Menu Close

Category: Daily News

Imprisoned SoCal Doctor Must Forfeit All Proceeds of Fraud

Before Ozempic and similar “wonder drugs,” medically- assisted weight loss had to happen the old-fashioned way— surgical intervention. For Southern California residents in the 2010s the Wizard of Weight Loss was Dr. Julian Omidi. To make a long story short, Omidi helmed a massive health insurance fraud scheme called “Get Thin.” Omidi’s scheme promised dramatic weight loss through Lap-Band surgery and other medical procedures.

A grand jury indicted Omidi and his company Surgery Center Management, LLC (“SCM”) for mail fraud, wire fraud, money laundering, and other related charges arising from the Get Thin scheme. In a nutshell, the government alleged that Omidi and SCM defrauded insurance companies by submitting false claims for reimbursement.

The claims included, among other misrepresentations, fraudulent patient test results and false assertions that a doctor had reviewed and approved the medical procedures at issue. After three-and-a-half years of pretrial litigation and a 48-day jury trial, the jury convicted Omidi and SCM of all charges. The district court sentenced Omidi to 84 months imprisonment and fined SCM over $22 million.

At a subsequent hearing, the district court considered forfeiture for both defendants. The government argued that the total proceeds of Get Thin’s business during the fraud period – $98,280,221 – should be forfeited because the whole business was “permeated with fraud.” In other words, even if some parts of Get Thin seemed legitimate, the government argued that “all proceeds of that business are forfeitable,” as “the proceeds of that so-called ‘legitimate’ side of the business would not exist but for the ‘fraudulent beginnings’ of the entire operation” (namely, the call center). Omidi and SCM objected to the forfeiture amount, arguing that Get Thin was “not entirely a fraud,” and the forfeiture amount should be limited to the proceeds traceable to falsified insurance claims.

The district court agreed with the government. Reviewing the relevant statutes and persuasive out-of-circuit authority, it agreed that the $98,280,221 in proceeds were directly or indirectly derived from the fraudulent Get Thin scheme.

The 9th Circuit Court of Appeal affirmed in the published case of USA v Omidi – 23-1719 (January 2023).

The question in this case is whether the district court erred in ordering the forfeiture of all Get Thin’s proceeds, even though conceivably some of the incoming funds ultimately paid for legitimate and medically necessary procedures.

Under § 981(a)(1)(C), any property which “constitutes or is derived from proceeds traceable to” a mail or wire fraud scheme is subject to forfeiture. Section 981(a)(2)(A) defines “proceeds” in a health care fraud scheme as “property of any kind obtained directly or indirectly, as the result of the commission of the offense giving rise to forfeiture, and any property traceable thereto, and is not limited to the net gain or profit realized from the offense”

Said more simply, any proceeds that directly or indirectly derive from the fraudulent scheme must be forfeited, even if particular proceeds were not profits from the offense itself.

Applying the above rules to this case, any money acquired via the fraudulent Get Thin funnel was subject to forfeiture.”

Kerlan-Jobe Orthopaedic Alleges Cedars-Sinai Conspiracy

The Kerlan-Jobe Orthopaedic Clinic, Medical Group, Inc. (Kerlan-Jobe), known for its pioneering Tommy John surgery and commitment to athletes and first responders, filed a $150 million lawsuit against Cedars-Sinai Medical Care Foundation, Santa Monica Orthopaedic and Sports Medicine Group (SMOG), and several top executives.

The lawsuit, filed in Los Angeles County Superior Court (Case number: 25STCV01015), alleges that Cedars engaged in a decades-long effort all designed to appropriate Kerlan-Jobe’s reputation, intellectual property, assets, and patient base without compensation.

“Cedars-Sinai, hiding behind its non-profit status, has orchestrated an underhanded scheme to crush Kerlan-Jobe, steal its assets, and prioritize profits over patient care,” said a spokesperson for Kerlan-Jobe. “We’re fighting not just for our practice, but for the Los Angeles community, including first responders who depend on us.”

Kerlan-Jobe alleges Cedars and members of its executive leadership conspired with SMOG, at times in violation of state and federal law, to:

– – Prevent patients from scheduling appointments with Kerlan-Jobe doctors, all while holding itself as Kerlan-Jobe and misleading the public.
– – Unlawfully reap a financial windfall for Cedars, ostensibly a “non-profit” healthcare institution, by seizing control of Kerlan-Jobe’s key assets, brand and intellectual property rights, while paying nothing to Kerlan-Jobe in return.
– – Drain Kerlan-Jobe of many of its key physicians and coerce them into accepting employment with SMOG in violation of non-compete and fiduciary duties owed to Kerlan-Jobe.
– – Retaliate against the remaining Kerlan-Jobe physicians who stood in the way and attempt to starve their medical practices until they will have no choice but to dissolve and fold Kerlan-Jobe into SMOG.

According to the complaint, Cedars and Kerlan-Jobe entered into a decades-long contract which expired on October 1, 2024 and provides for an 18-month wind down period. Upon execution of the contract, Cedars allegedly demanded that Kerlan-Jobe’s physicians “row the boat” to bring all patient services, referrals, surgeries and treatments through facilities that Cedars controls.

The complaint states that some former Kerlan-Jobe physicians cooperated and colluded with the Cedars Enterprise and received benefits such as directorship roles, multimillion-dollar bonuses and large lump sum payoffs.

In contrast, those at Kerlan-Jobe who exercised their contractual rights and independent professional judgment as to the care of their patients were allegedly punished for their oppositions.

The complaint alleges that as of November 1, 2024, Kerlan-Jobe has no ability to bill for patient services, no control over its phone lines or websites and only has three non-disqualified physicians left to rebuild a nationally-recognized sports orthopaedic practice that Cedars allegedly sought to systematically destroy.

The complaint further states that this misconduct is reprehensible to public health policy and violates the law. Cedars has allegedly become solely focused on increasing its rankings and national renown so that it could better attract and serve the rich and famous and enrich its senior executives through lucrative multimillion-dollar salaries. This puts Kerlan-Jobe’s commitment to serve the entire Los Angeles community, particularly at this critical time, in jeopardy.

“For 45 years, we’ve set the standard for sports medicine and community care. Cedars’ actions threaten not just our legacy but the well-being of thousands of patients,” the spokesperson added.

WCAB Retroactive Application of 4903.05(c)(1) Lien Declaration

Lien claimant Basso Pharmacy filed a lien pursuant to Labor Code section 4903(b) on April 17, 2008. The parties stipulated that lien claimant paid an activation fee of $100.00 on December 28, 2015 They further stipulated that lien claimant did not file a lien declaration pursuant to section 4903.05(c)(1).

Lien claimant contends that it was not required to file a declaration pursuant to section 4903.05 because the lien was filed in 2008, and it was never subject to the declaration requirement in section 4903.05(c)(1)

The WCJ found that as a result, lien claimant’s lien was dismissed with prejudice by operation of law as of Monday, July 3, 2017. Basso Pharmacy’s petition for reconsideration was denied in the panel decision of Carrillo v Troon Golf Management -ADJ4642758 (January 2025).

On Reconsideration Basso argued that it could not have legally filed such a declaration because its lien met none of the seven distinct requirements set forth in the Code. It had no obligation at the time of the original lien filing to consider any of these requirements because they in fact did not yet exist.

Sections 4903.05 and 4903.06 were added by Senate Bill (SB) 863 in 2012 and became effective January 1, 2013. Section 4903.05 was amended in 2016 by SB 1160 to add subdivision (c), the declaration requirement. The declaration requirement was described as an “anti-fraud measure.” (Sen. Rules Com., Off. of Sen. Floor Analysis, Analysis of Sen. Bill No. 1160 (2015- 1016 Reg. Sess.), as amended August 29, 2016, p. 4.)

Lien claimants had until Monday, July 3, 2017 at 5:00 p.m., to file a lien declaration. (Henkel Corporation v. Workers’ Comp. Appeals Bd. (Hernandez) (2018) 3 Cal.Comp.Cases 1424, 1426 [2018 Cal.Wrk.Comp. LEXIS 64] (Appeals Bd. en banc) (writ den.); Rodriguez v. Garden Plating Co. (2017) 82 Cal.Comp.Cases 1390 [2017 Cal.Wrk.Comp. LEXIS 124] (Appeals Bd. en banc).)

The legislative intent for the amendment of section 4903.05 to add the declaration requirement was to impose that requirement on “all lien claimants.” Section 4903.05(c)(1) addresses the declaration requirement for those liens filed after January 1, 2017, and section 4903.05(c)(2) addresses the declaration requirement for those liens filed before January 1, 2017.

The the WCAB panel concluded that “we will not – and cannot upset the legislative intent of the declaration requirement as requested by lien claimant. It is a cardinal rule of statutory construction that courts will choose that interpretation which most nearly effectuates the purpose of the Legislature. (Code Civ. Proc., § 1859.) “‘Once a particular legislative intent has been ascertained, it must be given effect even though it may not be consistent with the strict letter of the statute.’ “

“Accordingly, lien claimant was subject to the requirement to file a declaration pursuant to section 4903.05(c)(2), and had until 5:00 p.m. on Monday, July 3, 2017 to do so. As a result, lien claimant’s lien was dismissed with prejudice by operation of law as of Monday, July 3, 2017 at 5:01 p.m.”

Employee Awarded Attorney Fees After Appeal of “Berman” Hearing

Plaintiffs Mark Villalva and Bobby Jason Yelverton worked as train dispatchers for Bombardier Mass Transit Corporation. One weekend a month, plaintiffs were “on-call” and had to be available to respond to emergency calls.

Rather than going directly to court as they could have, they first decided to seek relief from the labor commissioner using the so-called “Berman” hearing process set forth in Labor Code section 98, et seq. This is an optional streamlined procedure designed to “benefit employees with wage claims against their employers.” (Sonic-Calabasas A, Inc. v. Moreno (2013) 57 Cal.4th 1109, 1127 (Sonic II).)

Plaintiffs each filed complaints with the labor commissioner using the administrative process provided by the Berman statutes, alleging they were entitled to overtime wages under section 1194 and wage statement penalties under section 226 for their unpaid on-call time. The commissioner denied both plaintiffs’ claims in their entirety.

Plaintiffs, represented by the same counsel, sought a de novo trial on their claims in the San Diego Superior Court pursuant to Labor Code section 98.2, which allows a party to seek review of the commissioner’s order “by filing an appeal to the superior court, where the appeal shall be heard de novo.” (§ 98.2, subd. (a).)

After conducting a four-day bench trial, the trial court ruled that plaintiffs were each entitled to between $70,000 and $78,000 in unpaid wages and wage statement penalties, a total of about $25,000 in costs under Code of Civil Procedure section 1032, and reasonable attorney fees and costs. The trial court granted the motion and awarded attorney fees and costs in the amount of $200,000.

The Court of Appeal denied Bombarder’s appeal in the published case of Villalva v. Bombardier Mass Transit Corp. -D082372 (January 2025).

On appeal, Bombardier did not contest its liability for the more than $140,000 in back wages and penalties. Bombardier’s sole argument is that section 98.2, subdivision (c) is the exclusive statute authorizing an award of attorney fees and costs in a superior court appeal from the labor commissioner’s Berman order. From this premise, Bombardier concludes that plaintiffs were not entitled to recover attorney fees and costs because section 98.2, subdivision (c) only authorizes an award against unsuccessful appellants in a de novo trial in superior court, not in favor of successful appellants.

The Court of Appeal disagreed with Bombardier’s premise. “The Berman procedure does penalize a party – employer or employee – who files an unsuccessful de novo superior court action by awarding attorney fees and costs against that party. (§ 98.2, subd. (c).) But the statute says nothing about a party who brings a successful de novo claim.”

“Prevailing plaintiffs in superior court actions for unpaid wages are generally entitled to an award of reasonable fees and costs (see, e.g., §§ 218.5, 226 and 1194), and nothing in section 98.2 suggests that the Legislature intended to make this remedy unavailable to employees who first attempt to obtain relief from the labor commissioner through the expedited Berman hearing process.”

“Because Bombardier’s argument contradicts the only published authority on point (Eicher v. Advanced Business Integrators, Inc. (2007) 151 Cal.App.4th 1363 (Eicher)) and shows insufficient regard for the Legislature’s unwavering encouragement of employee unpaid wage claims, we affirm the trial court’s order awarding $200,000 in attorney fees and costs to plaintiffs.”

P/C Insurance Market Profitability Improves in 2024

The U.S. property/casualty (P/C) market in 2024 is forecast to have continued its trajectory of improving underwriting results, according to the latest report — Insurance Economics and Underwriting Projections: A Forward View – from the Insurance Information Institute (Triple-I) and Milliman, a collaborating partner. Further premium growth and improved underwriting performance should continue in 2025 and 2026, provided geopolitical and economic conditions remain relatively stable.

Key Performance Indicators

– – Economics: P/C underlying economic growth ended 2024 slightly below U.S. GDP growth at 2.3% versus 2.5% year-over-year (YOY). However, in 2025 and 2026, P/C underlying growth is expected to be above overall GDP growth, an improvement in year-end expectations. A further economic milestone occurred in 2024 with the number of people employed in the U.S. insurance industry surpassing three million.
– – Underwriting: P/C net combined ratio (NCR) estimate of 99.5 is a YOY improvement of 2.2 points, while net written premium (NWP) is estimated to increase 9.5% YOY. Personal lines 2024 NCR estimate improved by nearly 1 point relative to our prior estimates, primarily due to better-than-expected Q3 performance in personal auto. Commercial lines 2024 NCR estimate increased by 1.2 points due to commercial property and general liability. NWP growth rate for personal lines is expected to continue to surpass commercial lines by 9 points in 2024.

Additional Report Highlights

– – Personal lines: Personal auto projected 2024 NCR of 98.8 is 6.1 points better than 2023, with 2024 NWP growth rate of 14.0% the second highest in over 15 years. Homeowners projected 2024 NCR of 104.8 is a 6.1-point improvement over 2023 despite an above-normal hurricane season.
– – Commercial lines: Commercial property projected 2024 NCR of 91.2 is 3.3 points worse than 2023, with Hurricane Milton projected to be the worst catastrophe for commercial property insurance since Hurricane Ian in 2022 Q3. General liability projected 2024 NCR of 103.7 is 3.6 points worse than actual 2023 experience.

“Commercial lines continue to have better underwriting results than personal lines, but the gap is closing,” said Dale Porfilio, FCAS, MAAA, Triple-I’s chief insurance officer. “The impact from natural catastrophes such as Hurricane Helene in Q3 2024 and Hurricane Milton in Q4 2024 significantly impacted commercial property. The substantial rate increases necessary to offset inflationary pressures on losses have driven the improved results in personal auto and homeowners,” he added.

Turning to workers’ compensation, Donna Glenn, FCAS, MAAA, chief actuary at the National Council on Compensation Insurance (NCCI), provided a preview of this year’s average lost cost level changes and discussed the long-term financial health of the workers compensation system.

The 2025 average loss cost decrease of 6% is moderate, which will inevitably have implications on the overall net written premium change,” Glenn said. She added that the –6% average loss cost level change in 2025 is notably different than was seen in 2024: an average decrease of more than 9%, representing the largest average decrease since before the pandemic.

Payroll for 2025 will develop throughout the year resulting from both wage and employment levels. Therefore, overall premium will become clearer as the year progresses,” Glenn said.

2024 Was Another Bad Year For US Health Care Cyberattacks

SecurityWeek has conducted an analysis of the healthcare breach database maintained by the US Department of Health and Human Services Office for Civil Rights (HHS OCR), which stores information on incidents impacting the protected health information of over 500 individuals.

The OCR was informed about 720 incidents between January 1, 2024, and December 31, 2024. Adding up the numbers from each breach suggests that roughly 186 million people are impacted.
Impacted information can include names, contact details, dates of birth, Social Security numbers, insurance information, medical information, and even financial information.

Of the total number of data breaches, approximately 520 affected healthcare providers. Another commonly impacted type of entity was healthcare business associate, which accounted for 120 incidents. Health plans were involved in nearly 100 incidents.

Close to 600 incidents were described as ‘hacking/IT incident’, which includes ransomware attacks. The second most common type of incident involved unauthorized access or disclosure.

Roughly 450 breaches involved network servers, and roughly 160 involved email, which is typically used by threat actors for phishing and malware delivery.

The OCR database also keeps track of the state where the impacted organization is located. Texas and California accounted for the highest number of incidents (roughly 60 each), followed by New York (46), Illinois (43), Florida (37), Pennsylvania (31), Ohio (29), Massachusetts (29), Tennessee (25) and Michigan (22).

The biggest healthcare data breach of 2024 impacted Change Healthcare. A ransomware attack aimed at the company resulted in the information of roughly 100 million individuals getting stolen.

The list of organizations impacted by major data breaches also includes Kaiser Permanente (13.4 million), Ascension Health (5.5 million), HealthEquity (4.3 million), Concentra Health Services (3.9 million), Centers for Medicare & Medicaid Services (3.1 million), Acadian Ambulance Service (2.8 million), A&A Services, dba Sav-Rx (2.8 million), WebTPA (2.5 million), and Integris Health (2.3 million).

HIPPA Journal reports that between 2009 and 2023, 5,887 healthcare data breaches of 500 or more records were reported to OCR. Those breaches have resulted in the exposure or impermissible disclosure of 519,935,970 healthcare records. That equates to more than 1.5x the population of the United States. In 2018, healthcare data breaches of 500 or more records were being reported at a rate of around 1 per day. Fast forward 5 years and the rate has more than doubled. In 2023, an average of 1.99 healthcare data breaches of 500 or more records were reported each day, and on average, 364,571 healthcare records were breached every day.

John Riggi, national adviser for cybersecurity and risk at the American Hospital Association was quoted by Modern Healthcare as saying “I have never seen the healthcare sector so engaged in cybersecurity,” he said, “from the [C-suite] level all the way down to operational staff.”

Sutter Health to Invest $1B in AI Imaging With GE HealthCare

Sutter Health is a comprehensive, integrated health system in northern California with 27 hospitals, 300 ambulatory sites, and imaging modalities.

Sutter Health and GE HealthCare just announced a seven-year strategic enterprise partnership, known as a Care Alliance, that aims to increase access to innovative imaging services and create a more seamless and coordinated experience for clinicians and patients across the Sutter Health system. This Care Alliance marks one of GE HealthCare’s largest ever enterprise strategic partnerships.

According to a report by Bloomberg the agreement is expected to generate $1 billion in revenue over the span of the partnership, GE Healthcare said. It marks one of the largest deals for the medical technology company since the firm was spun off from General Electric Co. two years ago.

GE HealthCare CEO Peter Arduini said he expects to enter into more strategic partnerships as consolidation of the health system continues and as the firm evolves from an imaging company to providing a variety of health-care solutions. Since the spinoff, the company has entered into more than 25 strategic partnerships, including a research and product development program with the Mayo Clinic and a 10-year partnership with the Ohio-based University Hospitals.

The first key focus area of the Care Alliance is an accelerated technology program across the Sutter Health system that will focus on some of the most advanced AI-powered imaging technology and digital solutions available to patients, including PET/CT, SPECT/CT, MRI, CT, X-ray, nuclear medicine and ultrasound. GE HealthCare’s interventional, mammography, diagnostic cardiology, maternal and infant care and anesthesia solutions will also be included in Sutter Health’s ambulatory care centers, helping to address the growing need for care outside of the traditional hospital setting.

This comprehensive technology refresh covers the breadth of GE HealthCare’s portfolio of solutions, providing clinicians with innovative options to meet changing patient needs more efficiently and quickly.

Imaging and ultrasound solutions, enabled by digital and AI advancements, will be implemented across the entire healthcare system over several years, reducing variation and providing the innovation clinicians need to best serve patients. Innovative new solutions include GE HealthCare’s Omni Legend PET/CT, StarGuide SPECT/CT and Vscan Air™ SL ultrasound with Caption AI™ software. Notably, GE HealthCare’s AIR™ Recon DL MR image reconstruction will be deployed and utilizes deep learning algorithms to improve image quality and MRI scan times. By optimizing image reconstruction AIR™ Recon DL reduces artifacts, and enhances image clarity and scan times, enabling clinicians to obtain high-quality diagnostic images while improving patient comfort and workflow efficiency.

The strategic partnership also supports Sutter Health’s larger access strategy, which includes opening dozens of new care sites across Northern California in the next few years. Additionally, it will further support the health system’s expansion of advanced service lines and destination centers of excellence including areas such as heart and vascular care, cancer care and neurosciences. This includes access to new technology and digital optimization to expand clinical procedures and services, helping enable precise, high-quality patient care from early screening to diagnosis to treatment to monitoring.

For example, Sutter Health plans to build a new cancer center on Sutter’s Memorial Medical Center campus in the California Central Valley and recently announced two new flagship campuses in Silicon Valley with specialty care focuses. Potential future areas of enhanced services across the Sutter Health system could include mental health, orthopedics, women’s health and pediatrics.

Sutter Health will adopt technology at a more rapid pace with an accelerated upgrade schedule, including the latest software releases to prevent obsolescence and keep technologies current over the long-term. The service delivery model will help ensure consistent operations and minimize unexpected disruptions—with patient safety, efficiency and reliability in mind.

The agreement will also include significant investment in Sutter Health’s workforce development programs to include ongoing training and education for technologists, nurses and physicians through Sutter Health University and other learning opportunities, which includes supporting the next generation of clinicians who are reflective of the communities they serve.

GE HealthCare plans to assist Sutter Health in the design of a scalable workforce and talent development program that includes talent pathway community outreach, collaborations with radiologic technologist schools, as well as talent acquisition, development and retention, including leadership and clinical learning journeys. The program will aim at addressing the critical clinician shortage and support healthcare providers’ clinical staffing needs.

Palisades Firefighters Participate in First-of-its-Kind Cancer Study

Established in July 2016 with funding from the Federal Emergency Management Agency (FEMA), the Fire Fighter Cancer Cohort Study (FFCCS) gathers nationwide data on firefighter health, including surveys, biomarkers, and exposure information related to cancer-causing substances. This partnership with the fire service aims to understand the health impacts of these exposures and prevent associated risks.

The long-term goal is to track the health of 10,000 firefighters from multiple fire departments across the nation over a span of 30 years.

Firefighters are exposed to multiple carcinogens in the workplace through inhalation, skin contamination, and ingestion. Cancer is a leading cause of fire service morbidity and mortality, and the International Agency for Research on Cancer (IARC) has determined that occupational exposure as a firefighter causes cancer.

As of September 30th, 2024, 6,287 firefighters from over 275 departments across 31 states are participating in the FFCCS.

And now, according to a report by Fox40.com, The Wildfire Conservancy is conducting a first-of-a-kind cancer study on firefighters battling the Palisades Fire. The goal is to track how wildland and urban interface firefighters’ extreme conditions increase their risk of cancer.

The initiative is a collaboration with Cal Fire, the National Firefighter Cancer Cohort Study, and the University of Arizona. This comes after the International Agency for Research on Cancer officially classified firefighting as a carcinogenic profession.

The doctor leading the study describes the conditions of the Palisades Fire as a “toxic soup of air and ash.“ “This is the equivalent of a 9/11 scale exposure incident and we need to start treating them like this,” Dr. Matt Rahn, Executive Director of Wildfire Conservatory.

The firefighters battling the Palisades blaze are being exposed to hazardous substances like carbon monoxide, and heavy metals which can lead to cancer, respiratory issues, and neurological damage.

The 50 participating firefighters get their blood drawn, provide a urine sample, and share personal details. They’re also given silicone wristbands that absorb contaminants like ash, soot, and smoke that will be tested.

“We are making plans with Cal Fire and others in the study to do a post-exposure, post-fire blood sample,” the Doctor continues. “One of the things that we’re able to look at is micro-RNA in the blood because it’s a marker of how much DNA damage has been done.”

FDA Continues Resisting Production of Pfizer Vaccine Documents

Public Health and Medical Professionals for Transparency (PHMPT) is a not-for-profit organization. It’s members include over 30 accomplished academics, professors, and scientists from the medical schools and related departments of our most prestigious universities, including Yale, Harvard, UCLA, UCSF, UCI and Brown.

These academics and scientists represent a cross section of every discipline relevant to the licensure of the Pfizer vaccine and include many of the best our country has to offer when it comes to reviewing and assessing the appropriateness and validity of the FDA’s decision-making in licensing of the Pfizer COVID Vaccine.

In furtherance of its mission, on August 27, 2021, PHMPT submitted the Freedom of Information Act (FOIA) Request to the FDA seeking all data and information pertaining to the application and approval of the Pfizer Vaccine. Federal law (21 C.F.R. § 601.51(e)) provides that: “After a license has been issued, the following data and information in the biological product file are immediately available for public disclosure unless extraordinary circumstances are shown.” PHMPT desires to perform its own independent analysis of the safety and efficacy the the vaccine, especially in light of the vaccine mandates being promulgated at the federal and state levels.

In the Second Joint Status Report following filing this case, the FDA assessed that there are more than 329,000 pages potentially responsive to the PHMPT FOIA request. The FDA asked that the Court limit the FOIA response to no more than 500 pages per month. This would be nearly 55 years or until about 2077.

The FDA lost the battle. On January 6, 2022 a federal judge soundly rejected the FDA’s request and ordered the FDA to produce all the data at a rate of 55,000 pages per month. In doing so the judge noted that “the Court recognizes the ‘unduly burdensome’ challenges that this FOIA request may present to the FDA.”

The January 6, 2022 order set a production schedule, which was partially modified on February 2, 2022. The production schedule required the FDA to “produce 80,000 pages on or before May 2, June 1, and July 1, 2022; 70,000 pages on or before August 1, 2022; and then 55,000 pages on or before the first business day of each month thereafter.”

On December 19, 2023, in a Joint Status Report, the FDA notified the Court that it had completed its production of responsive documents. However, on April 23, 2024, in a related case Plaintiff learned that the FDA may have identified but not produced an Emergency Use Authorization (“EUA”) file.

Thereafter, on July 17, 2024, in its response to Plaintiff’s adequacy-of-search letter, the FDA disclosed that it had in fact identified but not produced an EUA file for the Pfizer Vaccine. Because the Parties were unable to resolve this issue without court intervention, the matter was briefed. And on December 6, 2024, the Court entered an order finding that the EUA file was responsive to Plaintiff’s FOIA request and must be produced. The Court ordered the FDA to produce the EUA file on or before June 30, 2025.

This month marks three years after the 2022 court order, and the PHMPT and FDA continue litigating compliance with the federal law mandating the publics ability to review the FDA information used to justify approval of the Pfizer Vaccine. The FDA now requests that the Court not only delay the production of the EUA file, but indefinitely stay it. In its Cross-Motion for Summary Judgment, Plaintiff specifically requested that the Court order the FDA to produce the EUA file on or before February 20, 2025.

In denying the FDA’s recent request for a stay, U.S. District Judge Mark Pittman expressed his exhaustion with the agency’s “continued attempts to pause the production of information related to one of the preeminent events of our time – the Covid-19 pandemic.” He ordered that the FDA must release the requested “emergency use authorization” file by June 30, 2025.

Public Self-Insured Paid & Incurred Losses Increase

A California Workers’ Compensation Institute (CWCI) review of the initial report on fiscal year (FY) 2023/24 California workers’ compensation public self-insured data shows that an 18.7% increase in average medical payments and a 5.3% increase in average indemnity payments drove public self-insureds’ total paid losses up nearly $42.6 million to $552.9 million last year even though the number of claims fell by 1.8%.

At the same time, public self-insured total incurred losses (paid plus reserves for future payments) jumped nearly $150 million to a record $1.69 billion as average incurred medical rose 14.8% and average incurred indemnity jumped 9.4%.

The summary of public self-insured data issued on January 8 by the Office of Self-Insurance Plans (OSIP) offers the first snapshot of the workers’ comp experience of cities, counties, and other public self-insured entities for the 12 months ending June 30 of last year. The summary notes the number of medical-only and indemnity claims filed and the total paid and incurred losses on those claims.

Compared to the initial summary from the prior year (FY 2022/23), the new report shows California’s public self-insured work force increased by 4.5% to 2.18 million workers last year, with wages and salaries for those workers totaling nearly $174.2 billion. The public self-insured employers reported 118,114 claims last year, 2,214 (-1.8%) fewer than in the FY 2022/23 initial report, but despite that decline, both paid and incurred losses were up.

The distribution of the $552.9 million in paid losses on the FY 2023/24 public self-insured claims at first report shows indemnity payments totaled $327.9 million, $10.8 million (3.1%) more than in FY 2022/23, while medical payments totaled $225.0 million, up $31.8 million (16.5%) from the prior year.

With claim volume down and loss payments up, average benefits paid in the first reports climbed to $4,681 for the FY 2023/24 claims, 10.4% more than the initial payments on FY 2022/23 claims. The breakdown of the average payment shows public self-insureds averaged $2,776 in indemnity payments on the FY 2023/24 claims, up 5.3% from $2,636 in the prior year’s first report, while average paid medical climbed to $1,905, up 18.7% from $1,605 in the initial report for FY 2022/23.

The first report data on public self-insured incurred losses (paid amounts plus reserves for future payments) show total incurred losses on the FY 2023/24 claims of nearly $1.69 billion, 9.7% more than the $1.54 billion first report total from the prior year’s claims. With both medical-only and indemnity claim volume down, the year-over-year increase in total incurred losses was completely due to the increases in average incurred indemnity (+9.4%) and average incurred medical (+14.2%), which more than offset the 1.8% decline in claim volume, as the average incurred loss per claim jumped 11.8% from $12,744 in FY 2022/23 to $14,279 in FY 2023/24.

OSIP also compiles private self-insured claims data, which is reported on a calendar year basis rather than on a fiscal year basis, so the private self-insured data, which was posted in June, now lags the public self-insured data by 6 months. The next report on private self-insured claims will be issued next summer.

In the meantime, CWCI has issued a Bulletin that includes exhibits and additional details on the most recent public self-insurer paid and incurred losses, including comparative results from the past decade. CWCI members and subscribers may access the Bulletin by logging in at www.cwci.org. OSIP’s summaries of private and public self-insured employers since FY 2000/01 are available at https://www.dir.ca.gov/SIP/StatewideTotals.html.