Category: Daily News

Americans are over-diagnosed and over-treated for depression, according to a new study conducted at the Johns Hopkins Bloomberg School of Public Health. The study examines adults with clinician-identified depression and individuals who experienced major depressive episodes within a 12-month period. It found that when assessed for major depressive episodes using a structured interview, only 38.4 percent of adults with clinician-identified depression met the 12-month criteria for depression, despite the majority of participants being prescribed and using psychiatric medications.

“Depression over-diagnosis and over-treatment is common in the U.S. and frankly the numbers are staggering,” said Ramin J. Mojtabai, PhD, author of the study and an associate professor with the Bloomberg School’s Department of Mental Health. “Among study participants who were 65 years old or older with clinician-identified depression, 6 out of every 7 did not meet the 12-month major-depressive-episodes criteria. While participants who did not meet the criteria used significantly fewer services and treatment contacts, the majority of both groups used prescription psychiatric medication.”

Using a sample of 5,639 participants from the 2009-2010 United States National Survey of Drug Use and Health, Mojtabai assessed clinician-identified depression based on questions about conditions that the participants were told they had by a doctor or other medical professional in the past 12 months. The study indicates that even among participants without a lifetime history of major or minor depression, a majority reported having taken prescription psychiatric medications.

“A number of factors likely contribute to the high false-positive rate of depression diagnosis in community settings, including the relatively low prevalence of depression in these settings, clinicians’ uncertainty about the diagnostic criteria and the ambiguity regarding sub-threshold syndromes,” said Mojtabai. “Previous evidence has highlighted the under-diagnosis and under-treatment of major depression in community settings. The new data suggest that the under-diagnosis and under-treatment of many who are in need of treatment occurs in conjunction with the over-diagnosis and over-treatment of others who do not need such treatment. There is a need for improved targeting of diagnosis and treatment of depression and other mental disorders in these settings.”

After claiming for three years she damaged her hand desperately enough she was unable to even drive, a field worker pleaded guilty Tuesday to making false statements that allowed her to reap the benefits of workers’ compensation.

According to the story in the Salinas Californian, video surveillance capturing Ema Pantoja, 52, of Greenfield, performing activities inconsistent with her testimony provided the fodder necessary for the Monterey County District Attorney’s Office to file charges for insurance fraud, according to a release.

In January 2007, Pantoja alleged she sustained an injury to her left wrist and elbow while working in the fields owned by Scheid Vineyards. Although she received medical treatment and returned to work, by May 2007 Pantoja told an investigator she was unable to do anything with her lefthand, a premise she repeated to multiple doctors.

On May 7, 2008, Pantoja testified at a hearing about her physical limitations. She continued to receive medical treatment until May 2010.

Although Pantoja stated she couldn’t even drive and was forced to wear a wrist brace at all times, she was caught on tape performing impossible activities if her injury were true, according to the release.

She will be sentenced by Judge Larry Hayes on June 27. Insurance fraud as a felony carries a maximum penalty of five years in the California Department of Corrections and a fune of up to $150,000 or double the fraud amount. In addition, she may be on the hook for restitution which can include attorney’s fees and the cost of investigation.

Federal authorities have taken disciplinary action against a Las Vegas hospital cited for improperly sending newly released psychiatric patients by bus to neighboring California and other states in a practice called “patient dumping.” According to the story in Reuters Health, the Rawson-Neal Psychiatric Hospital was warned it was in violation of Medicare rules governing the discharge of patients and could lose critical funding under the federal healthcare insurance program if it failed to correct the problem. The notice came in a letter on Friday from the Centers for Medicare and Medicaid Services, an agency under the U.S. Health and Human Services Department, to the Southern Nevada Adult Mental Health Services agency, which is licensed to run the hospital for the state.

The letter said a March compliance survey, which remains confidential, “reported serious deficiencies” in discharge planning and governance. Rawson-Neal has until May 6 to furnish a plan to remedy the problems or face further actions to terminate its Medicare provider agreement, the letter said. Rufus Arther, a Medicaid operations branch chief for Nevada and California, said he was unable to quantify the exact amount of money at stake for Rawson-Neal.

Dr Tracey Green, Nevada’s top state health officer, estimated less than 10 percent of the hospital’s billings come from Medicare and none from Medicaid. Most of the hospital’s funding comes from the state, she said. “We are 100 percent confident that we will get the plan of corrections implemented and there will be no loss of federal funds,” she said. The hospital has tightened discharge policies to ensure patients released to other states have appropriate after-care treatment plans, Green said. She also said all psychiatric patients would from now on be chaperoned when the state pays to put them on Greyhound buses, planes or trains.

The hospital has faced increasing scrutiny since the Sacramento Bee newspaper documented in an investigative series that began last month that Rawson-Neal gave one-way Greyhound Bus tickets to up to 1,500 patients for destinations in California and 46 other states in the past five years. Some of those patients – how many remains the subject of multiple investigations – were put on buses without sufficient food, medicine or plans for housing and continued medical treatment. The Bee’s expose grew from its story about one particular discharge, that of James Flavy Coy Brown, 48, who was put in a taxi to a Greyhound Bus station with a ticket for a 15-hour ride to Sacramento in February and a three-day supply of pills to treat his schizophrenia, depression and anxiety. Staff at a Sacramento homeless shelter described him as arriving frightened and disoriented, without money or medication, though Brown eventually was reunited with a daughter from the East Coast who had not heard from him for years.

A state review of the matter led to discipline against two employees, and Nevada health and human services spokeswoman Mary Woods said earlier this week that an ongoing probe has uncovered violations of hospital policy in four or five discharges. While vowing to fully investigate the issue, Nevada Governor Brian Sandoval and state health officials have denied that illegal, out-of-state busing of patients is rampant or that the state condones or practices patient-dumping

Local officials in San Francisco and Los Angeles have said they are looking into the matter. The Bee found one-third of the patients given bus tickets went to California, the bulk of them arriving in Los Angeles, while 36 ended up in San Francisco.

CompWest Insurance has signed an agreement with Phoenix Risk Management Insurance Services, to write California health care workers’ compensation insurance program for specific classes in the health care industry.

Under the terms of the accord, CompWest will combine its underwriting, specialized loss control and integrated claim management services with Phoenix Risk Management’s significant experience in this particular segment to minimize injuries and reduce long-term insurance costs for policyholders.

The team will provide service-oriented, long-term, stable market for the growing health care industry for customers and retail agents.Targetting California operations with an annual premium between $75,000 and $500,000, the program aims a variety of classifications such as residential care for children, nursing homes, convalescent homes or hospitals and rest homes, physicians’ offices, residential care for elderly or adults and residential care for the developmentally disabled.

CompWest Insurance is part of the Accident Fund Holdings, which is a workers’ compensation insurance holding company conducting business through four operating units in the US – Accident Fund Cos., located in Lansing, Mich.; United Heartland, located in New Berlin, Wisc.; CompWest, located in San Francisco; and Third Coast Underwriters, located in Chicago. Accident Fund Holdings, Inc. is one of the largest privately held monoline workers’ compensation carriers in the country and is rated “A-” (Excellent) by A.M. Best. It is a wholly-owned subsidiary of Blue Cross Blue Shield of Michigan.

Early this month an Appeals Board significant panel decision held that where a lien claim falls within the lien activation fee requirements of Labor Code section 4903.06: (1) the lien activation fee must be paid prior to the commencement of a lien conference, which is the time that the conference is scheduled to begin, not the time when the case is actually called; (2) if the lien claimant fails to pay the lien activation fee prior to the commencement of a lien conference and/or fails to provide proof of payment at the conference, its lien must be dismissed with prejudice; (3) a breach of a defendant’s duty to serve required documents or to engage in settlement negotiations does not excuse a lien claimant’s obligation to pay the lien activation fee; and (4) a notice of intention is not required prior to dismissing a lien with prejudice for failure to pay the lien activation fee or failure to present proof of payment of the lien activation fee at a lien conference.

The facts of the case showed that a lien conference was set for January 9, 2013, at 8:30 a.m. and one of the lien claimants, Orthomed, did not appear at the conference. Because Orthomed did not submit proof of prior timely payment of the lien activation fee, and because the WCJ reviewed the record and determined that the lien activation fee had not in fact been paid, the WCJ dismissed Orthomed’s lien with prejudice, without first issuing a notice of intention. The WCAB sustained the dismissal in a case classified as a significant panel decision.

Significant panel decisions are not binding precedent. Their intent is to augment the body of binding appellate court and en banc decisions. A panel decision will be deemed significant if: (1) it involves an issue of general interest to the workers’ compensation community; and (2) all Appeals Board members review the decision and agree that it is significant. (Elliott v. Workers’ Comp. Appeals Bd. (2010) 182 Cal.App.4th 355, 361, fn. 3 [75 Cal.Comp.Cases 81]; Larch v. Workers’ Comp. Appeals Bd. (1999) 64 Cal.Comp.Cases 1098, 1099-1100 (writ den.).)

To ensure uniform application of the law concerning payment of the lien activation fee and consequences for failure to do so, the Appeals Board voted to grant reconsideration of the April 5 significant panel decision on Board motion (Lab. Code, § 5911; see also §§ 5900(b), 5906, 5315) and the Chairwoman of the Appeals Board, upon a majority vote of its members, reassigned this case to the Appeals Board as a whole for an en banc decision. (Lab. Code, § 115.)

Thus the WCAB sitting en banc rescinded the April 5, 2013 significant panel decision and issue a new en banc decision, Eliezer Figueroa v B.C. Doering Co., Employers Compensation Insurance Co that essentially reiterated the prior result. Now that the decision is en banc, it is binding authority in all trial level cases.