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Labor Department Survey Shows Reduction in Telework

The U.S. Bureau of Labor Statistics reported that in August and September 2022, 27.5 percent of private-sector establishments (2.5 million) had employees teleworking some or all the time.

Industries with the highest percent of establishments employing teleworkers were information (67.4 percent), professional and business services (49.0 percent), educational services (46.0 percent), and wholesale trade (39.0 percent).

Data in this release are from the 2022 Business Response Survey (BRS). BRS data were collected from private-sector establishments from August 1, 2022, through September 30, 2022. The survey’s topics included telework at establishments both at the time of the survey and before the COVID-19 pandemic, hiring by establishments in July 2022, and job vacancies at establishments at the time of the survey. Detailed tables by industry, state, and establishment size are available at www.bls.gov/brs.

Telework at private-sector establishments

– – The percent of establishments with employees teleworking changed over the last year. In August-September 2022, 72.5 percent of establishments had little or no telework, compared to 60.1 percent in July-September 2021.
– – The percent of establishments with some (but not all) employees teleworking was 16.4 percent in 2022, compared to 29.8 percent in 2021.
– – The percent of establishments with all their employees teleworking all the time was about the same – 11.1 in August-September 2022, compared to 10.3 percent in July-September 2021.
– – In August-September 2022, 95.1 percent of establishments (including those that did and did not have telework) expected the amount of telework at their establishment to remain the same over the next 6 months.

Private-sector new hires in July 2022

– – Nationwide, 22.4 percent of establishments hired new employees in July 2022.
– – In July 2022, 7.3 percent of establishments increased starting pay, and 5.4 percent expanded advertising to attract more applicants to newly filled positions. Among the other methods used by establishments to attract more applicants were: starting to use recruiters/talent agencies (2.4 percent); offering hiring bonuses (1.9 percent); reducing the job’s qualifications, such as education or experience (1.3 percent); expanding benefits (1.2 percent); offering more hours (1.0 percent); and expanding telework or remote work (0.7 percent).
– – In July 2022, 2.4 percent of establishments hired at least one employee who will telework all the time.
– – Nationally, 7.0 percent of establishments took more than 30 days to fill at least one open position. The percentage of establishments with positions that took more than 30 days to fill varied by industry. The industries most likely to take more than 30 days to fill positions were accommodation and food services (14.9 percent), health care and social assistance (12.3 percent), and manufacturing (11.1 percent). The industries with the lowest percentage of positions that had been filled after having been open for more than 30 days were natural resources and mining (3.9 percent), information (4.1 percent), and financial activities (4.4 percent).

Private-sector job vacancies in August-September 2022

– – Nationwide, 20.9 percent of establishments had vacancies they were attempting to fill when they were surveyed in August-September 2022, and 40.5 percent had vacancies within the 12 months prior to the survey (August 2021-September 2022).
– – In August-September 2022, 3.1 percent of establishments had at least one vacancy eligible for telework all the time.
– – Nationwide, 12.3 percent of establishments had at least one vacancy open for more than 30 days.
– – The percentage of establishments that had a vacancy open for more than 30 days varied by industry, ranging from 6.9 percent in natural resources and mining to 20.2 percent in accommodation and food services.
– – How establishments advertised their vacancies varied by the educational requirements of the position. Nationwide, 13.4 percent of establishments used online job boards or hiring platforms to advertise positions requiring a bachelor’s degree or higher, while 24.1 percent did so for positions that did not require a bachelor’s degree or higher.

City of L.A. Retail Industry Fair Work Week Ordinance Starts April 1

The City of Los Angeles recently joined Berkeley, San Francisco and Emeryville, Calif.; New York City; Philadelphia; Chicago; Seattle; Euless, Texas; and Oregon as jurisdictions that have enacted fair workweek legislation.

Starting April 1, 2023, Los Angeles retail businesses with at least 300 employees will need to comply with a new Fair Work Week Ordinance (FWWO). The FWWO provides a 180-day implementation period, and the City will not impose penalties or fines on Employers for violations that occur before September 28, 2023. However, during the 180-day period, an Employee or the OWS may bring a potential violation to an Employer’s attention and the Employer will be required to correct any actual violations (including curing the failure to pay Predictability Pay).

However, the City cannot guarantee how a Court might adjudicate a private civil action during the first 180 days after the Ordinance becomes effective.

The City of Los Angeles Fair Work Week Ordinance Frequently Asked Questions (Updated as of 3/15/2023) provides some information about how this new Ordinance works.

A covered Employer must satisfy all of the following criteria: – Identifies as a retail business in the North American Industry Classification System (NAICS) under Retail Trade categories 44-45;  – Has at least 300 employees globally; and – Exercises control (directly or indirectly) over the wages, hours or working conditions of any Employee.

A retail business is any business whose principal North American Industry Classification Systems (NAICS) code is within the retail trade categories and subcategories 44 through 45. If the business has more than one unique line of business and identifies with more than one NAICS code, the OWS will consider the NAICS code that corresponds with the business’s principal business activity, which is the activity that the business derives the largest percentage of its total receipts.

Regardless of where an Employer is located, the FWWO applies to a covered retail Employee who performs at least two hours of work in a particular week within the City of Los Angeles.

To determine if a workplace or job site lies within the City limits, you may use Neighborhood Info (http://neighborhoodinfo.lacity.org/). Follow the exact instructions of this website. If an address is located within the boundaries of the City of Los Angeles and is correctly entered, then the search will locate the address on the map with detailed address information.

The FWWO may not apply to a retail employee who is traveling through the City with no employment related stops. Time spent in the geographic boundaries of the City solely for the purpose of traveling through Los Angeles (from a point of origin outside Los Angeles to a destination outside Los Angeles) with no employment- related or commercial stops in Los Angeles except for refueling or the Employee’s personal meals or errands is not covered by the FWWO.

Before hiring an Employee, an Employer shall provide each new Employee a written good faith estimate of the Employee’s Work Schedule. The good faith estimate shall notify a new Employee of their rights under this Ordinance. In the alternative, the Employer may provide the new Employee with a copy of the poster required by Section 185.11.

An Employer shall shall also provide a written good faith estimate of an Employee’s Work Schedule within ten days of an Employee’s request.

.A good faith Work Schedule estimate shall not constitute a binding, contractual offer. However, if an Employee’s actual work hours substantially deviate from the good faith estimate, an Employer must have a documented, legitimate business reason, unknown at the time the good faith Work Schedule estimate was provided to the Employee, to substantiate the deviation.

An Employer shall provide an Employee with written notice of the Employees’ Work Schedule at least 14 calendar days before the start of the work period by posting the Work Schedule in a conspicuous and accessible location where Employee notices are customarily posted and visible to all Employees; or transmit the Work Schedule by electronic means or another manner reasonably caleulated to provide actual notice to each Employee.

Employees are entitled to premium pay in the event there are changes to their schedule. And there is a list of exceptions that prevent the requirement for premium pay.

Before hiring a new Employee or using a contractor, temporary service or staffing agency to perform work, an Employer shall first offer the work to current Employees if one or more of the current Employees is qualified to do the work as reasonably determined by the Employer; and the additional work hours would not result in the payment of a premium rate under California Labor Code Section 510.

An Employee who believes a violation has occurred must inform the Employer in writing of the suspected violation, along with supporting documentation. Employers have 15 calendar days from the receipt of this notification to take action to cure any violations.

Employers should cure the alleged violations and provide applicable restitution to Employees or be able to demonstrate they are in the process of curing the alleged violations at the end of the cure period. An example would be a written commitment by the Employer to cure previously overlooked Predictability Pay in an Employee’s next paycheck, which may be issued outside the 15-day cure period.

This is just a brief summary of some of the essential provisions of the new FWWO. Thus retail employers who are subject to the new Ordinance should carefully read the full Ordinance, the accompanying FAQ, and other resources such as the Society for Human Resources Management (SHRM) or legal counsel.

San Diego Doctor Pleads Guilty to $2M Insurance Fraud

48 year old Dr. Michael Villarroel, a U.S. Navy doctor who lives in Coronado, pleaded guilty admitting that he and others conspired to defraud the Navy by faking or exaggerating injuries to obtain insurance payments intended to help service members recovering from traumatic injuries. Villarroel acknowledged he knew the claimed injuries were false or exaggerated but signed off on applications for a share of the insurance payments.

Participants in the scheme obtained about $2 million in payments from the Traumatic Servicemembers Groups Life Insurance (TSGLI) program which is funded by service members and the Navy. Villarroel personally obtained more than $180,000 in kickbacks.

Villarroel admitted that from 2012 to at least December 2015, he conspired to commit wire fraud with Christopher Toups, a chief petty officer construction mechanic in the Navy; Kelene Meyer, Toups’ spouse and a nurse; and others. Toups prodded other service members to submit claims, told them to provide medical records to Meyer, requested part of the insurance payment in return, and distributed shares to Meyer and Villarroel. Meyer used her medical background to falsify or doctor supporting records to reflect fake or exaggerated injuries.

Villarroel claimed to have reviewed medical records and verified disabilities consistent with the injuries as needed for claims to be processed and qualify. At times Villarroel supported his determination by falsely stating he interviewed the claimant. At other times Villarroel gave Meyer medical records belonging to others to use in fabricating claims. Toups paid Villarroel in cash and by cashier’s check and, at points, Villarroel conducted transactions in amounts under $10,000 to evade currency transaction reporting requirements.

Villarroel is the tenth defendant to plead guilty to crimes committed under the scheme. Several conspirators were members of Explosive Ordinance Disposal Expeditionary Support Unit One (“EOD ESU One”), based in Coronado, California.

“Dr. Villarroel defrauded the Navy and the U.S. taxpayer by participating in a reprehensible scheme to wrongly obtain more than $2 million that should have been directed to wounded service members,” said Acting Special Agent in Charge Michael D. Butler II of the NCIS Economic Crimes Field Office. “NCIS and our partners remain committed to investigating all allegations of fraud that harms Department of the Navy service members and their families.”

“Dr. Villarroel abused his position of trust to enrich himself and his co-conspirators,” said Special Agent in Charge Stacey Moy of the FBI’s San Diego Field Office. “As a medical doctor and Naval Commander, Dr. Villarroel is held to a higher standard which makes this scheme to defraud the Traumatic Service Members Group Life Insurance program even more egregious. The FBI would like to thank our partners at Veterans Affairs – Office of Inspector General and Naval Criminal Investigative Service for their tremendous partnership on this case.”

“Fraudulently filing claims for unearned TSGLI benefits diverts compensation from deserving service members who suffered serious and debilitating injuries while on active duty,” said Special Agent in Charge Rebeccalynn Staples of the Department of Veterans Affairs Office of Inspector General’s Western Field Office.  “The VA OIG thanks the United States Attorney’s Office and our law enforcement partners for their efforts in bringing this defendant to justice.”

Villarroel is scheduled to be sentenced on June 16 at 9 a.m. by U.S. District Judge Janis L. Sammartino.

WCIRB Study Shows Experience Rating Improves Workplace Safety

In the California workers’ compensation system, experience rating is a merit rating system with the primary statutory goal of providing a direct financial incentive for employers to promote a safe workplace.

An experience modification, also called an X-Mod, compares the claims history of one employer to the average expected of other employers of similar size in the same industry. All things equal, an X-Mod greater than 100 percent increases the cost of an employer’s workers’ compensation insurance, while an X-Mod less than 100 percent decreases an employer’s premiums.

The key assumption underlying experience rating is that some employers will respond to significant experience rating events. Specifically, becoming experience-rated or experiencing changes in X-Mods, especially increases that cross the 100 percent threshold, is assumed to incentivize employers to address emerging work-related hazards to lower premiums and promote a safer workplace.

However, there is limited research validating the efficacy of experience rating in promoting safety and reducing work-related injuries. Prior research tends to support the safety incentive of experience rating mostly based on aggregate injury data or using a proxy measure for the experience rating status of employers, but results were somewhat limited in scope and not always conclusive.

To further analyze the effectiveness of experience rating in reducing work-related injuries, the WCIRB conducted a study based on over a decade of employers’ loss and payroll experience and published X-Mods to evaluate the independent impacts of experience rating on work-related injuries. The study used regression modeling to better understand whether employers respond to significant experience rating events and take action to reduce work-related injuries.

Specifically, this study focused on two types of “shock” experience rating events that would potentially provide safety incentives to employers: an employer becoming initially qualified for experience rating and an increase in an employer’s X-Mod from below 100 percent to above 100 percent. This study also analyzed whether impacts of experience rating events vary by employer size and industry.

The key findings of the study include:

– – Qualification for experience rating led to a larger decline (-17%) in claim frequency for newly rated employers relative to non-rated employers of similar size and industry in the first year of experience rating. The impact on claim frequency persisted for the study period, three years after the first X-Mod was issued (Figure 4)
– – For experience-rated employers, an increase in X-Mods from credit (less than 100%) to debit (greater than 100%) is associated with a larger decline in the likelihood (-2%) of having any claims. The difference adjusts for employer size and industry sector and is statistically significant (Figure 5)
– – A credit-to-debit increase in X-Mods is also associated with larger declines in future claim frequency for experience-rated employers for three years after the X-Mod increase. The difference in claim frequency change is statistically significant and the difference grew to 8% by the third year after the X-Mod increase (Figure 6)
– – The construction, manufacturing and hospitality industries have a relatively high share of X-Mod eligible employers In these three industries, employers that had an increase in their X-Mods from credit to debit had a larger decrease in future claim frequency than other experience-rated employers whose X-Mods did not increase from credit to debit In particular, construction employers with an X-Mod increase had a larger decline (-15%) in claim frequency by the third year of the X-Mod change than other experience-rated construction employers of similar size (Figure 7)
– – The impact of a credit-to-debit X-Mod increase on future claim frequency varies by employer size While an X-Mod increase is associated with a larger decline in claim frequency for employers of all sizes, medium- sized employers1 appear to have the largest relative decline (-8%) in claim frequency (Figure 9)

The full report is available in the Research section of the WCIRB website.

P&C Insurers 2022 Underwriting Losses Soar and Net Income Shrinks

Key financial results for private U.S. property/casualty insurers significantly worsened in 2022 from a year earlier, according to preliminary results from Verisk, a global data analytics provider, and the American Property Casualty Insurance Association (APCIA).

The industry experienced a $26.9 billion net underwriting loss in 2022, more than six times the $3.8 billion underwriting loss in 2021. The underwriting loss was the largest the industry has seen since 2011.

Net income fell to $41.2 billion in 2022, compared to $62.1 billion a year earlier – a 33.6% decline.

In 2022, incurred losses and loss adjustment expenses grew 14.1% while earned premiums grew 8.3%. The combined ratio – a key measure of profitability for insurers – deteriorated as well, to 102.7% in 2022, from 99.6% in 2021.

Policyholders’ surplus recovered somewhat from Q3 2022’s $911.7 billion to $952.4 billion, but still remains below that of year-end 2021 driven primarily by the large amount of unrealized capital losses accrued during 2022. Insurers’ rate of return on average policyholders’ surplus, a measure of overall profitability, declined to 4.2% in 2022 from 6.4% in 2021.

Fourth Quarter Sees Continued Growth in Net Written Premiums

The industry’s net income fell to $10.3 billion in fourth-quarter 2022 from $19.8 billion in fourth-quarter 2021, and the annualized rate of return on average surplus fell to 4.4% from 7.9% a year prior.

Net written premiums rose $13.8 billion in fourth-quarter 2022, or 8.2%, compared to a year earlier. Net underwriting losses declined to $5.5 billion in fourth-quarter 2022 from $1.8 billion in gains a year earlier, and the combined ratio deteriorated to 104.0% from 100.0% a year prior.

The insurance industry is being hammered by increasing input costs, natural catastrophes, legal system abuse, and resistance in some states to adequate rates,” said Robert Gordon, senior vice president, policy, research & international for APCIA. “Insurers suffered a 14.1 percent increase in incurred losses and loss adjustment expenses (16.6 percent in Q4), contributing to a more than $76 billion contraction in insurers’ surplus at a time when loss exposures are rapidly growing. In 2023, insurers are faced with a significant challenge to close the rate gap in order to meet their growing cost of capital.”

“Hurricane Ian and the effects of inflation resulted in major losses for property insurers last year, while accident severity continued to plague personal and commercial auto lines,” said Neil Spector, president of underwriting solutions at Verisk. “To remain profitable in these challenging times, many insurers are looking for new ways to reduce expenses, increase efficiencies, and enhance the customer experience. And they’re finding help from an ecosystem of advanced technology and analytics that is growing every day.”

The results are based on annual statements filed with insurance regulators by private property/casualty insurers domiciled in the United States, including excess and surplus insurers and domestic insur­ers owned by foreign parents, and excluding state funds for workers’ compensation and other residual market insurers, the National Flood Insurance Program, foreign insurers, and reinsurers.

The figures are consolidated estimates based on reports accounting for about 94% of all business written by U.S. property/casualty insurers. All figures are net of reinsurance unless otherwise noted and occasionally may not balance due to rounding.

GPT-4 AI Technology Easily Passed the Multistate Bar Exam – What’s Next?

GPT stands for Generative Pre-trained Transformer (GPT), a type of language model that uses deep learning to generate human-like, conversational text. GPT-4 is the newest version of OpenAI’s language model systems. Its previous version, GPT 3.5, powered the company’s wildly popular ChatGPT chatbot when it launched in November of 2022.

GPT-4, the new multimodal deep learning model from OpenAI, has passed the Uniform Bar Exam, demonstrating an enormous leap for machine learning and proving that an artificial intelligence program can perform complex legal tasks on par with or better than humans, according to a new paper co-authored by Daniel Martin Katz, professor of law at Illinois Institute of Technology’s Chicago-Kent College of Law.

The Uniform Bar Examination (UBE) is coordinated by the National Conference of Bat Examiners, and is composed of the Multistate Essay Examination (MEE), two Multistate Performance Test (MPT) tasks, and the Multistate Bar Examination (MBE). It is uniformly administered, graded, and scored and results in a portable score that can be transferred to other UBE jurisdictions.

In a period of roughly four years, the leading large language model family (GPT) has progressed from zero percent on the Multistate Bar Exam for GPT-2 to nearly 76 percent on the Multistate Bar Exam in GPT-4. (The Multistate Bar Exam is the multiple-choice section of the Uniform Bar Exam.) Overall, the authors report a 297 Uniform Bar Exam score for GPT-4, which reflects passing the bar by a fairly comfortable margin. The highest threshold in the country is Arizona at 273 (Illinois is 266).

“GPT-4 represents a new frontier in AI’s role in the legal profession and society at large,” says Katz, who collaborated with the legal AI company Casetext and fellow researcher Michael Bommarito. “The bar exam is an interesting test for AI to pass because it highlights the prospect of such technology becoming a ‘force multiplier’ that expands access to legal services to all members of society, including those who couldn’t previously afford to hire a lawyer.”

Katz did predict that within a few years, perhaps even by the end of this year, large corporations like Microsoft and Google may start experimenting with offering AI legal services. Nothing that could replace an attorney in a courtroom – yet – but work that is typically performed by law researchers and paralegals, like compiling data or answering clients’ questions about the law.

GPT-4 scored a 75 percent on the bar exam, higher than the 68 percent average and good enough to place in the 90th percentile. In a previous paper that Katz co-wrote, GPT-3.5 scored a 50 percent and passed only two multiple choice portions of the bar exam, placing it in the 10th percentile.

In this test, GPT-4 not only took the multiple choice sections, but also the essays (worth 30 percent) and performance test (worth 20 percent). Although many have been skeptical about AI’s ability to pass sections that require generating language, GPT-4 did so by a significant margin, giving responses that were generally on par with the “representative good answers” provided by many state bars.

The latest GPT model also shows fewer “hallucinations,” in which an AI language model confidently asserts wrong answers that have no basis in reality.

Passing the bar exam requires the command of not just ordinary English, but of complex “legalese,” which is difficult even for humans. GPT’s rapid advancement in this field is sure to have wide implications for the legal profession.

Lawyers need to figure out how to really use these tools. And those that do, it’ll be a very positive thing for them. We’re sitting on the dawn of a major increase in potential capacity,” says Katz. “These are tools that allow you to more effectively do your work, so you need to learn how to use them to maximum efficacy.”

“I’m generally very optimistic about it,” said Matthew Shepard, a public defender and board member of the Chicago chapter of the National Lawyers Guild, which often provides pro bono counsel to arrestees and activists. “I think it will be helpful in assisting attorneys with filing motions and going through large quantities of discovery”

“Sounds like it could help out a lot of pro se litigants,” agreed Zane Thompson, a workers’ compensation attorney with the Chicago law firm Ganan & Shapiro.

MSP Manual Update Requires Providers to Identify and Bill MSAs

Under the Medicare law, as enacted in 1965, Medicare was the primary payer for services except those covered by Workers’ Compensation (WC). In 1980, Congress enacted the first of a series of provisions that made Medicare the secondary payer to certain additional primary plans. The purpose was to shift costs from the Medicare program to private sources of payment. These provisions are known as the Medicare Secondary Payer (MSP) provisions.

A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a financial agreement that allocates a portion of a workers’ compensation settlement to pay for future medical services related to the workers’ compensation injury, illness, or disease. These funds must be depleted before Medicare will pay for treatment related to the workers’ compensation injury, illness, or disease.

When Medicare is the secondary payer, the provider, physician, or other supplier, or beneficiary must first submit the claim to the primary payer. The primary payer is required to process and make primary payment on the claim in accordance with the coverage provisions of its contract.

A recent change to a Medicare Secondary Payer Manual brings Medicare Set-Asides into play for doctors and other medical service providers, who as of March 24 are obligated to direct bill those trusts.

According to an Allen Koba blog article on this development, just a year after Medicare’s Workers’ Compensation Medicare Set-Aside Reference Guide update strenuously emphasized the utility of MSAs in protecting Beneficiary entitlements post settlement, the Centers for Medicare and Medicaid Services now put MSA policy in motion with this recent directive.

This change is consistent with Medicare’s WCMSA policy and previous guidance that allocations of future medical expenses should be properly funded and spent down in order to protect entitlements. Previous versions of this Manual illustrated primary insurance as opposed to secondary insurance, but made no specific reference to Medicare Set-Asides.

Paramount to this change is the obligation to identify which Beneficiaries should have a Medicare Set-Aside, which can be accomplished through a series of direct inquiries to the patient as well as a review of the Common Working File for an indicator of a WCMSA’s existence. Medicare added Section 30.2.2.1 to chapter 3 of the Medicare Secondary Payer Manual, which includes the following:

– – Specific questions providers must ask every Medicare Beneficiary to determine whether a Medicare Set-Aside exists.
– – Details to check the HETS 270/271 response for a “w.” This indication notifies providers that a WCMSA record exists.
– – The process for billing Medicare as primary insurance upon Medicare Set-Aside exhaustion.

The key takeaway from this update is that providers are required to determine whether Medicare is a primary or secondary payer for each inpatient admission of a Medicare beneficiary and outpatient encounter with a Medicare beneficiary prior to submitting a bill to Medicare. It must accomplish this by asking the beneficiary about other insurance coverage.

Section 20.2.1 of the Update provides and outline of questions which provides important points of data to gather from Medicare beneficiaries that are helpful for providers to determine who has primary payment responsibility for a claim or set of claims by asking the questions upon each inpatient and outpatient admission

For more information or questions on this topic, please contact info@allankoba.com.

Congressman Seeks to Plug Fraudsters “Shocking Loophole”

A U.S. lawmaker is taking action after a Kaiser Health News investigation exposed weaknesses in the federal system meant to stop repeat Medicare and Medicaid fraud and abuse.

Rep. Lloyd Doggett (D-Texas) said he decided to introduce a bill in the House late last week after KHN’s reporting revealed what he called a “shocking loophole.”

The ability of fraudsters to continue billing Medicare for services is outrageous,” Doggett said. “This is an obvious correction that is needed to safeguard our system. Wherever there are large amounts of government money available, someone tries to steal it.”

KHN found a laundry list of weaknesses that allows people accused or convicted of fraud to easily sidestep bans imposed by federal officials. Among those gaps is the Centers for Medicare & Medicaid Services’ lack of authority to deny or revoke National Provider Identifier, or NPI, numbers after federal regulators have prohibited a person or business from receiving payments from government programs.

Doctors, nurses, other practitioners, and health businesses use the unique, 10-digit NPI numbers to bill and file claims with insurers and others, including Medicare and Medicaid.

Taking away the NPI would “be equivalent of prohibiting a practitioner from practicing in total,” Dara Corrigan, director of CMS’ Center for Program Integrity, wrote in an email response to questions about KHN’s investigation. CMS declined to comment on Doggett’s proposed legislation.

The bill, HR 1745, would give CMS the authority to deactivate NPIs tied to anyone convicted of waste, fraud, or abuse and whose name appears on the exclusions list kept by the Office of Inspector General for the U.S. Department of Health and Human Services. The proposed law would also require CMS to implement recommendations that the inspector general has made to improve NPI reporting and provider transparency.

This strikes me as what should be an easy bipartisan measure,” Doggett said, adding that he had presented the bill in a face-to-face meeting with Rep. Jason Smith (R-Mo.), who chairs the House Ways and Means Committee. Doggett also alerted that panel’s health subcommittee chair, Rep. Vern Buchanan (R-Fla.).

“They both talk about the need to eliminate fraud, and this is one modest but important way to do it,” Doggett said. Neither Smith’s nor Buchanan’s offices responded to requests for comment.

The OIG declined to comment.

Former Justice Department officials told KHN that repeat violators are savvy and find ways to circumvent the system. KHN examined a sample of 300 health care business owners and executives who are among more than 1,600 on the OIG’s exclusion list since January 2017. Journalists reviewed court and property records, social media, and other publicly available documents.

KHN found:

– – Eight people appeared to be serving or served in roles that could violate their bans;
– – Six transferred control of a business to family or household members;
– – Nine had previous, unrelated felony or fraud convictions, and went on to defraud the health care system;
– – And seven were repeat violators, some of whom raked in tens of millions of federal health care dollars before getting caught by officials after a prior exclusion.

Doggett’s bill is “a pretty smart step in the right direction in fixing this issue,” said John Kelly, a former assistant chief of health care fraud at the Department of Justice who is now a partner for the law firm Barnes & Thornburg. Kelly had previously recommended that NPIs should be “essentially wiped clean” when a person is on the exclusions list.

Kelly, who confirmed that Doggett’s office reached out to him after KHN’s investigation was published in December, said taking the NPI number away “certainly doesn’t eliminate all risk” but it’s a move “in the right direction.”

“If you want to bill Medicare, you have to have a valid NPI,” Kelly said.

Evidence in 17 YouTube Videos Leads to Insurance Fraud Arrest

A Southern California couple has been arrested after running a YouTube channel that had videos of them allegedly committing insurance fraud.

Christopher Phelps, 40, of Yucaipa, and his wife, Kimberly Phelps, 40, were arrested on multiple felony counts of insurance fraud, assault with a deadly weapon and child endangerment after the couple allegedly caused collisions in an attempt to collect insurance payouts. Christopher Phelps was previously arrested last month on similar charges.

The California Department of Insurance began an investigation after the San Bernardino County Sheriff’s Department became aware of a YouTube channel where dashcam videos of traffic collisions and rage road incidents were posted.

The investigation connected the channel to Christopher Phelps under the name “BLU3 GHO57.” The channel had approximately 162 dashcam videos of vehicle collisions, attempted or near collisions, road rage incidents, and other content involving the couple. In multiple incidents Christopher Phelps’ child is also in the vehicle.

The investigation discovered approximately 23 collisions documented on the channel which were linked to 17 insurance claims filed by Christopher Phelps and 42 videos related to road rage incidents and attempted collisions involving him. Several of the videos appeared to be intentional acts. The Department’s investigation included numerous search warrants, collecting and reviewing hours of videos, and attempting to locate additional victims through videos posted to Department social media accounts.

Last month, the Department was contacted by the San Bernardino County Sheriff’s Department after Christopher Phelps was involved in a suspicious collision, appearing to stop for no apparent reason and causing a truck pulling a trailer to rear-end his vehicle.

Shortly after the collision, he posted to YouTube a rear-facing dashcam video of the moments leading up to the collision. Department detectives responded to the area of the collision in Yucaipa and canvased the area for surveillance video and witnesses, which led to the earlier arrest. Following that arrest he posted bail and was released.

Christopher Phelps has been charged with six felony counts of assault with a deadly weapon, 11 felony counts of insurance fraud, and five felony counts of child endangerment. Kimberly Phelps has been charged with two counts of felony child endangerment and one count of felony insurance fraud. Christopher Phelps was previously charged with one felony count of assault with a deadly weapon and one felony count of causing a vehicle collision for the purpose of presenting a false claim following his arrest last month.

Department detectives arrested the couple in San Bernardino. Christopher Phelps was booked at the West Valley Detention Center and is being held on $500,000 bail. Kimberly Phelps was booked at the Central Detention Center and is being held on $500,000 bail.

The San Bernardino County District Attorney’s Office is prosecuting this case.

Carson CA Facility Closes After $838,800 Cal/OSHA Citations

Cal/OSHA issued 18 citations, including six citations for willful-serious violations, to Parter Medical Products, Inc. for failing to protect its employees from overexposure to ethylene oxide (EtO), a toxic chemical. A willful violation is issued when evidence shows that the employer committed an intentional and knowing violation. The penalties total $838,800 to date, and the status of the ongoing investigation remains “open.”

“Our inspection showed this was not an isolated incident of chemical overexposure to workers,” said Cal/OSHA Chief Jeff Killip. “The employer failed to take action to protect employees even after it knew that some of them were exposed to dangerous levels of ethylene oxide.”

Parter Medical Products, Inc. dba Parter Sterilization Services was founded in 1984, and uses ethylene oxide gas to sterilize medical devices. Chronic exposure to ethylene oxide is associated with cancer, reproductive effects and neurotoxicity. Its odor is undetectable to humans until the concentration exceeds hazardous levels.

On August 5, 2022, Cal/OSHA’s Process Safety Management (PSM) Unit opened an inspection at the Parter facility in Carson. The PSM Unit is responsible for inspecting refineries and chemical plants that handle large quantities of toxic and flammable materials. PSM’s inspection followed an investigation by South Coast Air Quality Management District, which referred the matter to Cal/OSHA.

Parter shut down its facility in August 2022 for several months while it made modifications to reduce outdoor ethylene oxide emissions.

However, Parter’s remediation efforts did not solve the employee-exposure issues indoors. When Cal/OSHA resumed its inspection in December 2022, it found that one employee was overexposed to ethylene oxide his entire shift. Under Cal/OSHA regulations, the permissible exposure limit for eight hours is no more than 1 ppm (parts per million). The employee’s exposure averaged 5 ppm during the shift and averaged 9 ppm during a three-and-a-half-hour period. Tests show Parter employees were exposed to ethylene oxide above the permissible limit from 2019 until 2022.

Cal/OSHA’s citations include violations for the employer’s failure to have an effective safety plan to evaluate and develop controls for hazards, failure to develop a respiratory protection plan as required, failure to monitor employee exposure, and failure to notify workers of exposure over the permissible limit for ethylene oxide.

Parter is located at 17015 Kingsview Avenue in Carson California. The Carson City Council unanimously voted in early 2022 to request air monitors be placed in various locations of the city to monitor air quality.

The City of Carson was advised by South Coast Air Quality Management District (AQMD) that an air pollutant discharge by Parter may constitute a health hazard late in July in the nearby industrial area.

South Coast AQMD has conducted multiple on-site inspections at the facility and conducted field operations in the surrounding area. On July 29, 2022, a Notice of Violation was issued to Parter for Public Nuisance in violation of agency Rule 402 and California Health & Safety Code § 41700. This violation was based on elevated EtO emissions detected through air monitoring efforts outside of the facility at an adjacent business.

South Coast AQMD is further investigating EtO emissions in the nearby residential communities and the agency is working with the City of Carson to identify additional locations to collect 24-hour samples in the nearest community and school. So far, data from residential monitors show EtO levels to be within typical background levels.

Parter had indicated their EtO equipment will remain shut down until additional air pollution controls can be implemented including the modifications and upgrades to air pollution control equipment and temporary enclosures. The facility has initiated the permitting process for the upgrades and South Coast AQMD will review and approve those applications as quickly as possible.

During South Coast AQMD’s monitoring efforts at several commercial EtO sterilization facilities, the agency became aware of fugitive emissions from sources that were not previously known. South Coast AQMD’s investigation has identified that existing pollution controls will need to be upgraded and measures will be needed to reduce fugitive emissions.

South Coast AQMD is working on amending Rule 1405 – Control of Ethylene Oxide and Chlorofluorocarbon Emissions from Sterilization or Fumigation Processes to strengthen requirements to address fugitive emissions, as well as provisions to further reduce EtO emissions from operations at these facilities.