Category: Daily News

Cal/OSHA has cited Dignity Health, operator of Northridge Hospital Medical Center, for safety and health violations that exposed the hospital’s 1,700 employees to hazards . These include failure to record information in 18 cases where hospital workers were stuck with needles, and failure to provide closable containers in emergency rooms that would keep biohazard waste from spilling.

Cal/OSHA ’s Van Nuys office opened an investigation in June after receiving a complaint. Investigators aided by Cal/OSHA’s medical unit found 13 health code violations.

There were four serious violations of the bloodborne pathogens standard, which requires employers to protect workers from coming into contact with blood or other disease carrying body fluids. A serious violation is cited when there is a realistic possibility that death or serious harm could result from the actual hazardous condition. In this case, the serious violations included :

1) Failure to gather information required by the Sharps injury log, such as type and brand of needles involved in the 18 injury cases. The employer had no procedure in place to review the log, or to solicit required input from employees about factors contributing to contaminated needle injuries. Well kept injury logs, and their regular review, help to identify the causes of injuries and prevent future occurrences.
2) Failure to provide containers that would prevent spillage or protrusion of contaminated needles in emergency treatment and trauma rooms. Additionally, the employer did not provide readily accessible hand washing facilities for emergency room employees.
3) Failure to provide appropriate sizes of gloves for employees using the medication cart in the trauma room and the after-hours intake area.

Cal/OSHA also issued eight general and regulatory violations because Dignity Health kept broken gurneys in the working area, skipped essential elements of training employees in safe patient handling, and failed to take corrective action after accidents occurred. Fines for all violations total $44,125.

A $23.2 million settlement has been reached by the California Department of Insurance and whistleblowers with pharmaceutical company Warner Chilcott to resolve a lawsuit alleging drug marketing fraud in violation of state law. (In 2013, Actavis announced the acquisition of Warner Chilcott creating an $11 billion leading specialty pharmaceutical company with over $3 billion in pro forma sales.) The settlement resolves allegations filed by three former Warner Chilcott employees. The lawsuit alleged that Warner Chilcott executives violated the California Insurance Code False Claims Act, which prohibits anyone from defrauding private insurance companies by using kickbacks or other inducements to procure or steer clients or patients.

The former Warner Chilcott employees alleged the company knowingly used illegal inducements to influence physician decisions, including paying kickbacks and falsifying prior authorization forms to increase the number of prescriptions written for several Warner Chilcott medications. Whistleblowers alleged Warner Chilcott management funneled kickbacks and inducements to physicians under the guise of physician education, often hosting events with little or no education content at high-end hotels and spas-all in an effort to encourage physicians to increase the number of prescriptions written for Warner Chilcott medications.

Of the $23.2 million state settlement, California will receive $11.8 million, which is to be used for enhanced insurance fraud investigation and prevention efforts.

In addition to the allegations of violating California law, a separate lawsuit was filed in federal court in Massachusetts alleging Warner Chilcott violated the Federal False Claims Act. The U.S. Department of Justice announced a settlement of the federal allegations on October 29, in which Warner Chilcott pleaded guilty to healthcare fraud and agreed to pay $125 million to resolve both federal civil and criminal liability for alleged activities that violated the federal anti-kickback and HIPAA statutes, and for false claims submitted to Medicare and Medicaid.

The Division of Workers’ Compensation (DWC) is announcing the decrease of the mileage rate for medical and medical – legal travel expenses by three and one – half cents – down from 57.5 to 54.0 cents per mile effective January 1, 2016. This rate must be paid for travel on or after January 1, 2016 regardless of the date of injury.

Labor Code section 4600, in conjunction with Government Code section 19820 and the Department of Personnel Administration regulations, establishes the rate payable for mileage reimbursement for medical and medical – legal expenses and ties it to the Internal Revenue Service (IRS).

IRS Bulletin Number IR – 2015 – 137 dated December 17, 2015 announced the rate decrease. The IRS standard mileage rate for business is based on an annual study of the fixed and variable costs of operating an automobile.

The updated mileage reimbursement form is posted on the DWC website.

Detectives with the California Department of Insurance arrested nine individuals involved in a complex scheme allegedly targeting more than 230 workers’ compensation insurers and self-insured employers. Siblings Francisco Javier Gomez, Jr., 32, and Angela Rehmann, 38, owners of G&G Interpreting Services, allegedly fraudulently billed more than $24.6 million for interpreting services for injured workers with Latino surnames. G&G Interpreting Services changed their company name to American Liberty Interpreting in August 2012. The company is family owned and operated. Francisco Javier Gomez, Jr., Angela Rehmann, Cynthia Gomez, Gloria Sandoval, Arnulfo Reyes III, Crystal Garcia, and Jamilett Ortega are related.

According to Department of Insurance detectives, over a four year period G&G Interpreting allegedly billed for translation services provided to clinics where the majority of the clinic staff spoke Spanish and there was no need for translation services. In other cases, the company billed for services to clinics where 13 treating physicians spoke fluent Spanish-and again-there was no need for translation.

G&G Interpreting had a substantial operation providing Spanish-language interpreting services across the Los Angeles Basin and Southern California for injured workers receiving healthcare services through the workers’ compensation system. Billing occurred in San Diego, Riverside, San Bernardino, Orange, Los Angeles, Ventura and Santa Barbara Counties.

The investigation revealed that 83,411 interpreting service events exceeded 12 hours in a day-more hours than the clinics were actually open. Detectives also discovered that G&G Interpreting billed workers’ compensation insurers more than $422,000 for the services of an interpreter who was actually incarcerated in state prison during the time the company claimed she was providing interpreting services; in fact, she is still in state prison.

The arrest operation was conducted by the Department of Insurance with assistance from the California Highway Patrol and the Riverside County District Attorney’s Office and San Bernardino District Attorney’s Office. The case is being prosecuted by the Los Angeles County District Attorney’s Office. Officials carried out a morning raid on a North Hollywood home, which is one of the nine sites investigators arrested suspected conspirators. As the investigation continues, the California Department of Insurance said they need the public’s help to stop similar schemes.

“For example, if an interpreter does show up in the room in a medical clinic as a part of your workers’ compensation case and you don’t need one, we urge you to call the California Department of Insurance,” Jones said.

Investigators are trying to determine whether the owners of G&G, Angela Rehman and her brother Francisco Gomez, opened a new operation to hide their activities.This investigation is ongoing.

Sheik Zahid Ali was injured in 2006, after having driven a tractor-trailer rig filled with latex paint from Hayward, California to Spokane, Washington. While unloading the trailer a pressurized cap came off the trailer causing serious injury. The truck was owned by Ali’s Trucking; the trailer was owned by Trimac who was insured by Lexington Insurance Company. The injury was industrial. The significant issue was the claim of an employment relationship with Trimac.

Trimac is a multi-national corporation that specializes in transporting liquid latex-based products from producer to buyer. To transport its products, Trimac used approximately four tractors it owned driven by about six employee-drivers and about 14 tractors leased to it by about 32 “independent contractors.” One such owner/operator was Ali’s Trucking, a business owned by Intaz Ali. Intaz owned two tractors he had purchased from Trimac. He leased the tractors back to Trimac for its business, sometimes driving one himself and using other drivers. Ali’s Trucking had no business premises apart from Trimac’s Hayward location, where Ali’s Trucking kept its tractors. Ali’s Trucking entered into a contract with Trimac, entitled “Lease Agreement Independent Contractor” (Lease Agreement) which designates Trimac as “Carrier” and Ali’s Trucking as “Independent Contractor.”

However the relationships among Trimac, Ali’s Trucking and Sheik operated quite differently in practice from the way their relationships are outlined in these contracts. Most significantly was the exercise of control over drivers. Although the Lease Agreement purported to place responsibility on the Independent Contractor for “selecting, hiring, firing, supervising, training, setting wages and working conditions” for their drivers and employees. But the way in which the operation actually worked reflects substantial Trimac involvement.

At the conclusion of a hearing on the employment issue, it was found that that Sheik Zahid Ali was an employee of Trimac.  It was further found that “[t]he legal relationship between Sheik Ali, Ali’s Trucking and Trimac was one of joint employment. Both employers had the right to direct and control Sheik Ali’s activities while he was at work on the joint enterprise of transporting materials for Trimac and Ali’s Trucking and that Trimac not only had the right to control, it affirmatively exercised that control. Trimac appealed this finding.

The WCAB and the Court of Appeal affirmed in the unpublished case of Lexington Insurance Co. v. WCAB (Ali).

The seminal case of Borello and Sons, Inc. v. DIR (1989) 48 Cal.3d 341 acknowledged that the right to control work details is the primary consideration. Ultimately, Lexington’s arguments must fail because it has fallen short of demonstrating that the decision is unsupported by substantial evidence or that, as a matter of law, all commercial truck drivers whom a transportation company designates as “independent contractors” are necessarily so.