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The former campus cop seen in a viral video pepper-spraying student protesters will receive worker’s compensation totaling $38,059. The Davis Enterprise reports that John Pike, 40, of Roseville, reportedly suffered depression and anxiety brought on by death threats he and his family received after the Nov. 18, 2011, confrontation at an Occupy UC Davis encampment. Workers' Compensation Administrative Law Judge Harter approved the settlement agreement between Pike and the University of California on Oct. 16.

"This case has been resolved in accordance with state law and processes on workers’ compensation," said UC Davis spokesman Andy Fell in an email message. Sacramento attorney Jason Marcus, who represented Pike, declined to comment on Wednesday.

Bernie Goldsmith, a Davis lawyer supportive of the protesters, said that the settlement "sends a clear message to the next officer nervously facing off with a group of passive, unarmed students: Go on ahead. Brutalize them. Trample their rights. You will be well taken care of."

The state’s Disability Evaluation Unit determines permanent disability ratings based on doctors’ reports. Richard Lieberman, a Piedmont psychiatrist acting as the agreed-upon expert, rated Pike’s disability as "moderate," according to a Jan. 5 psychiatric report released by the state Department of Industrial Relations in response to a public records request. Pike faced "continuing and significant internal and external stress with respect to resolving and solving the significant emotional upheavals that have occurred" in his life and had not shown evidence of substantial improvement, concluded Lieberman, who spoke with Pike twice in 2012. A second psychiatrist, Bernard Bauer of San Francisco, blindly scored Pike’s responses on a battery of psychological tests.

Opponents of the settlement complain that Pike will get more money than those he pepper-sprayed. In January, UCD agreed to pay $1 million to settle a federal suit. Twenty-one plaintiffs who were sprayed or arrested were to receive $30,000 each. Another 15 who also had claims approved were to be paid $6,666 apiece.

Chief Matt Carmichael fired Pike in July 2012, following eight months of paid administrative leave. During that time, separate investigations came to different conclusions about how Pike responded when seated students, with their arms locked together, would not clear a path for officers leading away cuffed protesters. A public task force, led by former California Supreme Court Justice Cruz Reynoso, faulted both police and administrators for their roles in incident. Its investigation found that Pike did not need to use the pepper spray, at all, and that he used a spray not sanctioned for use by the department and that he doused the protesters from an unsafe distance. An internal affairs investigation resulted in a panel calling only for Pike’s suspension, according to a confidential report obtained by the Sacramento Bee.

At the time of his psychiatric evaluation, Pike was appealing his termination. UCD has not rehired him.

The former Marine will receive retirement benefits for his 11 years of campus employment. He was being paid an annual salary of $121,680 at the time he was fired.

Pike also ordered a second officer, Alexander Lee, to spray protesters. Citing state law and university policy, UCD has revealed no more about Lee. He also ceased to be employed by the campus in July 2012.

Carmichael’s predecessor, Annette Spicuzza, retired during the pepper-spray investigation.

UCD and its Police Department have undertaken reforms aimed at preventing similar confrontations with student protesters. This month, the campus has hosted public meetings gathering feedback on both a draft freedom of expression policy and a plan for an independent civilian oversight board for the department ...
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/ 2013 News, Daily News
A state workplace safety agency today announced it is resuming an investigation into a company building an elevator at the San Francisco 49ers' planned new stadium in Santa Clara where a man was killed in June. The San Jose Mercury News says that the California Division of Occupational Safety and Health reported it had rescinded its decision giving Schindler Elevator a notice that no violation occurred in the June 11 death of Donald White, Cal-OSHA spokeswoman Erika Monterroza said.

Cal-OSHA also revealed some new details in the probes of the deaths of White and Edward Erving Lake Jr., who died at the Levi Stadium construction site on Oct. 14. The $1.3 billion Levi Stadium project is to serve as the new home for the 49ers when it is completed next summer. The choice Cal-OSHA made Tuesday to revive its investigation into White's death came after "some questions were raised, so they are looking at the evidence," Monterroza said.

The agency, which is not releasing the new questions concerning the White investigation, had mailed Schindler the notice of no violation on Oct. 14, Monterroza said. The agency has until Dec. 11, six months after the accident that killed White, to complete the investigation and decide whether Schindler violated state safety codes, according to Monterroza.

Cal-OSHA can fine a company $7,000 for general and regulatory violations, $25,000 for a serious violation and from $5,000 to $70,000 for a willful violation of occupational safety codes, according to Greg Siggins, a Cal/OSHA spokesman.

White, 63, an experienced mechanic for subcontractor Schindler, was killed while standing beneath the counterweight of an elevator at the stadium site, according to Cal-OSHA public information officer Kathleen Hennessy. Cal-OSHA has since revealed that before the fatal accident, White "was in communication with the person operating the elevator and was aware the elevator was in operation, but did not move," Hennessy said.

"It's still somewhat of a mystery" why White did not move while knowing the elevator was coming down toward him, Hennessy said.

The investigation into Lake, an employee of subcontractor Gerdau Ameristeel, found that the 61-year-old truck driver was killed when a bundle of rebar being unloaded from his truck by a forklift fell off the side of his truck and on top of him, Hennessy said. The 30-foot-long bundle contained 30 pieces of steel rebar, used to reinforce concrete, Hennessy said.

"This is another open investigation," Hennessy said. "For the moment, no citations have been issued, but they might be."

Jonathan Harvey, project co-director for Turner Devcon, the stadium project's general contractor, said that Cal/OSHA had not released information to him about the investigations and so he could not comment ...
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/ 2013 News, Daily News
59 year of Jeff Thranow, of Aptos California, owner of Costa Bella Builders was sentenced on two felony counts of insurance fraud this week.

After paying almost $115,000 in restitution Thranow was then sentenced to an additional one year in jail.

Other Costa Bella employees were also sentenced for their role in the fraud. Vittorio Castelli was sentenced to 6 months in jail for one count of felony insurance fraud. Kathleen Castelli was sentenced for one misdemeanor count of insurance fraud and one count of failure to pay payroll taxes.

The California Department of Insurance, Morgan Hill Office, received information from employees about possible insurance fraud. CDI and investigators from the Santa Cruz County District Attorney Workers’ Compensation Fraud Unit secured search warrants for the business records of the company.

The joint investigation revealed multiple violations relating to the payment of insurance premiums and payroll taxes.

The Employment Development Department also joined in the investigation upon discovering the defendants' failure to pay payroll taxes to EDD. The investigation uncovered the company stopped paying payroll taxes and workers comp insurance and began paying employees in cash.

Defendants were ordered and paid $85,000 in premium restitution and back taxes of almost $30,000 at sentencing.

Employers are required to register their businesses and to report and pay taxes to EDD for all employees. Unemployment Insurance Code felony violations have a maximum penalty of three years in prison and/or up to $20,000 fine. Failure to secure workers’ compensation insurance has a penalty of up to one year in jail and up to double the amount of the premium owed as a fine payable to the California State Treasury for the Uninsured Employers Fund. The Workers’ Compensation Unit of the District Attorney’s Office investigates and prosecutes cases involving applicant fraud, employer fraud, premium fraud, provider fraud and employers who do not carry workers’ compensation insurance ...
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/ 2013 News, Daily News
On August 9, 2013, the WCIRB submitted its January 1, 2014 Regulatory Filing to the California Department of Insurance proposing changes to the Insurance Commissioner’s regulations contained in the California Workers' Compensation Uniform Statistical Reporting Plan - 1995 (USRP), the California Workers' Compensation Experience Rating Plan - 1995 (ERP), and the Miscellaneous Regulations for the Recording and Reporting of Data–1995 (Misc. Regs.). The Insurance Commissioner held a public hearing on September 30, 2013 to consider the proposed changes.

On October 17, 2013, the Commissioner issued a Decision approving all of the WCIRB’s proposed changes as filed. Among these changes approved effective January 1, 2014 are:
  • ;Numerous changes to the Standard Classification System contained in Part 3 of the USRP
  • Changes to data reporting requirements to conform to national data reporting specifications
  • Amendments to the audit rules to allow for the use of collective bargaining agreements to validate an employee’s hourly wage rate for dual wage classification assignment purposes
  • Amendments to facilitate the bifurcation of pure premium rate filings and regulatory filings
In addition, the Commissioner approved a number of regulatory changes to be effective on January 1, 2015 including amendments to the USRP pertaining to policy reporting requirements and significant amendments to the ERP limiting the impact on an employer’s experience modification of a single claim incurred during the experience period to 25 points.

The Commissioner’s Decision pertains only to the WCIRB’s January 1, 2014 Regulatory Filing and does not address the WCIRB’s January 1, 2014 Pure Premium Rate Filing which contains proposed changes to pure premium rates for 2014. The Commissioner has scheduled a public hearing regarding January 1, 2014 pure premium rates for October 28, 2013. See related story, Hearing Date Set for January 1, 2014 Pure Premium Rate Filing.

The WCIRB cannot issue experience modification for policies incepting January 1, 2014 and beyond until the Commissioner issues a Decision with respect to the pure premium rate filing.

The WCIRB is currently updating the USRP, ERP and Misc. Regs. to reflect the Commissioner’s Decision. Once completed, copies of these documents will be posted to the Publications and Filings section of In the interim, the WCIRB has created the Quick Reference Guide 2014 summarizing the approved changes to the regulations ...
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/ 2013 News, Daily News
The San Jose Mercury News reports that the CEO of a spinal implant company was convicted of overcharging the county and San Jose for workers' compensation reimbursements, prosecutors said.

Trudy Maurer, 68, is head of Implantium, a San Francisco-based company that purchases surgical implants from manufacturers and supplies them to hospitals. Implantium bills workers' compensation insurance carriers for the devices and is allowed by law to make $250 profit per device. According to prosecutors, the company altered invoices submitted to San Jose and Santa Clara County for workers' compensation claims, exaggerating the price paid to manufacturers of surgical spinal implants.

Santa Clara County prosecutor Katharina Wells said Maurer and another employee, Tigran Shahsuvaryan, were charged last April with the crimes.

Maurer pleaded no contest on Thursday to four counts of felony insurance fraud. She was fined $50,000 and given a six-month probationary sentence, during which she will be electronically monitored, according to court documents. Implantium previously returned $130,000 to the overcharged insurance companies.

After Maurer serves her sentence, the counts will be reduced to misdemeanors.

"Workers' compensation fraud impacts all employers in California, pushing rates higher," said prosecutor Katharina Wells.

The company overbilled insurance carriers for the cost of the implants, inflating the manufacturer's price by as much as tens of thousands of dollars, prosecutors said.

Santa Clara County and San Jose are self-insured for workers' compensation.

Prosecutors said it was one of the first such cases against a medical device supplier in the state.

Shahsuvaryan's case is still pending. Wells said he faces the same charges as Maurer ...
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/ 2013 News, Daily News
Swiss customs agents have seized one million fake tablets of anti-anxiety drug Xanax at the Zurich airport,authorities said on Friday. "Counterfeit medicine is one which is deliberately and fraudulently mislabeled with respect to identity and/or source," states the World Health Organization (WHO). "Counterfeiting can apply to both branded and generic products and counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging."

The counterfeit tablets, packed in four crates and weighing 400kg, had originated in China, according to Swissmedic, the Swiss Agency for Therapeutic Products. "Analyses in the Swissmedic laboratory revealed that the drugs, which are prescribed to treat symptoms of acute anxiety, contained no active ingredients whatsoever," Swissmedic said in a statement. The Swiss regulator said in June that it had already seized about 90 shipments this year representing a high-potential health risk. It also has ordered the shutdown of Internet websites trading drugs illegally. "According to experts, the drugs would be unrecognisable as counterfeits at a first glance." Xanax is a drug manufactured by Pfizer used to treat severe anxiety or panic disorder. The fake tablets were destroyed.

Developing countries are a massive market for counterfeit medications, a massive trade worth billions of dollars that is often deadly. According to the WHO, fake drugs range from antibiotics to birth-control medicines, anti-tetanus serums, antimalarials, organ transplant drugs, heart disease and diabetes. In parts of Asia, Africa and Latin America, fraudulent medicines are thought to amount to as much as 30 per cent of the market, according to the UN drug agency.

Also making up a large part of medicines sold online, fake medicines can contain the wrong dose of active ingredients or toxic substances such as rat poison, according to the UN drug agency.

Back in July 2012, Chinese police seized $182 million worth of counterfeit medicine in one month during a countrywide sweep. Drugs found during the seizure included medication for diabetes, high blood pressure, and even rabies. Unlike drugs found at the Zurich airport, most of the medication did contain harmful substances.

Governments are fighting to safeguard the distribution of legitimate drugs and crack down on counterfeit products. Systematic checks of medical shipments are carried out every year, and imports of bogus medicines have been declining in Switzerland, Swissmedic said in June. Counterfeit drugs generated an estimated $75 billion in revenue in 2010, according to the National Association of Boards of Pharmacy. Each year more than 100,000 people around the world may die from substandard and counterfeit medications, according to an estimate by Amir Attaran, an associate professor at the University of Ottawa, and Roger Bate, an economist at the American Enterprise Institute.

The United States has a growing problem with counterfeit drugs. In 2012, tainted steroids killed 11 people near Boston and sickened another 100. In another case, vials of the cancer medicine Avastin were found to contain no active ingredients. The vials were sourced in Turkey, shipped to Switzerland, then Denmark, finally to the United Kingdom from which they were exported to U.S. wholesale distributors. The Wall Street Journal reported that the U.S. wholesale distributor was hired by Canada Drugs, which also owns, a retail pharmacy website that sells prescription medication internationally, with a focus on the American market.

In 2007-08, 149 Americans died from a contaminated blood thinner called Heparin that was legally imported into the United States. Investigated by the FDA Office of Criminal Investigations, the Albers Medical investigation is the most prolific example to date.

On August 21, 2005, the U.S. Attorney’s Office for the Western District of Missouri issued a press release announcing that three businesses and eleven individuals were indicted for their involvement in a $42 million conspiracy to sell counterfeit, smuggled and misbranded Lipitor and other drugs and for participating in a conspiracy to sell stolen drugs. As part of this investigation, FDA initiated a recall of more than 18 million Lipitor tablets, which ranks as the largest recall in the history of criminal investigations of counterfeit medications. Participants in this scheme conspired to purchase and sell counterfeit, misbranded and illegally imported drugs. Foreign versions of Lipitor and Celebrex were smuggled into the U.S. from South America and re-sold after being re-packaged to conceal the true origin of the drugs. Counterfeit Lipitor also was manufactured in South America and then smuggled into the U.S. where it was co-mingled with the genuine foreign Lipitor and sold in the U.S.

In addition, participants conspired to buy, sell and traffic almost eight million dollars worth of stolen Glaxo Smith Kline and Roche drugs, using fake pedigrees to launder the drugs and thereby concealing that they were stolen. There also were charges related to the sale of counterfeit Procrit, as well as counterfeit and misbranded Serostim and Neupogen. Procrit is an injectable drug used in the treatment of anemia and Neupogen is an injectable drug used by cancer patients to stimulate the production of white blood cells in order to decrease the incidence of infections ...
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/ 2013 News, Daily News
An article in the Insurance Journal says it was an "interesting but quiet year" for California Lawmakers on Workers’ Comp. Bills signed by Gov. Jerry Brown included laws on pharmaceutical compounding, preventing out-of-state athletes from filling for workers’ comp, funding for the state’s prescription drug monitoring program and more. There were 17 total, according to a list compiled by the California Workers’ Compensation Institute (CWCI). But overall, it was a quiet year in terms of workers’ comp laws, as expected.

Pharmacy Billing (SB 146, Lara): Eliminates the requirement that copies of prescriptions be sent with requests for payment unless the provider entered into a written agreement to do so. Also enables any entity that was denied payment of a pharmacy bill submitted from Jan. 1 to March 31, 2014 to resubmit the bill if payment was denied for failure to include a copy of the prescription. It allows payers to request copies of prescriptions for a review of records of prescriptions dispensed by a pharmacy.

Electronic Transmittal of Policy Info (SB 251, Calderon): Allows insurers to electronically transmit offers of renewal, notices of conditional renewal and offers of coverage, and sets requirements for doing so.

Compounding Pharmacies (SB 294, Emmerson): Prohibits pharmacies without a California Sterile Compounding Pharmacy License from compounding or dispensing sterile drug products for injection, ocular administration or inhalation, and requires out-of-state pharmacies compounding these products for shipping to California to have such a license as well. Also requires the pharmacies to allow annual inspections and removes the option for accreditation from outside agencies.

SB 863 Technical Corrections (SB 375, Senate Labor Committee): Corrects erroneous cross-references included in Senate Bill 863 - including changing a reference to "administrative hearing" interpreters to "medical examination" interpreters - and making technical, clarifying, and conforming changes with respect to the provisions.

OSHA Standards - Meal/Rest/Recovery Periods (SB 435 Padilla): Applies Cal/OSHA’s heat illness prevention standard and other Cal/OSHA regulations to laws covering meal breaks and rest and recovery periods.

Paid Leave of Absence for San Diego Lifeguards (SB 527, Block): Enables full-time, year-round lifeguards employed by the City of San Diego to be eligible for “4850 leave” following a work injury.

Overprescribing Investigations (SB 670, Steinberg): Bolsters state medical board investigations of doctors suspected of overprescribing. Enables the board during investigations involving the death of a patient to inspect and copy the patient’s medical records by providing a written request declaring that after reasonable efforts, it is unable to locate or contact the patient’s beneficiary or representative. The bill also expands the definition of unprofessional conduct to include a physician’s repeated failure without good cause to be interviewed by investigators and allows an administrative law judge to issue an interim order limiting the physician’s authority to prescribe, furnish, administer or dispense controlled substances.

CURES (SB 809, DeSaulnier): Assesses an annual $6 fee on provider and dispenser licenses to fund the Controlled Substance Utilization Review and Evaluation System (CURES) monitoring program. The changes also require the state Medical Board to develop and distribute to physicians and acute care hospitals materials on assessing a patient’s risk of abusing or diverting controlled substances and information about CURES, and require the state to streamline the application and approval process for medical providers and pharmacists to access CURES.

Workers’ Compensation Death Benefits for Dependent Children (AB 607, Perea): Enables a deceased employee’s totally dependent children to receive workers’ comp death benefits irrespective of whether the employee’s surviving spouse is totally dependent.

Occupational Safety Standards for Hazardous Drugs (AB 1202, Skinner): Requires the Occupational Safety and Health Standards Board to establish safety and health standards for health care facilities with employees who work with or near antineoplastic drugs used in chemotherapy, which may cause rashes, infertility, miscarriages, and birth defects, and have been linked to a variety of cancers. The standards must be consistent with, but not exceed, National Institute for Occupational Safety and Health recommendations.

Limits on Workers’ Comp Claims by Professional Athletes (AB 1309, Perea): Restricts cumulative trauma and occupational disease claims by professional athletes in five sports (baseball, basketball, football, ice hockey and soccer), especially those who played for out-of-state teams, under specified conditions. According to the bill’s author, the California Insurance Guarantee Association has paid nearly $42 million in claims to professional athletes since 2002. An average of 34 new claims are being filed each month.

Interpreters (AB 1376, Hernandez): Delays DWC’s workers’ comp qualified medical interpreter certification regulations, required by SB 863, from taking effect until March 1, 2014.

State Compensation Insurance Fund Executive Appointments (AB 1394, Assembly Ins. Committee): Allows the State Fund Board of Directors to appoint a chief medical officer, a chief actuarial officer, a chief claims operations officer and a chief of internal affairs.

As for the next session or the next, both workers’ pundits expect to hear a growing cacophony from the chorus of workers’ comp stakeholders as the positive and negative impacts of SB 863 begin to be felt.
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/ 2013 News, Daily News
The City of Sierra Madre hires and fires volunteer firefighters, sets the rules and regulations for their work, requires them to work specific shifts and to arrive on time, and requires them to report to supervisors and to work within the framework of the Sierra Madre Fire Department (SMFD). Volunteer firefighters also receive training and are covered by workers’ compensation. The City keeps records of the volunteer firefighters’ service. It pays volunteer firefighters a stipend of $1 per day, paid every 90 days. It also pays voluntary firefighters approximately $33 per day when "hired out" with a SMFD strike team of firefighters sent to assist other agencies in fighting non-local large-scale fires. None of that was enough to make a volunteer firefighter an employee for DFEC discrimination claims according to a new case from the Court of Appeal.

In 2007 Kaylin Enriquez applied for a position as a firefighter for the SMFD, after completing her firefighter training. She was appointed to work as a probationary volunteer firefighter. After learning that she had been accepted to the training program she resigned from her other job with FirstMed Ambulance. Enriquez eventually completed her probationary period as a volunteer firefighter. On April 10, 2008 Enriquez began the background check procedure required for employment by the Sierra Madre Police Department (SMPD).

Meanwhile, Enriquez had witnessed incidents that several firefighters in the SMFD claimed involved sexual harassment. Enriquez then received a phone call from SMPD Chief Marilyn Diaz, who stated the police department was putting Enriquez’s employment on hold pending resolution of issues regarding Enriquez’s status with the SMFD.

On August 2, 2008 the SMFD issued Enriquez a disciplinary notice that wrongly accused her of ignoring an admonishment not to discuss her interview or the investigation with anyone but her "authorized representative." The notice stated that she had created an uncomfortable working environment by discussing the incidents with City staff. The notice stated that Enriquez was "[d]ishonest, [d]isobedient; [took a]ctions that adversely affected the safety of employees or others; . . . [engaged in h]arassment of fellow employees; [and engaged in v]iolation of any city policy." The City refused to remove the disciplinary notice after Enriquez explained inconsistencies and errors in the notice.

Enriquez’s prospective employment with the SMPD, originally scheduled to begin August 4, 2008, was postponed initially for six months and then indefinitely. The SMPD ultimately withdrew its employment offer "as a result of the Disciplinary Notice and subsequent action." At the end of 2009 Captain Kristine Lowe of the SMFD informed Enriquez via Facebook message that the SMFD was placing Enriquez on leave from her position as volunteer firefighter because she had not yet obtained her Emergency Medical Technician certification/accreditation (EMT certification). The EMT training requirement had not been enforced in the two years Enriquez had been a volunteer firefighter. Enriquez attempted to enroll in the first available EMT training course upon learning of the certification requirement, but all of the classes were full and there was no waiting list.

Enriguez filed a civil action with 22 causes of action. As to the employment-related causes of action (causes of action 1-20 and 22), the City argued that Enriquez did not receive "significant remuneration" for her services and therefore was not an employee and could not state causes of action for employment discrimination. The trial court sustained a demurrer without leave to amend. The Court of Appeal affirmed the dismissal in the unpublished case of Enriquez v. City of Sierra Madre.

The key legal issue on appeal was whether the plaintiff was an employee and therefore protected from wrongful termination and employment discrimination under FEHA. To satisfy the hiring prong of the thirteen factors articulated by the Supreme Court in Community for Creative Non-Violence v. Reid [1989], a purported employee must establish the existence of remuneration, in some form, in exchange for work. Individuals who are not compensated for their services are not employees for purposes of discrimination statutes. Substantial indirect compensation can satisfy the threshold requirement of remuneration. This can include state-funded disability pension, . . . survivors’ benefits for dependents, . . . scholarships for dependents upon disability or death, . . . bestowal of a state flag to family upon death in the line of duty, . . . benefits under the Federal Public Safety Officers’ Benefits Act when on duty, . . . group life insurance, . . . tuition reimbursement for courses in emergency medical and fire service techniques, . . . coverage under a Workers Compensation Act, . . . tax-exemptions for unreimbursed travel expenses, . . . ability to purchase, without paying extra fees, a special commemorative registration plate for private vehicles, . . . and access to a method by which [the volunteer firefighter] may obtain certification as a paramedic.

Enriquez argued that her receipt of workers’ compensation benefits was sufficient to give her employee status. The Court of Appeal decided that this was not enough. Enriquez did not receive any retirement, health care, insurance, tuition reimbursement or other similar benefits that would support a finding that she was an employee. The court in Estrada v. City of Los Angeles (2013) 218 Cal.App.4th 143, which involved a volunteer reserve police officer, recently rejected the argument that receipt of workers’ compensation benefits alone confers employee status in a DFEH claim ...
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/ 2013 News, Daily News
The workers’ compensation office in Goleta - the only one in the county and open since 1999 - is being closed on November 30 with all of its clients and employees transferred to the Oxnard branch. The state’s Department of Industrial Relations (DIR) announced the decision last month.

At the City Council meeting of October 1, 2013 Goleta Mayor Aceves sought Council concurrence to agendize a letter opposing the proposed closure of the local Division of Workers’ Compensation District Offices by the State Department of Industrial Relations (DIR).

The agenda item noted that "It is unclear from the press release or the articles written on the closure what the exact motivation is to close this office and whether or not it is part of a statewide consolidation effort. No local hearing or outreach was conducted by the State Division of Workers’ Compensation (DWC) regarding this proposal. Moreover, the goals to be achieved and options considered were never shared with the public. Accordingly, the public was never given the opportunity to be part of the solution."

"We regret any inconvenience," said DIR spokesperson Peter Melton. "Because [Oxnard is] less than an hour away, the decision was made to merge the offices." Melton added that the closure is mainly due to the building’s monthly rent - more than $20,000 - and the increased space at the Oxnard office. He added that the Goleta branch - the only one closing right now - is one of the smallest out of the state’s 24, with only one judge and 1,254 hearing requests so far this year.

Aceves said he hopes the letter results in a public hearing or perhaps a compromise in which cases are held in Goleta a couple of days per week. There is no word on whether other cities in the county plan on taking similar action. Employees at the Goleta office said they couldn’t comment on the closure.

Megan Compton, an attorney for the Santa Barbara law firm Ghitterman, Ghitterman and Feld, which handles many workers’ compensation cases, said she worries how this closure will impede not only people with legal representation but also those without. And those with severe disabilities and/or without cars will be further hindered, she said, as the trip from Goleta to Oxnard would take more than three hours and four buses ...
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/ 2013 News, Daily News
The Division of Workers’ Compensation (DWC) is now accepting nominations for its annual Carrie Nevans Community Service Awards which will be presented during the luncheons at the 21st annual educational conferences in February 2014. The awards, which began in 2010, were renamed in memory and honor of Carrie Nevans, the acting administrative director who passed away in 2011.

"This award acknowledges those MVPs who go above and beyond to benefit the comp system for the betterment of employees and employers," said Department of Industrial Relations (DIR) Director Christine Baker. DWC is a division of DIR.

Nominations should be made for those individuals who have made a significant contribution to the betterment of the workers’ compensation community in the highest professional manner. DWC will evaluate the nominations and honor one Southern California recipient in Los Angeles and another Northern California recipient in Oakland during an award ceremony at the educational conferences.

Those who make a nomination should complete the attached DWC nomination form and send to Wendy So at no later than January 10, 2014.

Last year’s award in Northern California was given to Angie Wei, Legislative Director of the California Federation of Labor, AFL-CIO. Sean McNally, president of KBA Engineering in Bakersfield was the Southern California recipient. Both were commissioners with the Commission on Health and Safety and Workers’ Compensation. The awards were presented at the 20th annual DWC educational conference luncheons ...
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/ 2013 News, Daily News
Governor Brown signed new law clarifying a death benefit presumption.

Existing law provides that totally dependent minor children of the deceased worker shall receive death benefits until the youngest child attains 18 years of age, or until the death of a child physically or mentally incapacitated from earning, at a weekly rate of at least $224. Existing law conclusively presumes, for the purpose of determining the amount of workers’ compensation benefits, that children under 18, or certain adult children, who were living with the employee-parent at the time of injury resulting in death, or for whose maintenance the employee-parent was legally liable at the time of the injury resulting in death, is wholly dependent for support on the deceased employee-parent if there is no surviving totally dependent parent.

A.B. 607 eliminates the requirement that, in order to conclusively presume that children under 18, or certain adult children, are wholly dependent for support on the deceased employee-parent, there not be a surviving totally dependent parent.

According to the sponsor, the Police Officers Research Association of California (PORAC), this law was necessary to clarify the rights of totally disabled children of employees who have died on the job to receive dependent death benefits. PORAC claims that an unusual phrase in the statute appears to limit the scope of death benefits to cases where there is a merely partially dependent surviving spouse, but denies the expanded "disabled child" death benefit where there is a fully dependent surviving spouse. The bill deletes this offending clause, thereby ensuring that totally disabled dependent children regardless of age obtain the death benefit to which they should be entitled.

While PORAC is the sponsor of this measure, the death benefit being addressed by the bill is not one of the "special" public safety officer benefits that are afforded to defined police and firefighters. Rather, this new law applies to the totally disabled dependent children of any employee who dies as a result of a job-related injury.

While there does not appear to be any rigorous quantification of the extent to which the new law might expand the number of cases where this death benefit is awarded, after legislative consultation with representatives of employer organizations, the consensus seemed to be that there are relatively few cases, and of those, the beneficiaries were probably intended to be covered by the existing statute.

Back in 2002, AB 749 enacted a broad range of workers' compensation benefit increases, notably in the amounts paid for permanent disabilities. However, one small piece of that measure adopted the language at issue in AB 607. While it remains unclear precisely what was intended by the 2002 language when it was enacted, correcting the resulting confusion seems consistent with the intent of the original enactment ...
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/ 2013 News, Daily News
Existing law specifies the time period within which various proceedings may be commenced under provisions of law relating to workers’ compensation. With certain exceptions, a proceeding to collect death benefits is required to be commenced within one year from the date of death or, in some cases, from the last furnishing of benefits. However, no proceedings for death benefits may be commenced more than 240 weeks from the date of injury.

AB 1373 would have provided that certain proceedings related to the collection of death benefits of firefighters and peace officers may be commenced within, but no later than, 480 weeks from the date of injury and in no event more than one year after the date of death if all of the specified criteria are met, including, but not limited to, that the employee’s death is the result of a specified injury.

According to the author, and the sponsor the California Professional Firefighters, there are cases where current law they say "unfairly harms" the dependents of fallen public safety officers. In circumstances where a safety officer dies more than 240 weeks after a diagnosis of the condition that causes death, current law does not provide benefits for surviving dependents. However, there are conditions where survival for more than 240 weeks after diagnosis is not uncommon, notably a cancer that goes temporarily into remission, or a blood-borne disease that results in a debilitating but long, slow decline.

A number of public agencies opposed the bill primarily on the basis of increased costs as well as the uncertainty of the as-yet unspecified time period. These agencies believe that the workers' compensation benefits available to public safety officers are already sufficiently generous, and local governments are simply not in the position to incur new financial obligations.

Last year the legislature passed AB 2451 which also proposed to extend the statute of limitations in presumption cases. AB 2451 was significantly broader in at least 2 respects: it also applied to death resulting from heart conditions, and it did not limit the cases where the extended limitations period applied to those where the date of injury was during active employment. Rather, AB 2451 would have applied regardless of when the condition arose, resulting in significantly more uncertainty, and significantly more cases, than AB 1373 will apply to. Governor Brown vetoed AB 2451 last year.

And he also vetoed AB 1373 passed by the legislature this year. His veto message said "This measure is identical to the one I vetoed last year. At that time, I outlined the information needed to properly evaluate the implications of this bill. I have not yet received that information." ...
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/ 2013 News, Daily News
Governor Brown signed AB 1376 which Delays until March 1, 2014, a regulation adopted by the Division of Workers' Compensation (DWC) that requires medical interpreters in the workers' compensation system to be certified. The bill is deemed an urgency measure and thus takes effect immediately.

The regulation that was is in place prior to this measure being signed by the Governor, provides for three pathways for an interpreter to become certified. First, an interpreter who is on the existing State Personnel Board (SPB) list is automatically certified - however, the SPB has not updated its list in several years, and it is not "open" for new applicants at this time. An interpreter can also seek certification by passing either the Certification Commission for Healthcare Interpreters (CCHI) exam, or the National Board of Certification for Medical Interpreters (National Board) exams. Representatives of interpreters indicate that it can take up to six months to navigate these certification processes. The bill provides approximately six and a half months from the effective date of the regulation for uncertified interpreters to obtain the necessary certification.

According to proponents of this law, Voters Injured At Work (VIAW), the regulation adopted by the DWC was not able to include a delayed implementation date that would allow interpreters adequate time to comply with the specific certification requirements allowed by the regulation. As a result, VIAW claimed that an insufficient number of certified interpreters will lead to delays in obtaining medical treatment for injured workers who require an interpreter to effectively communicate with their physician.

Prior to the passage of last year's workers' compensation reform bill, SB 863 (DeLeon), multiple stakeholders reported significant abuse and serious problems with how medical interpreters were provided to injured workers. One of the most common complaints was the use of non-certified medical interpreters providing interpretive services to injured workers. These non-certified interpreters (also known as provisionally certified interpreters) were largely unregulated ...
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A former Livingston police officer pleaded no contest Friday to insurance fraud and was ordered to repay the state more than $14,000. The Merced Sun-Star reports that Sammy Galindo, 31, pleaded to a single felony count of workers’ compensation fraud in Merced Superior Court before Judge Ronald W. Hansen. The judge ordered Galindo to serve two years of probation and pay $14,200 in restitution.

This sends the message that nobody is immune from the law and if you engage in fraud, you’ll be prosecuted," said Walter Wall, the deputy district attorney who prosecuted the case.

After Friday’s hearing, Galindo made his first restitution payment of $4,500, Wall said. Galindo’s attorney, Marshall Hogkins, could not be reached for comment Friday.

According to the complaint, Galindo claimed he injured his right shoulder while making an arrest May18, 2011. He was placed on disability leave. It was at least the third disability claim Galindo had made since he was hired in September 2006. Livingston Police officials found it suspicious..Galindo claimed he was unable to move his shoulder without pain, but video surveillance taken by private investigators on June30, 2011, shows him performing heavy manual labor, including unloading a large tree from the bed of a pickup, digging holes in his yard and mowing his lawn.

Subsequent medical examinations showed no damage to Galindo’s shoulder, according to court documents.

When investigators confronted Galindo, he initially denied performing any yardwork. As part of his plea, he acknowledged making false statements to detectives, prosecutors said.

According to court records, the Livingston Police Department fired Galindo in September 2012 for dishonesty and violating the Police Officer’s Code of Ethics. He lost his appeal during a mediation hearing that same year.

Police Chief Ruben Chavez declined to comment directly on the case Friday, citing personnel confidentiality laws. Speaking in general terms, Chavez acknowledged that cases involving lying police officers do more than harm the image of law enforcement, they can undermine any investigations or convictions that involved those individuals. "As officers, we’re held to a very high standard of integrity and professionalism," Chavez said. "Anytime an issue of credibility comes up, it causes great concern. You cannot risk losing the trust of the community." ...
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Kan-Di-Ki, LLC, doing business as Diagnostic Laboratories and Radiology has agreed to pay $17.5 million to resolve allegations that it submitted false claims to Medicare and Medi-Cal that were tainted by a kickback scheme.

Diagnostic Labs, which is headquartered in Burbank, provides lab and x-ray services to patients at skilled nursing facilities (SNFs) in Southern California. SNFs, commonly known as nursing homes, are a healthcare option for senior citizens who are in need of constant medical attention.

Diagnostic Labs allegedly charged SNFs below cost rates for Medicare Part A business, in exchange for the facilities’ provision of Medicare Part B and Medi-Cal business back to Diagnostic Labs;This scheme is alleged to have violated the federal Anti-Kickback Act (42 U.S.C. § 1320a-7b(b)(2)(A)) and the federal and state False Claims Acts.

"When medical facility owners illegally offer discounts to customers to generate business, it results in inflated claims to government health care programs and increases costs for all taxpayers," said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the Department of Health and Human Services’ Office of Inspector General; "This $17.5 million settlement demonstrates OIG’s ongoing commitment to safeguarding federal health care programs and taxpayer dollars against all types of fraudulent activities."

The United States will receive $12.95 million of the settlement amount, and California will receive $4.55 million.

This settlement resolves a lawsuit filed under the qui tam, or "whistleblower," provisions of the federal and state False Claims Acts, which allow private citizens with knowledge of fraud to bring civil actions on behalf of the federal and state governments and share in any recovery;The case was filed in 2010 in federal court in Los Angeles by two former Diagnostic Labs employees, and is titled United States and State of California ex rel. Pasqua et al. v. Kan-Di-Ki, LLC, Civil Action No. CV10-0965 JST (RZx) (C.D. Cal.); The two men who filed the lawsuit, Jon Pasqua and Jeff Hauser, will collectively receive $3,755,500 as their share of the federal recovery. Their share of the state recovery has not yet been determined.

The United States Attorney’s Office for the Central District of California, the Justice Department’s Civil Division, and the California Attorney General’s Office handled the civil settlement. This matter was investigated by the U.S. Department of Health and Human Services, Office of Inspector General ...
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USA Today reports that hospitals are starting to cut thousands of jobs amid falling insurance payments and inpatient visits.The payroll cuts are surprising because the Affordable Care Act (ACA), whose implementation took a big step forward this month, is eventually expected to provide health coverage to as many as 30 million additional Americans. "While the rest of the U.S. economy is stabilizing or improving, health care is entering into a recession," says John Howser, assistant vice chancellor of Vanderbilt University Medical Center.

Health care providers announced more layoffs than any other industry last month - 8,128 - largely because of reductions by hospitals, according to outplacement firm Challenger Gray and Christmas. So far this year, the health care sector has announced 41,085 layoffs, the third-most behind financial and industrial companies.Total private hospital employment is still up by 36,000 in the past 12 months, but it's down by 8,000 since April, and more staff reductions are expected into next year.

This month, Indiana University Health laid off about 900 workers as part of a move to trim its budget by $1 billion over five years. Vanderbilt plans to eliminate 1,000 jobs by the end of the year to help shave operating costs 8% a year. The Cleveland Clinic is offering buyouts to 3,000 employees as it shaves its annual operating costs by $330 million. "This is a challenging time for the health care industry," says Jim Terwilliger, president of two of Indiana health's hospitals. "The pace of change is far greater than any time in recent history."

There are myriad reasons for the cuts, which are affecting administrative staff as well as nurses and doctors. Medicare, Medicaid and private insurance companies are all reducing reimbursement to hospitals. The federal budget cuts known as sequestration have cut Medicare reimbursement by 2%, the American Hospital Association says. The health care law has further reduced the Medicare payments to hospitals that provide lower-quality service or have high readmission rates.The National Institutes of Health reduced funding to hospitals by 5% as part of sequestration, forcing hospitals to trim research staff. The number of inpatient hospital days fell 4% from 2007 to 2011, in part because of the economic downturn, the hospital association says. As more Baby Boomers turn 65, their services will be reimbursed at Medicare rates that are lower than those of private payers, putting further pressure on hospital revenue.

The new health care law was supposed to ease the burden on hospitals by expanding Medicaid coverage to more low-income Americans, who often use hospital services in emergencies, then don't pay their bills. But 26 states rejected the ACA's offer of federal funding to expand Medicaid. That decision led to about a third of the job cuts by Nashville-based Vanderbilt, Howser says ...
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The Insurance Journal reports that class action lawsuits in federal courts on both coasts have been initiated on behalf of small businesses in California, New York and New Jersey against American International Group (AIG) over workers’ compensation reporting. Plaintiff attorneys say the case could involve thousands of firms doing business from the 1970s until the early 2000s and could result in damages up to hundreds of millions of dollars, although no figure has yet been established.

AIG says the suits are an attempt to reopen charges that have already been settled.

The suit filed this week against AIG and its subsidiary companies, and former AIG CEO Maurice Greenberg, charges unfair business practices, fraud and violations of the federal racketeering statutes. The attorneys who filed the suit allege that beginning in the 1970s AIG engaged in a scheme to misreport the amount of workers’ comp premium it collected in each state, which resulted in insured employers paying more in certain workers’ comp fees. Plaintiffs claim that by making it appear that less money in workers’ comp premium was collected, AIG caused insurance regulators to assess artificially inflated fees on insured employers for certain state mandated workers’ comp programs, the attorneys argue.

In 2010 AIG agreed to pay $146.5 million in fines and additional taxes to state insurance regulators for alleged under-reporting of premiums to states more than a decade ago. AIG has also agreed to pay $450 million to resolve litigation brought by other insurance carriers over the misreporting. The deal was believed to have resolved a multi-state probe that examined whether AIG violated premium reporting rules governing workers comp insurance from 1985 to 1996. The misreporting had the effect of lowering the premium taxes and premium-based assessments AIG paid, according to regulators.

In a response to this week’s suit AIG referred to that deal. "The court filings attempt to recycle allegations of wrongdoing from decades past that AIG has already resolved via settlements with its regulators and with civil plaintiffs," AIG said in a statement issued to Insurance Journal on Thursday. "AIG will defend the cases vigorously."

However that deal did not give damages to the companies that were paying the higher premiums as a result of AIG’s "scheme," an attorney on the case said on Thursday. "The wrong that we’re suing for has not been dealt with at all," said Drew Pomerance, a partner in Roxborough, Pomerance, Nye and Adreani LLP, the firm representing the class in California. "AIG has not compensated any insured employers affected by this conduct." With an air of confidence he added: "There’s been judgment against them before, and we expect to get a judgment against them this time."

Based on previous litigation and analysis, Pomerance estimates AIG underreported premiums by $2 billion, which could lead to a large figure for any damages that may be sought. "It looks like there was more than $2 billion of underreporting and probably substantially more over the years," he said. "It could be tens to hundreds of millions of dollars in damages."

The first court of appearance in California is a case management conference set for Jan. 17 in the U.S. District Court for the Northern District of California in San Francisco. Similar appearances are expected in New York and New Jersey, according to Pomerance ...
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Knowing what is, or is not a good subrogation case takes time and experience. The negligence "reasonable man" standard has clear extremes, and a grey area in the center that makes a determination of what conduct is below the standard sometimes difficult. A new case from the California court of appeal shows what ended up to be not such a good case for the injured worker.

Plaintiff James C. Keith filed an action against the City of Pleasant Hill, and Kelli M. Geis, a police officer employed by the City, seeking damages for injuries he suffered at his job when he was struck by a water pump attached to a hose that became entangled with the underside of Geis’s squad car.

Keith was working for the Contra Costa Water District at the time, performing repairs in the street on Golf Club Road in Pleasant Hill. The construction area was set up with orange traffic cones directing eastbound traffic on Golf Club Road into the right hand, or "number two" lane. Keith was working in the number one lane, where a hole had been dug to fix a leaking pipe. As part of the construction work, the District workers placed a flexible hose attached to a water pump across the active lane of traffic, the number two lane.

Kelli Geis, a Pleasant Hill police officer, was driving a patrol car eastbound on Golf Club Road on a nonemergency assignment to back up a fellow officer. The posted speed limit was 25 miles per hour. Geis slowed as she entered the construction area, and passed over the hose at under 25 miles per hour. Traffic had been passing over this hose for several hours earlier that day, with some vehicles traveling faster than Geis and some traveling slower. When Geis passed over the hose, it became entangled in the undercarriage of her vehicle. As she continued driving, the hose pulled the water pump out of the excavation hole. The pump struck Keith’s leg, causing multiple serious fractures. The force of the impact also sent him into the air, causing him to fall on and injure his head and shoulder. Geis was not aware of the accident at the time it occurred. As she traveled further down the road, another driver indicated to her that some material was trailing from her patrol vehicle. She stopped the car and retrieved a section of yellow hose.

Defendants filed a motion for summary judgment. Defendants argued that Geis did not breach any duty to Keith. In opposition, Keith offered the opinion of an expert in accident reconstruction and analysis who concluded that Geis’s speed had "caused the pressurized hose to ‘jump’ higher than other motorists who had traveled at slower speeds over the hose, which allowed the hose to catch or entangle on the undercarriage of [her] vehicle."

The trial court granted summary judgment in favor of the City and police officer. The judgment was affirmed in favor of the defendants in the unpublished case of Keith v. City of Pleasant Hill.

The Court concluded that it "is not reasonable to require a driver of a vehicle to foresee that driving at or below the posted speed limit over a hose that has been deliberately extended over the road, and which the driver has no choice but to drive over, will become entangled in the undercarriage of his or her vehicle. If such were the case, any vehicle driven over such a hose would potentially subject its driver to liability. Indeed, it is difficult to perceive how a driver could avoid potential liability in this case, given that hundreds of vehicles of all sizes had driven over the hose prior to Geis, some at different speeds and all without incident."

The outcome of this case is not surprising. The opinion is based on simple common sense. Often it is just common sense that helps a claim administrator determine what is or is not a good case for subrogation. Keith's claim is a good example of a case that would not justify a subrogation effort ...
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Senate Bill (SB) 863 includes a program to provide supplemental payments to injured workers for whose permanent disability benefits are "disproportionately low" in comparison to their earnings loss. This program is to be funded by a $120 million per year surcharge. However, the language in the statute does not expressly define what is "disproportionately low." The bill provided the Director of the Department of Industrial Relations (DIR) with wide leeway in the design and implementation of the program. In addition, the bill required the Director in consultation with the California Commission on Health and Safety and Workers’ Compensation (CHSWC) to determine eligibility and the amount of payments to be made based on a study.

CHSWC has released on its website for public comment and feedback the Working Paper, "Identifying Permanently Disabled Workers with Disproportionate Earnings Losses for Supplemental Payments. The paper was repared by RAND, and conducted by the Office of the Director, Department of Industrial Relations in consultation with CHSWC. The Working Paper presents one definition of how this program could be defined and implemented. The Director’s office will be using RAND’s findings in the development of the return-to-work program. The tentative working title of the program is the Special Earning Loss Supplement (SELS).

One of the topics of the RAND study included the issue of the period over which to observe the post injury loss experience of injured workers. In this regard, the study claims "a person’s actual losses can only be measured after they have been realized. That is, we can only compare pre-injury and post-injury earnings after an individual has actually accumulated their post-injury earnings." ...."This implies that eligibility criteria based on actual earnings needs to focus on the earnings in the post-injury period for a sufficient period of time after the date of injury to allow for the effects of the injury to be realized. Past RAND work suggests it takes 3-5 years after the date of injury for earnings losses to stabilize (Reville et al. 2005). Given this time frame, this suggests that an eligibility determination based on actual earnings losses would likely need to focus on earnings that occur several years after the date of injury (or the date at which the injury is determined to have become permanent). An obvious consequence of this requirement is that if eligibility can only be determined several years after an injury, then compensation can only be paid out several years after an injury."

The California Applicant Attorneys Association has voiced its objection to such a delay in making the SELS payment. In addition to other issues raised by the CAAA objection, the letter states "we strongly object to the suggestion in the RAND Paper that a worker’s eligibility for this program can be determined only several years after the injury. That suggestion essentially dismisses the findings of this study. As noted above, this study found that virtually all workers who do not return to their at-injury employer - regardless of their assigned disability rating - experience an almost total loss of earnings. When it is already known that certain workers will experience a total loss of earnings, requiring those workers to wait several years to prove that earnings loss would be unconscionable."

The SELS benefit will not be administered or paid by California employers. Thus, employers theoretically would have no particular interest in this controversy ...
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The Orange County Register reports that a Santa Fe Springs-based healthcare management company has acquired Pacific Hospital of Long Beach. The move by College Health Enterprises Inc. to purchase Pacific Hospital comes as Pacific Hospital faces state and federal investigations into alleged fraudulent spinal surgeries for workers' compensation cases.

The deal was confirmed Tuesday evening by John Molina, CFO of Molina Healthcare Inc., and whose Long Beach-based company will be involved in managing the community hospital at 2776 Pacific Ave., a first in its portfolio of businesses. Molina said he expects the hospital to expand with the rollout of Obamacare, which is designed to give medical service to low-income people. "The focus of Pacific Hospital is to create access to what before had been barriers," he said.

Financial terms of the acquisition by College Health, which was founded in 1986 and operates hospitals in Cerritos and Costa Mesa, were not disclosed. The deal became effective at midnight Tuesday, said Molina. As of late Tuesday, Barry J. Weiss, president of College Health, hadn't returned a phone call seeking comment.

Molina Healthcare, a managed care insurer specializing in Medicaid-eligible families and individuals, said it will form a separate business unit to manage College Health's acute-care services at Pacific Hospital. The new Molina Healthcare unit is to be called American Family Care Hospital Management, Molina said.

Molina said the newly created business unit will retain more than 300 of Pacific Hospital's 700 workers. He was uncertain how many of the employees College Health will keep.

As part of the deal, College Health is to run two of Pacific Hospital's psychiatric units. One is located at the main campus, with a smaller one located at Pacific Avenue and Pacific Coast Highway.

In June, the State Compensation Insurance Fund filed a complaint in federal court in Santa Ana claiming Pacific Hospital of Long Beach and other entities affiliated with it have been running scams for years to illegally boost payments for medical services provided to injured workers. SCIF wants to recoup some of the $160 million it has paid over the past dozen years under civil statutes used to prosecute organized crime syndicates. The Fund filed the federal lawsuit under the Racketeer Influenced and Corrupt Organizations Act against Pacific Hospital owners Michael D. Drobot Sr. and his son Michael R. Drobot Jr., the principals of HealthSmart Pacific, and several companies they operate, alleging five different schemes to illegally boost payments by the insurance fund.

The fund uncovered the alleged schemes after it launched an investigation into Pacific Hospital's bills. It had learned of reports that the Federal Bureau of Investigation had served search warrants at the hospital and an affiliated entity, Industrial Pharmacy Management ...
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