Category: Daily News

Charles Taylor has agreed to acquire Metro Risk Management LLC (MRM) from Nautilus International Holding Corporation for an undisclosed amount.

MRM was founded in 1996 as a subsidiary of Metropolitan Stevedore Company (the original parent corporation), which was one of the earliest self-insured, self-administered companies in the State of California.

Nautilus and its subsidiaries – Metro Ports, Metro Cruise Services, Metro Shore Services and Metro Risk Management – are a suite of companies known internationally as leaders in stevedoring, terminal operations, logistics, risk management and more.

Charles Taylor is a leading international provider of professional services to clients in the global insurance market. It has been providing services to insurance clients since 1884 and today has over 1,800 staff in 71 offices, spread across 28 countries in the UK, the Americas, Asia Pacific, Europe,the Middle East and Africa.

The deal is part of Charles Taylor’s plans to extend its US workers’ compensation claims capabilities. Based in Southern California, MRM provides state and federal workers’ compensation claims administration services to self-insured clients and insurers.

Acquiring the third-party claims administrator will see the addition of 13 highly experienced workers’ compensation claims specialists to the Charles Taylor team – expanding the buyer’s presence in Long Beach in support of its TPA growth in the US.

James Callahan, Nautilus chairman, president, and chief executive, said the transaction will provide its staff with greater opportunities for career development and advancement.

“We have worked closely with Charles Taylor for many years, and know first-hand the insurance expertise and professionalism of the team. Charles Taylor provides MRM with the resources and expertise to expand its services to a wider range of clients,” he noted.

Christopher Schaffer, USA CEO, Charles Taylor Insurance Support Services, commented: “We are excited to join forces with MRM, given the company’s history of providing quality services and proven expertise to long-term, deeply satisfied clients.”

He said MRM broadens Charles Taylor’s claim services on the West Coast – adding to the core federal workers’ compensation, ports and terminals, marine, casualty, and cyber TPA business.

For Charles Taylor group chief executive David Marock, the acquisition reflects the firm’s continued commitment to growing its TPA business in the US and globally.

Federal Judge George H. Wu was again scheduled to hear more arguments in his downtown Los Angeles Courtroom 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 is facing multiple counts of insurance fraud filed by Orange County prosecutors. His federal lawsuit claims that SB 1160 and Labor Code 4615, the anti-fraud law that took effect January 1, violates the 5th, 6th, and 14th amendments of the United States Constitution. His request for a preliminary injunction was originally scheduled for hearing on July 13, 2017 and the motion was continued to August 24 to allow additional briefing.

Plaintiffs argued that 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. However in the Tentative Ruling Judge Wu pointed out that “Defendants do not explain how these pre-existing procedures would actually be used to challenge a stay imposed by Section 4615.” He thus provided the parties additional time before the August 24 hearing to provide information about how due process might be afforded lien claimants under 4615.

The 18 page Tentative Ruling by Judge Wu in July focused the case on the narrow issue of a “facial” challenge to newly adopted Labor Code Section 4615 which implements SB 1160. He ruled that to succeed in a facial challenge to a statute a plaintiff must establish that a law is unconstitutional in all of its applications. Because facial constitutional challenges often rest on speculation, they are disfavored. Thus, the fact that a statute “might operate unconstitutionally under some circumstances is not enough to render it invalid against a facial challenge.”

Between July 13 and August 24 many additional arguments and declarations were filed by both parties. The Defense filed a 117 page Declaration of Workers’ Compensation Chief Judge Paige Levy that clearly 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 several panel decisions 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.

Plaintiffs responded to the Levy declaration by claiming “The State knows that the statute is unconstitutional on its face and that the statute provides no mechanism for due process to those affected by the statute. … Because of the clear lack of due process – on its face – the State had no choice but to throw a ‘Hail Mary.’ Behold the declaration of Paige Levy.” They asked for expedited discovery to depose Judge Levy.

The outcome of the August 24 hearing according to the minute order was “Court and counsel confer re scheduling. For reasons stated on the record, Plaintiffs’ motion is continued to September 25, 2017 at 8:30 a.m., with Plaintiffs’ supplemental declaration due by September 12, 2017. Defendants will respond by September 20, 2017.”  Thus the outcome of this case will not be known at least until the end of September.

A controversial genetic testing firm under federal investigation for healthcare fraud has been placed into court-ordered receivership – a form of bankruptcy – that could lead to the restructuring and sale of the company. The CEO and founder of Proove Biosciences has also left the company.

Proove Biosciences specializes in DNA testing that the company claims can improve the effectiveness of pain management treatment and determine whether a patient is at risk of opioid addiction.

In June, FBI agents raided the company’s headquarters in Irvine, California. Former and current employees who were interviewed said the agents were focused on possible kickbacks to doctors who encouraged patients to take Proove’s DNA tests. Physicians reportedly could make $144,000 a year in kickbacks that were called “research fees.”

In July, Pain News Network reported that Proove was linked to a Medicare fraud case in which three Indiana healthcare providers allegedly “caused Proove Bioscience” to falsely and fraudulently bill various health care programs for genetic tests administered to Physicians Primary Care patients that were not medically necessary and never interpreted.”

Proove was not named as a defendant in the Indiana case. In an email to PNN, the company CEO said Proove had cooperated with investigators.

The CEO claimed “Proove received written and signed determinations of medical necessity supporting the tests ordered and billed to insurance carriers just like every other laboratory which requires such a determination on a test requisition form. Thus Proove operated appropriately and consistent with usual and customary practices.”

The CEO also defended Proove research, published in the Journal of Addiction Research & Therapy, which claimed to show the effectiveness of its genetic tests.The publisher of the journal, OMICS International, has been accused by the Federal Trade Commission (FTC) of deceiving researchers and readers about the true nature of its publications and peer review process.

“Proove can only speak to its experience with this particular journal,” the CEO said in an email to PNN. “Specifically for papers submitted to this journal, our R&D team and academic collaborators engaged in documented, extensive peer-review, received suggested edits and provided responses to the suggested edits to the manuscripts submitted for review and publication. Thus, Proove would certainly consider the publications accepted from Proove-affiliated authors in that journal to be ‘peer-reviewed’.”

According to the FTC complaint filed last August, OMICS  has created hundreds of “open access” online medical journals that publish articles with little or no peer review. Researchers are also charged significant fees to get their articles published by OMICS, a “pay to play” policy that some consider unethical because it diminishes the quality of academic journals and the peer review process.

Proove has aggressively promoted its genetic tests with healthcare providers around the country. A pain clinic in Montana, for example, had a Proove “patient engagement representative” employed on site at the Benefis Pain Management Center.

Arizona’s attorney general sued Insys Therapeutics Inc this week, accusing the drugmaker of engaging in a fraudulent marketing scheme aimed at increasing sales of a fentanyl-based cancer pain medicine.

According to the report in Reuters Health, the lawsuit by Arizona Attorney General Mark Brnovich in Maricopa County Superior Court in Phoenix comes during a series of federal and state investigations centered on Insys’ Subsys opioid drug.

The lawsuit, filed in Maricopa County Superior Court in Phoenix, accused Insys of paying doctors sham speaker fees in exchange for writing prescriptions of Subsys without regard for the health of patients.

The lawsuit also named three Arizona doctors as defendants who it said collected speaker fees from Insys while writing prescriptions that generated more than $33 million in sales of Subsys, or 64 percent of all sales of the drug in the state.

“We need to put a stop to the unethical and greedy behavior in the pharmaceutical industry that is fueling the opioid crisis in our state,” Brnovich said in a statement.

Insys did not immediately respond to a request for comment. Lawyers for the three doctors – Steve Fanto, Nikesh Seth and Sheldon Gingerich – could not be immediately identified.

The case is the latest to center on Subsys, an under-the-tongue spray intended for cancer patients that contains fentanyl, a highly addictive and regulated synthetic opioid.

In December, federal prosecutors in Boston charged six former Insys executives and managers, including ex-Chief Executive Michael Babich, with engaging in a scheme to bribe doctors to prescribe Subsys.

Federal charges have also been filed in several other states against other ex-Insys employees and medical practitioners who prescribed Subsys.

Two former Insys Therapeutics Inc sales representatives including the wife of its ex-chief executive pleaded guilty in July 2017 to engaging in schemes to pay kickbacks to medical practitioners to prescribe a drug containing the opioid fentanyl.

Natalie Levine, who worked at the Arizona-based drugmaker from 2013 to 2014, plead guilty in federal court in Hartford, Connecticut, to conspiring to violate a federal anti-kickback statute, prosecutors said.

Karen Hill, a sales representative who became the company’s district manager for the Miami region, pleaded guilty in federal court in Mobile, Alabama to conspiring to violate the same anti-kickback law, court records show.

Insys has said it is in talks with the U.S. Justice Department to resolve the federal probe.

The Arizona-based drugmaker previously agreed to pay a combined $8.95 million to resolve investigations by attorneys general in Oregon, New Hampshire and Illinois.

Most of the events that led to sustained prescription opioid use were not hospital events and associated procedures, but diagnoses that were either nonspecific or associated with spinal or other conditions for which opioid administration is not considered standard of care, according to a study published by JAMA Surgery.

The initial event associated with exposure to prescription opioids has not been widely explored, but is often maintained to stem from an injury or surgical procedure.

Andrew J. Schoenfeld, M.D., M.Sc., of Brigham and Women’s Hospital, Harvard Medical School, Boston, and colleagues evaluated the medical diagnoses linked with an opioid prescription that resulted in sustained opioid use in Americans insured through TRICARE, the insurance plan of the U.S. Department of Defense that provides health care coverage for over 9 million beneficiaries. This population may be comparable to the proportion of the general public at greatest risk of sustained opioid use.

The researchers identified 117,118 patients (opioid naïve, i.e., no use of prescription opioids for six months before receipt of a new prescription) who met the criteria for sustained prescription opioid use. Only 800 individuals (0.7 percent) received their initial opioid prescription following an inpatient encounter, with 0.4 percent having undergone an inpatient procedure.

The most common diagnosis associated with the initial opioid prescription for the entire group was other ill-defined conditions (30.6 percent). The most frequent diagnosis among patients treated in military facilities was lumbago. Spinal conditions were among the most frequent diagnoses in both civilian and military settings.

Among specific categories of conditions associated with the initial opioid prescription, spine and orthopedic disorders were the most prominent.

Limitations of the study include its retrospective design and reliance on insurance claims.

“Improved adherence to best practices in opioid prescribing and requirements for better documentation of the rationale for such prescriptions may reduce the risk of sustained use,” the authors write.

This suggestion seems like good advice for claims administrators as they review any Request for Authorization for an opioid medication.