assembly speaker, “I made sure that special interests, no matter who they were – labor or non labor – did not take advantage of the Legislature,” but he said it was clear this time was not the case.

“Those bastards,” he added.

A report in MedPage Today claims that the experience of hospitals with significant surges of severely ill COVID-infected patients has delivered a powerful marketing case for the future of palliative care beyond the current pandemic, experts say.

While studies have shown that palliative care improves quality of life and reduces caregiver burden, not everyone can access it, “partly because we don’t have enough clinicians, services, and programs — especially for people outside of the hospital who are seriously ill but not hospice-eligible,” she said.

Enter telemedicine, which can dramatically increase access for people in community settings, at home, in assisted living facilities, in long-term care. One clinician can see 8 to 10 seriously ill patients a day at multiple sites without leaving the office — exponentially increasing access.

It’s not only more efficient for the clinician, it expands access for patients who can get to the clinic only with difficulty because they are homebound, live miles away or constrained by geographical barriers, or depend on public transit.

At the height of the COVID surge in New York City, three large health systems separately recruited and deployed palliative care and other professionals from across the country to serve as back-up volunteers to hospital teams on the ground. They gave debriefings for frontline providers, held family meetings and goals-of-care conversations online, even offered psychological and grief support.

“We have made huge strides toward building palliative care into the healthcare system focused on the broad concept of improving quality of life, recognizing that serious illness can turn one’s life upside down,” says Ashwin Kotwal, MD, assistant professor of geriatrics at the University of California San Francisco. “It’s not just about end-of-life support but addressing physical symptoms throughout the disease trajectory, along with psycho-social and spiritual needs. And communication is a big part of what we do.”

Kotwal spent the last year building a tele-palliative care program at the San Francisco VA Medical Center, focusing on patients who were homebound or who lived four hours or more from the clinic. Then COVID came along.

For Michael Fratkin, MD, founder and CEO of Resolution Care Network in Eureka, California, the telemedicine encounter is not just more convenient, it’s superior.

“The heart of the matter is the preservation of boundaries in healing relationships. We find that a video visit in real time is substantially better than invading people’s homes,” he says. “This is such a leveling technology. Something about the framing of the computer screen sets limits and puts us more on the same level. Clients show me only what they want to show me in their homes. It keeps the boundaries clearer.”

What happens on these visits for Fratkin’s community-based palliative care service, which covers a large rural area: trust-building; goal setting; shared-decision-making; advance care planning; symptom management. Surprisingly, he says, there are greater opportunities for intimacy in this encounter, even though the clinician can’t reach out and put a hand on the patient’s shoulder.

Of course, the future of telemedicine in palliative care will depend on reimbursement. Currently, temporary emergency Medicare waivers, extended for three months on July 23, have allowed payment for professional telehealth and some telephone visits, including physicians’ advance care planning conversations with patients and families. The emergency will end eventually, but at least 20 bills have been introduced in Congress to make some aspects of telemedicine coverage permanent.