Category: Daily News

A contingent of local and state law enforcement raided a San Jose marijuana dispensary last Thursday and arrested its owner and manager, based on allegations of illegal marijuana sales and workers’ compensation fraud, authorities said.

According to the report in the San Jose Mercury News, police and investigators from the Santa Clara County District Attorney’s Office led the operation at San Jose Organics, on Tully Road east of Monterey Road, aided by agents from the state Board of Equalization and the Employment Development Department.

Deputy District Attorney Edward Liang said the search of the club stemmed from an investigation into illicit marijuana trafficking and possible tax and workers’ compensation fraud. He declined to provide additional details about the scope of, or what spurred the probe, only that it involved violations including operating in an unlawful location and outside of prescribed regulations.

Authorities arrested on site the business’s manager, Brian Wong, a San Francisco resident. The owner, Ben Lew, was arrested in San Francisco. Both were booked on suspicion of possessing marijuana for sale, selling marijuana and maintaining a place to unlawfully sell marijuana, Liang said.

Agents carried boxes of evidence out of the storefront shop. Liang said the investigation continues, and that additional charges could be considered.

Following arrests made earlier today, a federal indictment was unsealed charging three southern California defendants with conspiracy to commit health care fraud and 15 counts of health care fraud.

Chiropractor Bahar Gharib-Danesh, 38, of Woodland Hills, was arrested in Los Angeles; Chiropractor Na Young Eoh, 41, of Bakersfield, was arrested in Bakersfield; and clinical psychologist John Terrence, 72, of Marina Del Rey, is expected to voluntarily appear before the U.S. District Court in Fresno within the next 30 days.

According to the indictment returned on July 2, 2015, Gharib-Danesh was a chiropractor and the manager of Pain Relief Health Centers (PRHC). PRHC was headquartered in Los Angeles, and had clinics in Bakersfield, Visalia and Fresno, as well as in Los Angeles County. Eoh was also a chiropractor, and was the treating physician for PRHC’s Kern County workers’ compensation claims. Terrence was a clinical psychologist who saw patients from the Bakersfield clinic.

According to the indictment, PRHC recruited patients who were workers claiming to have an injury. In treating the patients, Gharib instructed her staff to add as many injured body parts for treatment as possible to generate higher billings. The treatment plan generally included shock wave therapy, electro stimulation therapy, myo-facial release/massage, physical therapy, chiropractic manipulation, compound creams, and psychological evaluation. Nearly every patient was scheduled for the same treatments, and the maximum amount of treatments allowed by law was generally billed to the insurance company. Eoh operated out of the Bakersfield Clinic, the Visalia Clinic, and the Fresno Clinic and would sign the treatment plans and referral forms.

If the claim of injury was denied by the insurance company, a lien would be filed, and the claims would either be litigated before the California Workers’ Compensation Appeals Board or be settled by negotiations through the parties. Lien settlements for less than the full amount of the claim were acceptable because of the high volume of patients recruited and by the large amount of medical fees generated.

The indictment further alleges that Gharib directed Eoh to refer all patients who came into the clinic to Terrence for a psychological evaluation, regardless of the injury the patient reported. Terrence submitted bills and reports for each patient that were virtually identical. He also allegedly fraudulently billed for patients at a rate higher than legally allowed. According to the indictment, Terrence provided each patient with approximately 20.8 hours of psychological evaluations in a single day. On one day, Terrence billed a total of 291.2 hours for treating 14 patients. In one period of two weeks, Terrence billed over a thousand hours treating patients and writing reports. Between 2005 and 2012, Terrence submitted claims for psychological services in workers’ compensation cases totaling in excess of $5.6 million.

If convicted, each defendant faces a maximum statutory penalty of 20 years in prison and a $250,000 fine on each count of the indictment.

A new analysis of 2015 independent medical review (IMR) outcomes shows there was no significant reduction in IMR volume in the first quarter of this year, even though the independent medical reviewers continue to concur with the utilization review (UR) physician’s denial or modification of treatment in about 90 percent of the cases.

The CWCI analysis compares data from 33,909 IMR determination letters issued in the first three months of this year in response to applications submitted to the state after a utilization review (UR) physician modified or denied a requested medical service to similar data from the 137,781 IMR decisions issued in 2014.

State legislators who enacted IMR expected the volume of requests would decline following an initial learning curve as doctors, attorneys and others involved in the process became familiar with the types of treatment that would meet the evidence-based medicine standards and be approved through UR and IMR, but the new data indicate that after more than 2 years, IMR volume has yet to subside.

A review of the IMR decisions issued in the first quarter shows that after reviewing the patient’s records and any additional information provided in support of the request, the IMR physicians upheld the UR doctor’s modification or denial of the service 89 percent of the time, nearly matching the 91 percent uphold rate from 2014.

The mix of services submitted for IMR also showed little change, as prescription drugs again topped the list, accounting for 48 percent of the first quarter IMR decisions (vs. 45 percent in 2014), with the UR denial or modification upheld in 92 percent of those cases. Requests for prescription drugs, physical therapy, durable medical equipment, injections and diagnostic tests and measurements together accounted for ¾ of all services submitted for IMR in the first quarter, though requests for surgery, which accounted for 4.4 percent of the IMR cases (vs. 4.7 percent in 2014) surpassed diagnostic tests and measurements as the fifth most common type of service submitted for IMR, even though the uphold rate for modifications or denials of surgical requests held steady at 89 percent.

The first quarter IMR results also show that a relatively small number of physicians continue to account for the majority of the disputed medical services, as the top 10 percent of physicians named in IMR decision letters (516 providers) accounted for 70 percent of the IMR requests, though that was down from 83 percent last year, while the top 1 percent of physicians (52 providers) accounted for 28 percent of the disputed service requests in the first quarter, down from 44 percent last year.

In addition, the study documents continued geographic variation, with 38 percent of the first quarter IMR decision letters addressed to Los Angeles County recipients – 1.5 times the proportion of claims that come from that region, whereas in all other regions of the state the percentage of IMR decisions was either in line with or disproportionately low relative to the percentage of claims from the region.

CWCI has published more details on the first quarter IMR outcomes in a Spotlight Report, “California Workers’ Compensation Independent Medical Review: 1st Quarter 2015 Outcomes,” which CWCI members and subscribers can access in the research section of the Institute’s website.

You don’t have to look very far to get head-bangingly upset about the current state of medical and scientific research. Pfizer (maybe) hid evidence that Zoloft use by pregnant women caused heart defects in babies. GlaxoSmithKlein paid $3 billion in fines for a) generating a fake journal article saying Paxil was safe for kids b) paying doctors lavish speaker fees and using sham advisory boards to promote Wellbutrin for off-label use and c) failing to report that Avandia, a diabetes drug, could potentially cause heart problems. Merck, for its part, is currently being accused of lying about the efficacy of its mumps vaccine in order to maintain its market monopoly on the drug.

And you can’t necessarily just go straight to the source and trust an article in a “peer reviewed” journal either. Who can you trust? Well, the truth is out there. Here’s where to start.

Part of the delight of the public interest website Retraction Watch is that it exposes the many weird things that scientists study. Outer space dentistry? Check. Rabbit hepatitis? Check. The nutritional value of mushrooms? Yep. So that’s pretty fun, but then the less fun part is why are those guys lying about this stuff?.

It is generally believed that retractions help maintain the purity of science, help with the integrity of individual scientific journals and the whole of the scientific literature, and, when properly enforced, help keep scientists from bending the rules regarding scientific misconduct and publication. Yet several articles have appeared in the library literature concerning the fate of retracted articles. When researchers in one study tracked the fate of retracted, invalid articles they found that, after retraction, completely retracted articles were cited a total of 733 times.

Research misconduct became a public issue in the United States in 1981 when then Representative Albert Gore, Jr., chairman of the Investigations and Oversight Subcommittee of the House Science and Technology Committee, held the first hearing on the emerging problem. The hearing was prompted by the public disclosure of research misconduct cases at four major research centers in 1980. Some twelve cases of research misconduct were disclosed in this country between 1974-1981. Congressional attention to research misconduct was maintained throughout the 1980s by additional allegations of research misconduct and reports that the National Institutes of Health (NIH), universities, and other research institutions were inadequately responding to those allegations.

Congress took action in 1985 by passing the Health Research Extension Act. The Act, in part, added Section 493 to the Public Health Service (PHS) Act. Section 493 required the Secretary of Health and Human Services to issue a regulation requiring applicant or awardee institutions to establish “an administrative process to review reports of scientific fraud” and “report to the Secretary any investigation of alleged scientific fraud which appears substantial.”

The Department of Industrial Relations reminds employers of the labor law requirement to notify their workers in writing about their rights under the Healthy Workplace Healthy Family Act of 2014 (Assembly bill 1522) – California’s new paid sick leave law – that took effect on July 1, 2015.

All employers were required to post a notice about the new law in a conspicuous place at the worksite beginning January 1, 2015. More information on the requirements of the new law is available on the DIR website, including a Frequently Asked Questions page that was posted in February 2015.

Most employees must be individually notified: Employers must provide most employees with individual notices detailing their rights to paid sick leave per Labor Code sections 2810.5 and 246(h), even in situations where the employer’s policy exceeds the state provisions. Employees that fall within the following groups are not required to receive individual notification, per Labor Code section 2810.5(c) if they are:

1) Directly employed by the state, city, county, special district;
2) Exempt from payment of overtime or the Industrial Welfare Commission wages;
3) Covered by a valid collective bargaining agreement.

Notification template: Employers can print and complete a template available on the Labor Commissioner’s website in English, Spanish or Vietnamese, and provide it as an individual notification to each of their employees. Employers can also provide this same information in a notice of their own creation.

Delivery of notification: The notice can be submitted with the employee’s next wage payment after July 1, 2015. It can be printed on a detachable part of the paycheck itself or attached to the paycheck as a separate document. Alternatively, the notice can be handed to employees or mailed to them by Wednesday, July 8, 2015.

Employers and workers can refer to DIR’s webpage for more information on the new law, including a recorded training webinar and presentation slides, as well as FAQ’s. DIR has also produced a short video on the new law.