Category: Daily News

Declarations and brief continue to be filed in federal court for and against imposing a preliminary injunction halting the implementation of newly adopted SB 1160. This new law provides for a stay on lien claims filed by indicted medical providers until after their case has been resolved.

Dr. Eduardo Anguizola who is facing multiple counts of insurance fraud filed by Orange County prosecutors is the lead plaintiff who claims Labor Code 4615 violates the procedural component of the due process clause because it immediately stays all liens without notice or a hearing.

The defendants responded that Section 4615 affords sufficient process because Plaintiffs still have the same rights afforded to them by the workers’ compensation scheme generally. The Defense filed a 117 page Declaration of Workers’ Compensation Chief Judge Paige Levy that articulated how lien claimants subject to 4615 have rights to due process under the new law, and indeed attached several illustrative cases on the stay law that have been decided by either Removal or Reconsideration by the WCAB.

Essentially she pointed out several panel decisions that have held that any lien claimant who asserts they do not fall subject to the stay have the right to have their argument heard and decided upon filing a DOR on the issue. Any WCJ that had refused to do so was overturned. Judge Levy pointed out the statutory and regulatory provisions that allowed lien claimants to challenge the application of the “automatic stay” to their individual cases.

The plaintiffs were given time to rebut Judge Levy, and filed a brief and many declarations accordingly. They claim these documents “address the seriously misleading declaration of Judge Levy.”

They argue “Now, faced with the State-submitted declaration of Paige S. Levy, the Chief Judge of the California Division of Workers’ Compensation, the Court gave the Plaintiffs a fair chance to reveal what is occurring in the California workers’ compensation courts and to address the seriously misleading declaration of Judge Levy.”

They say “Judge Levy offers only anecdotal references to a handful of cases to support the State’s claim that workers’ compensation judges are providing due process to claimants affected by Section 4615. Judge Levy’s declaration is wholly refuted by the detailed declarations submitted concurrently with this brief and is contravened by the DIR and WCAB’s own publications, guidelines, procedures, manuals, recent public admissions, website, and press releases.”

They further argue that “the regulations providing procedures like Petitions for Reconsideration and Petitions for Removal are inapplicable because they arise only after a Court has issued an order. However, Section 4615 stays are imposed not by judicial orders but by clerical actions performed in a backroom and distributed to WCAB judges, typically by “flagging” the liens on the EAMS system, resulting in their dismissal by operation of law, a situation in which the workers’ compensation court does not hear the matter at all.”

Plaintiffs attach numerous declarations by lien claimants who portray the situation for lien claimants quite differently from Judge Levy. One of them was from Attorney Marty Renetzky who started and ran Medical Collection Company for 6 years and 6 medical clinics for Dr. Floyd Cord from 1981 through 1983. He also started and ran Vista Bay Medical Group until 1991, started and ran Golden State Auto Appraisal Company for 7 years, and currently runs Crestview Medical Collections.

He says “American Allied Diagnostics Medical Group, Inc., has taken all steps to appropriately document and pursue its liens. This includes filing liens, paying activation fees and appearing at all relevant hearings.” Yet he says its liens ended up on the stayed liens list although they have not been charged with any crime. They were never given official notice of this, and he says they have no procedure to contest this status.

He does not say that any petition for reconsideration or removal has been filed or rejected, so he does not specifically show how Judge Levy was wrong or how the procedure outlined in her declaration does not work for this lien claimant.

Another court hearing is set for September 28, 2017 at 8:30 am. Judge Wu may make is ruling on a preliminary injunction at this next hearing.

The California Labor Commissioner’s Office cited 14 garment manufacturers and contractors $372,135 for labor law and garment registration violations, following inspections of 18 garment manufacturers last month in the Los Angeles area. The businesses cited employ 170 workers in the Los Angeles garment district.

The penalties included $275,835 in fines and stop orders for seven employers operating without workers’ compensation insurance coverage. Fourteen businesses were cited $34,300 for garment regulation violations, including failure to register as a garment manufacturer, display the garment registration or maintain required records. Investigators also confiscated 5,725 illegally manufactured garments with an estimated street value of $103,000 from six of the businesses.

“Garment manufacturers who thwart the law threaten workers’ rights and undermine honest employers in the industry, making it difficult for legitimate businesses to succeed,” said Labor Commissioner Julie A. Su. “These illegal entities should take note: We will shine a light on the underground economy and those who contract with unregistered contractors will also be held accountable.”

The Labor Commissioner’s office is also pursuing wage theft investigations on those employers who failed to pay proper wages under the California Labor Code.

The Garment Manufacturing Act of 1980 requires that all industry employers register with the Labor Commissioner and demonstrate adequate character, competency and responsibility, including workers’ compensation insurance coverage. Garment manufacturers who contract with unregistered entities are automatically deemed joint employers of the workers in the contract facility. Clothing confiscated from illegal operations cannot be sold, and will be donated to a non-profit agency that will provide the items to homeless and domestic violence shelters in the Los Angeles area.

The Labor Commissioner also administers a special wage claim adjudication process for garment workers pursuant to California’s AB 633, passed in 1999. This law provides not only an expedited process for garment workers to file wage claims but also provides a wage guarantee where garment manufacturers are responsible for wage theft at their contractors’ facilities.

The Labor Commissioner’s Office, officially known as the Division of Labor Standards Enforcement, is a division of the Department of Industrial Relations (DIR). Among its wide-ranging enforcement responsibilities, the Labor Commissioner’s Office inspects workplaces for wage and hour violations, adjudicates wage claims, investigates retaliation complaints and educates the public on labor laws.

In 2014, Commissioner Su launched the Wage Theft is a Crime multilingual public awareness campaign. The campaign defines wage theft and informs workers of their rights and the resources available to them to recover unpaid wages or report other labor law violations. Employees with work-related questions or complaints may contact DIR’s Call Center in English or Spanish at 844-LABOR-DIR (844-522-6734).

As U.S. consumer outrage grows over prescription drug prices, state authorities and patient advocates in Maryland are preparing to enforce the nation’s first law designed to punish drugmaker price-gouging.

The state Attorney General’s office said it will field complaints and investigate “unconscionable increases” in essential generic medicines when the closely watched law takes effect Oct. 1.

Drugmakers fear the Maryland law will embolden other states and are seeking a court injunction. Both sides made their arguments on Thursday before a U.S. District Court judge in Baltimore, who could decide on an injunction in the coming days.

According to the Report in Reuters Health, anticipating the law will survive the legal challenge, the Attorney General’s office said it is working with health economists at Johns Hopkins University to identify price spikes, which are not made public by drugmakers. Patient advocacy groups are urging consumers to report increased costs for their medicines. Maryland Citizens’ Health Initiative will add an option to report price gouging to its website.

Pharmaceutical companies have so far dodged stricter federal oversight despite growing outrage over price hikes. Valeant Pharmaceuticals International Inc raised the price of heart medications Isuprel by about 720 percent and Nitropress by 310 percent, after acquiring them in 2015. Mylan NV raised the price of its life-saving EpiPen six-fold between 2008 and 2016.

But states, struggling to cover rising healthcare costs, are taking up the fight. At least 176 bills on pharmaceutical pricing and payment have been introduced this year in 36 states, according to the National Conference of State Legislatures.

Maryland’s law is the most aggressive legislation to be passed so far, and allows the state to levy fines and order a reversal of price increases.

The Association for Accessible Medicines, a generic industry trade group that filed the lawsuit, argues that the law is unconstitutional because it does not define price-gouging and amounts to intervention by an individual state in interstate commerce.

“The issue of drug pricing is a national issue … not something that should be handled piecemeal in 50 different ways,” said Jeff Francer, general counsel for the trade group which represents companies like Teva Pharmaceutical Industries Ltd and Novartis AG’s Sandoz unit.

Maryland Attorney General Brian Frosh said that states have a well-defined role to play in policing “unconscionable” business activity against consumers, especially when they have no other recourse. He cited consumer contracts for telephone service, which are non-negotiable.

Several states have passed laws requiring drugmakers to disclose price increases, but the Maryland law is one of a few drawing the most attention from the drug industry.

Nevada has been sued by two industry trade groups after passing in June a law requiring diabetes drugmakers to justify price increases above a certain amount.

Ohio voters next year will decide on a ballot measure requiring drugmakers to offer state groups the same discounts given to the federal Department of Veterans Affairs. A similar measure failed in California last year, but the state’s legislature this week approved a drug pricing bill requiring drugmakers to justify price increases over 16 percent in a two-year period. It now goes to the state’s governor for a final decision.

Digital devices and mobile applications are breathing new life into traditional workers’ compensation services. According to the report in the Claims Journal – this was a key takeaway from the session, “Ridesharing Technology: Transforming Transportation in Workers’ Compensation,” presented at the 2017 California Workers’ Compensation & Risk Conference in Dana Point, California.

“Until recently, the workers’ compensation industry relied on an antiquated approach to coordinating transportation, which required a lot of manual oversight,” said Joseph McCullough, senior vice president of product at One Call Care Management. “Not surprisingly, this model resulted in a significant number of missed medical appointments, which can delay and even derail an injured worker’s progress toward recovery with significant and costly consequences.”

Within the past few years, ridesharing has become widely accepted with rapid adoption in healthcare and workers’ compensation. “Integrating ridesharing with a secure digital platform and proper credentialing has been the key to making this model safe and appropriate for the workers’ compensation market. With these critical components in place, One Call has experienced a 50 percent increase in daily ridesharing trips over the last seven months,” noted McCullough.

Digitization of non-emergency medical transportation, as well as other additional services, is a radical shift for the industry. As a forward-thinking player in this space, One Call has leveraged technology and formed strategic partnerships to meet the evolving needs of payers and injured workers. Today, transportation network companies (TNCs), like Lyft, use ridesharing to provide full digital capabilities, complete transparency into ride coordination and an overall streamlined process.

“Going from passive to active ride management is a transformative experience for everyone involved, and the industry will reap significant benefits including a reduction in failed and late pick-ups, as well as minimizing the need to reschedule medical appointments and transportation. Clinical, claims and return-to-work outcomes improve as patients attend appointments with greater consistency and reliability,” said McCullough.

As with any industry disruption, there have been fears over exposure and liability. Some initially considered ridesharing to be risky because of a misconception, largely perpetuated by traditional vendors like taxi companies, that the industry was not being properly regulated. In truth, 48 states have passed TNC-related regulations for driver and vehicle safety, licensing, background checks and liability insurance and these regulations are often stricter and more onerous than those regulating traditional taxi companies.

“This demonstrates that safety standards and regulations do exist,” said McCullough. “Beyond these requirements, patient experience is also enhanced. Injured workers have improved visibility into the details of their rides, and they can rate their satisfaction with drivers and their ride experience.”

Clients also want deeper and broader insights into their ancillary services. “We strive to provide prescriptive as well as actionable intelligence,” added McCullough. “We’ve made strategic investments in our technology platform and tools, which have advanced our analytic capabilities. We’re well positioned to do more with data – in a secure environment. Our clients can draw powerful conclusions from various data points, especially as they begin to develop and integrate their own mobile apps.”

Using this same type of modern digital platform, it’s possible to streamline the delivery of other accompanying services, such as web-based video translation services. “Similar to transportation, interpretation and language services are vital to communicating and facilitating the treatment plan with injured workers. Our goal is to eliminate any barriers so they receive the care they need to recover and return to work,” concluded McCullough.

California Insurance Commissioner Dave Jones on Tuesday issued a decision regarding the Workers’ Compensation Insurance Rating Bureau’s Jan. 1, 2018 regulatory filing, which was submitted to the California Department of Insurance on June 27.

Jones approved the following:

–  The WCIRB’s proposed changes to the California Workers’ Compensation Uniform Statistical Reporting Plan – 1995;

–  Miscellaneous Regulations for the Recording and Reporting of Data – 1995;

–  California Workers’ Compensation Experience Rating Plan -1995.

Some of these changes are effective Jan. 1, 2018, and others are effective Jan. 1, 2019.

The WCIRB will begin calculating January 2018 experience modifications within the next several days.

The Decision pertains only to the WCIRB’s Regulatory Filing and does not include amendments to advisory pure premium rates.

Changes to advisory pure premium rates were proposed in the WCIRB’s Jan. 1, 2018 pure premium rate filing, which was submitted to the CDI on Aug. 18 and amended on September 8.