Category: Daily News

The California Attorney General’s office announced the arrest of and filing of charges against Dr. Arash Malian Padidar, a Santa Clara County physician with an office located at 105 N Bascom Ave Ste 104 San Jose, CA 95128.

He is accused of illegally prescribing opioids to patients. The arrest and charges are the result of an investigation into an alleged two-years-long illegal prescription scheme by the California Department of Justice (DOJ). Padidar was arrested by DOJ agents and booked into the Santa Clara County Jail.

DOJ investigators found that Padidar’s illegal prescription scheme was carried out between October 2018 and October 2020 and involved the highly addictive pain medication Norco. He is facing charges on seven felony counts, including for obtaining opioids by fraud, deceit and misrepresentation, issuing prescriptions without a legitimate medical purpose, forging the name of another physician who’s name he allegedly obtained, and issuing a prescription, unlawful use of personal information and conspiracy to commit a crime.

According to the allegations on the criminal complaint, Padidar wrote prescriptions that were given to an unnamed conspirator, who filled the prescriptions at several Wallgreen and other pharmacies, and then the unnamed coconspirator gave the pills back to Padidar.

Padidar’s alleged activity was uncovered when an employee who had helped with the scheme came forward a month or two after being fired by the doctor in July 2019, according to a criminal complaint filed with Santa Clara County Superior Court.

The investigation and arrest were conducted by DOJ’s Division of Medi-Cal Fraud & Elder Abuse (DMFEA), which was alerted to the alleged crimes by the DEA.

DMFEA protects Californians by investigating and prosecuting those who defraud the Medi-Cal program as well as those who commit elder abuse. These investigations are made possible only through the coordination and collaboration of governmental agencies, as well as the critical help from whistleblowers who report incidences of abuse or Medi-Cal fraud at oag.ca.gov/dmfea/reporting.

DMFEA receives 75% of its funding from HHS under a grant award totaling $53,792,132 for federal fiscal year 2022-2023. The remaining 25% is funded by the State of California. The federal fiscal year is defined as through September 30, 2023.

“Doctors are trusted with the immense responsibility of protecting our health and our lives,” said Attorney General Bonta. “When a bad actor exploits their position for personal gain, they not only shatter our trust, they harm vulnerable patients. Let today’s arrest serve as a warning: The California Department of Justice will not tolerate abuses of power and will hold perpetrators accountable.”

“This investigation focused on a trusted member of the medical community who allegedly utilized forgery and fraud to obtain highly addictive opioids for his own personal benefit,” said Drug Enforcement Administration (DEA) Special Agent in Charge Brian M. Clark. “Healthcare professionals have a duty to prescribe controlled substances in a manner that ensures the well-being of the public. DEA will continue to keep communities safe and healthy by holding those accountable who put them in harm’s way. I want to thank CA DOJ Division of Medi-Cal Fraud and Elder Abuse and DEA Diversion for their exceptional work in this investigation.”

Hospital acquisitions have consolidated care into fewer and larger health systems. From 2000 to 2020, the share of hospital beds that are part of health systems has risen from 58 percent to 81 percent nationally. A quarter of hospital markets no longer had any independent hospitals by 2020.

A new study published by Elevance Health describes how prices, costs, and quality change when previously independent hospitals are acquired by systems.

Hospital care is the largest segment in the $4.3 trillion U.S. healthcare sector, with $1.3 trillion in annual spending. Despite a decline in inpatient volume over the last decade, hospital spending as a share of the sector increased from 30 to 31 percent over this time.

Most prior studies did not have access to negotiated prices between plans and hospitals, and therefore had to rely on average prices inferred from accounting data reported to the federal government. However, recent work has shown that these imputed prices are only weakly correlated with true prices. As a result, the new study draws conclusions about efficiency gains of the hospitals. Prior studies have not comprehensively evaluated the impact of efficiency gains for independent hospitals after acquisition.  

Hospitals experienced large cost efficiencies and higher revenues after system acquisition.

– – Operating expenses declined by 6 percent, above market trend, at the acquired hospital following system ownership, without any offsetting increase in costs at the acquirer system.
– – Reductions in personnel spending accounted for about 60 percent of the total decline in operating costs.
– – Independent hospital acquisitions by hospital systems increased average inpatient prices for commercially insured patients by 5 percent above market trend, holding procedure intensity constant.
– – Across the top seven Major Diagnostic Categories by volume, prices increased 5-8 percent, with digestive, infectious diseases, labor & delivery, respiratory, and the circulatory system experiencing the largest price increases.
– – The size of the acquiring system size did not seem to matter with respect to price increases at the acquired hospital, suggesting that price increases were uniform at acquired independent hospitals.

Hospital quality declined following acquisition, leading to worse outcomes for patients.

– – For Elevance Health’s affiliated members receiving cardiac care, readmission rates increased by 10-12 percent and remained elevated for three years after the acquisition.
– – Readmission rates for Medicare patients admitted with acute, non-deferrable conditions conservatively increased by 2-3 percent.
– – Acquired hospitals that experienced greater staff reductions experienced greater readmission rate increases, suggesting the reduction in personnel may be a contributing factor.

Access to care was generally reduced for patients at acquired hospitals.

– – The study observed the closure of maternity wards, which were concentrated in rural hospitals.
– – Given aforementioned price increases and staff reductions, one could expect a decrease in hospital patient volume, however the study did not detect a change.
– – Access to medical technology did not change after acquisition.

The Study Authors conclude by saying “This brief highlights that independent hospital mergers have negative consequences for insurers, employers, and consumers. Specifically, payers and patients are exposed to higher prices without a commensurate increase in quality of hospital care.”

“Further, access to care does not improve, with acquired systems no more likely to expand access to medical technology or services. Instead, patients are likely to experience a reduction in access to maternity wards and reduction in staff. As hospital mergers continue to occur at a high rate, it is important that stakeholders understand their implications.”

According to a new report – “The Future of Workplace Safety Technology Is Now” – just published by the National Council on Compensation Insurance (NCCI) technology, part 1 of a 3 part report, the workplace, and the role of workers are changing more dramatically today and at a faster pace than ever before.

Along with shifting jobs and evolving workplaces come new and changing exposures to worker injuries. Questions continue to arise about the status and evolution of safety technologies. In fact, some insurers are testing or discussing these technologies, and in some cases, providing them to their customers/policyholders.

Based on interviews with multiple workers compensation insurers, safety technology vendors/suppliers, and insureds, this series is a presentation of perspectives from various stakeholders. In this article, the first installment of NCCI’s series it explores carrier viewpoints on the latest trends in safety technology.

The safety technology industry has evolved since NCCI published its first article on this topic in 2019. The four insurers that it interviewed for this article are currently using or exploring multiple types of safety technologies, including wearables, Artificial Intelligence (AI)/Computer Vision, the Internet of Things (IoT), software applications, and drones.

Key insights include:

– – Insurers are exploring multiple types of advanced safety technologies and are at various stages of implementation
– – Back injury prevention is a common focus for new workplace safety technology; however, applications are available to address many other injury types
– – Manufacturing, warehousing, and logistics industries are mentioned as principal target industries for modern safety solutions
– – An employer culture of “safety and trust” is seen as critical to the adoption and sustainable use of advanced safety technologies
– – Integrating workplace safety and operational efficiency may result in wider adoption of safety technologies
– – More testing and analysis are needed to fully quantify the value of modern workplace safety technologies
– – Safety technologies are deemed to be a “game-changer” by some industry experts; all interviewees see these technologies playing a major role in the future of worker injury prevention

For example, the report said that Drones, also known as Unmanned Aircraft Systems (UAS), can evaluate certain exposures without putting workers at risk for injury. Drones can evaluate roofing conditions and cell phone towers, as well as monitor air quality in confined spaces.

When asked if safety technology is a “game-changer,” the responses varied, ranging from “It can be ” – to “Absolutely.” Safety technology was mentioned as a potential differentiator to offer higher service and value. It was also noted that “safety technology will point out problems but may not point out solutions. But pinpointing the problem could lead to a solution.”

Part 1 of The Future of Workplace Safety Technology Is Now is available at no charge on the NCCI website.

An influential bipartisan group of U.S. Senators sent letters to regulators within the U.S. Treasury for detailed information on nonprofit hospitals’ reported charity care and community investments. This is a sign of legislators’ increasing scrutiny of tax-exempt hospitals‘ business practices

Sens. Elizabeth Warren, D-Massachusetts, Raphael Warnock, D-Georgia, Bill Cassidy, M.D., R-Louisiana, and Chuck Grassley, R-Iowa, wrote they “are alarmed by reports that despite their tax-exempt status, certain nonprofit hospitals may be taking advantage of this overly broad definition of ‘community benefit’ and engaging in practices that are not in the best interest of the patient.”

Back in February 2018, Grassley and then-Chairman Orrin Hatch of Utah pressed the IRS for information on enforcement practices and compliance data on non-profit hospitals. In May 2018 he received a “Report to Congress on Private Tax-Exempt, Taxable, and Government-Owned Hospitals” which documented some decline in charity care provided to qualified patients in their geographical care.  

And now the newest round of letters to the IRS outlined studies from academic and policy groups highlighting that the tax-exempt status of the nation’s nonprofit hospitals collectively was worth about $28 billion in 2020 and how this tally paled in comparison to the charity care most of those hospitals had provided during that same period.

For example, Nonprofits like Allina Health System, which runs more than 100 hospitals and clinics in the Midwest and rakes in $4 billion in revenue annually, get tax breaks in exchange for providing care to the poor. In 2020, the health system avoided $266 million in taxes thanks to its nonprofit status, according to the Times reporting, citing data from the Lown Institute, a think tank that studies health care. The health system spent less than half of 1% of its expenses on charity care, whereas the national average is about 2%, according to an analysis of hospital financial filings published in Health Affairs.

At the center of the tax debate is what counts as community care and charity to qualify for tax exemption under IRS guidelines. For instance, 82% of nonprofit hospital systems spent less on community programs than the value of their tax exemptions in 2019, according to a Lown Institute report. The American Hospital Association disputed that analysis claiming Lown ignored a range of community investment categories in its math. Lown research said that was intentional – because many of those categories should not count.

Federal law does not say how much community benefit hospitals have to provide, but they do have to report their spending to the IRS each year, broken down by free and discounted care, unreimbursed care from government programs, and public health programming. And claims of abuse of the vagueness of the tax law have been quickly contested by the hospital lobby, which highlights that charity care is just one component of the broader activities that constitute a nonprofit hospital’s community benefit spending.

However, that ambiguity was squarely in the crosshairs of the legislators authoring this newest round of inquiry, who said the long-standing community benefit standard “is arguably insufficient in its current form to guarantee protection and services to the communities hosting these hospitals.”

They said we “are alarmed by reports that despite their tax-exempt status, certain nonprofit hospitals may be taking advantage of this overly broad definition of “community benefit” and engaging in practices that are not in the best interest of the patient. These practices – along with lax federal oversight – have allowed some nonprofit hospitals to avoid providing essential care in the community for those who need it most.”

A 2020 report by the GAO found that the “lack of clarity” around what constitutes community benefits makes IRS’ oversight of nonprofit hospitals “challenging.”In response, GAO made specific recommendations to the IRS to further increase transparency and ensure nonprofit hospitals are meeting their community obligations.

Since the report’s publication in September 2020, the IRS has implemented several of GAO’s recommendations: creating a “well-documented process to identify hospitals at risk for noncompliance with the community benefit standard,” adjusting the Form 990 Schedule H instructions to ensure more relevant responses, and establishing specific audit codes to better identify potentially noncompliant institutions.

Yet the Senators complain in their letter that “more is required to ensure nonprofit hospitals’ community benefit information is standardized, consistent and easily identifiable.”

Ronald Hittle was an at-will employee of the City of Stockton and served as the City’s Fire Chief from 2005 through 2011.

In May 2010, the City received an anonymous letter purporting to be from an employee of the Stockton Fire Department. The letter described Hittle as a “corrupt, racist, lying, religious fanatic who should not be allowed to continue as the Fire Chief of Stockton.” The source of this information was not an anonymous individual, but later established as a high-ranking Fire Department manager.

The City hired an outside independent investigator, Trudy Largent, to investigate various allegations of misconduct. In a 250-page report referencing over 50 exhibits, Largent sustained almost all of the allegations of misconduct against Hittle. This investigation ultimately led to his termination by the City.

Largent’s Report specifically concluded that Hittle: (1) lacked effectiveness and judgment in his ongoing leadership of the Fire Department; (2) used City time and a City vehicle to attend a religious event, and approved on-duty attendance of other Fire Department managers to do the same; (3) failed to properly report his time off; (4) engaged in potential favoritism of certain Fire Department employees based on a financial conflict of interest not disclosed to the City; (5) endorsed a private consultant’s business in violation of City policy; and (6) had potentially conflicting loyalties in his management role and responsibilities, including Hittle’s relationship with the head of the local firefighters’ union.

Hittle sued the City, former City Manager Robert Deis, and former Deputy City Manager Laurie Montes claiming that his termination was in fact the result of unlawful employment discrimination in violation of Title VII of the Civil Rights Act of 1964 and California’s Fair Employment and Housing Act. Hittle alleged that Deis and Montes terminated his employment as Fire Chief “based upon his religion.”

Defendants moved for summary judgment seeking dismissal of all of Hittle’s claims. Hittle subsequently cross-moved for partial summary judgment as to his federal and state religious discrimination claims on April 1, 2021. On March 1, 2022, the district court denied Hittle’s motion and granted Defendants’ motion as to all of Hittle’s claims. The 9th Circuit Court of Appeals affirmed in the published case of Hittle v City of Stockton -22-15485 (August 2023).

The panel held that, in analyzing employment discrimination claims under Title VII and the California FEHA, the court may use the McDonnell Douglas Corp. v. Green burden-shifting framework – 411 U.S. 792 (1973) – under which the plaintiff must establish a prima facie case of discrimination.

The burden then shifts to the defendant to articulate a legitimate, nondiscriminatory reason for the challenged actions.

Finally, the burden returns to the plaintiff to show that the proffered nondiscriminatory reason is pretextual. Alternatively, the plaintiff may prevail on summary judgment by showing direct or circumstantial evidence of discrimination.

Hittle was required to show that his religion was “a motivating factor” in defendants’ decision to fire him with respect to his federal claims, and that his religion was “a substantial motivating factor” with respect to his FEHA claims.

The panel concluded that Hittle failed to present sufficient direct evidence of discriminatory animus in defendants’ statements and the City’s notice of intent to remove him from City service. And Hittle also failed to present sufficient specific and substantial circumstantial evidence of religious animus by defendants. On summary judgment, circumstantial evidence of discrimination “must be ‘specific’ and ‘substantial'”

“The district court’s grant of summary judgment in defendants’ favor was appropriate where defendants’ legitimate, non-discriminatory reasons for firing Hittle were sufficient to rebut his evidence of discrimination, and he failed to persuasively argue that these non-discriminatory reasons were pretextual.”