3D printing is a process of making a three-dimensional solid object of virtually any shape from a digital model. 3D printable models may be created with a 3D scanner. To perform a print, the machine reads the design from 3D printable file and lays down successive layers of liquid, powder, paper or sheet material to build the model from a series of cross sections. These layers, which correspond to the virtual cross sections from the model, are joined or automatically fused to create the final shape. The primary advantage of this technique is its ability to create almost any shape or geometric feature.The 3D printing technology is used for both prototyping and distributed manufacturing with applications in architecture, construction, industrial design, automotive, aerospace, military, engineering, dental and medical industries, biotech (human tissue replacement), fashion, footwear, jewelry, eyewear, education, geographic information systems, food, and many other fields. Several projects and companies are develop affordable 3D printers for home desktop use.
NBC News reports that doctors in the Netherlands have for the first time successfully replaced most of a human’s skull with a 3-D printed plastic one - and likely saved a woman's life in the process.The 23-hour surgery took place three months ago at University Medical Center Utrecht. The hospital announced details of the groundbreaking operation this week and said the patient, a 22-year-old woman, is doing just fine.
The woman, whose name wasn’t released, suffered from severe headaches due to a thickening of her skull. She slowly lost her vision, her motor coordination was suffering and it was only a matter of time before other essential brain functions would have atrophied, Dr. Verweij said in a press release issued by UMC Utrecht. Verweij noted that in some brain operations it’s common for part of the skull to be temporarily removed to reduce pressure on the brain, then put back later or replaced by an artificial implant. In this case, doctors inserted nearly an entire plastic skull that was manufactured with the help of Anatomics, an Australian medical device company that specializes in 3-D printing,
"We used to create an implant by hand in the operating theater using a kind of cement, but those implants did not have a very good fit," Dr. Verweij said. "Now we can use 3-D printing to ensure that these components are an exact fit. This has major advantages, not only cosmetically but also because patients often have better brain function compared with the old method."
Three months after surgery, the woman’s pain is gone and she can see again. "The patient has fully regained her vision, she has no more complaints, she's gone back to work and there are almost no traces that she had any surgery at all," said Dr. Verweij.
In another success story, Business Insider reports that a British surgeon successfully implanted a 3-D printed pelvis for a man who lost half his pelvis to bone cancer. It was the first transplant of its kind. The patient, who is in his sixties and has remained unnamed, suffered from a rare type of bone cancer called chondrosarcoma. It affected the entire right side of his pelvis. According to orthopedic surgeon Craig Gerrand, who performed the surgery, it would have been impossible to attach a standard implant because so much bone had to be removed. In order to create the 3-D printed pelvis, the surgeons took scans of the man’s pelvis to take exact measurements of how much 3-D printed bone needed to be produced and passed it along to Stanmore Implants. The company used the scans to create a titanium 3-D replacement, by fusing layers of titanium together and then coating it with a mineral that would allow the remaining bone cells to attach. After the titanium pelvis was attached, the team added a standard hip replacement to complete the surgery. The procedure, which happened three years ago, was an unrivaled success. The man has been walking with a cane and remains happy with the results.
3D printing is revolutionizing the health care sector: The technology has been successfully used to make prosthetic limbs, custom hearing aids, now a pelvis and a human skull, and potentially human tissue by what is called "bioprinting." ...
NBC News reports that doctors in the Netherlands have for the first time successfully replaced most of a human’s skull with a 3-D printed plastic one - and likely saved a woman's life in the process.The 23-hour surgery took place three months ago at University Medical Center Utrecht. The hospital announced details of the groundbreaking operation this week and said the patient, a 22-year-old woman, is doing just fine.
The woman, whose name wasn’t released, suffered from severe headaches due to a thickening of her skull. She slowly lost her vision, her motor coordination was suffering and it was only a matter of time before other essential brain functions would have atrophied, Dr. Verweij said in a press release issued by UMC Utrecht. Verweij noted that in some brain operations it’s common for part of the skull to be temporarily removed to reduce pressure on the brain, then put back later or replaced by an artificial implant. In this case, doctors inserted nearly an entire plastic skull that was manufactured with the help of Anatomics, an Australian medical device company that specializes in 3-D printing,
"We used to create an implant by hand in the operating theater using a kind of cement, but those implants did not have a very good fit," Dr. Verweij said. "Now we can use 3-D printing to ensure that these components are an exact fit. This has major advantages, not only cosmetically but also because patients often have better brain function compared with the old method."
Three months after surgery, the woman’s pain is gone and she can see again. "The patient has fully regained her vision, she has no more complaints, she's gone back to work and there are almost no traces that she had any surgery at all," said Dr. Verweij.
In another success story, Business Insider reports that a British surgeon successfully implanted a 3-D printed pelvis for a man who lost half his pelvis to bone cancer. It was the first transplant of its kind. The patient, who is in his sixties and has remained unnamed, suffered from a rare type of bone cancer called chondrosarcoma. It affected the entire right side of his pelvis. According to orthopedic surgeon Craig Gerrand, who performed the surgery, it would have been impossible to attach a standard implant because so much bone had to be removed. In order to create the 3-D printed pelvis, the surgeons took scans of the man’s pelvis to take exact measurements of how much 3-D printed bone needed to be produced and passed it along to Stanmore Implants. The company used the scans to create a titanium 3-D replacement, by fusing layers of titanium together and then coating it with a mineral that would allow the remaining bone cells to attach. After the titanium pelvis was attached, the team added a standard hip replacement to complete the surgery. The procedure, which happened three years ago, was an unrivaled success. The man has been walking with a cane and remains happy with the results.
3D printing is revolutionizing the health care sector: The technology has been successfully used to make prosthetic limbs, custom hearing aids, now a pelvis and a human skull, and potentially human tissue by what is called "bioprinting." ...
A Southern California man who ran a durable medical equipment (DME) supply company has been found guilty by a federal jury in Los Angeles for his role in a $1.5 million Medicare fraud scheme. Vahe Tahmasian, 36, of Glendale, California., was found guilty this month in U.S. District Court in the Central District of California of one count of conspiracy to commit health care fraud, six counts of health care fraud and six counts of aggravated identity theft. Sentencing is set for June 9, 2014.
The evidence introduced at trial showed that between April 2009 and February 2011, Tahmasian operated a Medicare fraud scheme at Orthomed Appliance Inc. (Orthomed), a DME supply company in West Hollywood, Calif. Tahmasian and his co-conspirator, Eric Mkhitarian, purchased Orthomed from the previous owners and put the company in the name of a straw owner.The defendant and his co-conspirator then stole the personal identifying information of Medicare beneficiaries and doctors in the company’s patient files and used that information to submit a large volume of fraudulent claims to Medicare. The evidence showed that during a three-month period in late 2010, Tahmasian submitted more than $1.2 million in fraudulent claims to Medicare for services that were never prescribed by a physician and never provided to the Medicare beneficiaries. Tahmasian and his co-conspirator then took out more than $622,000 in cash from the company over a six-week period in early 2011. The evidence at trial showed that Tahmasian used a fake California driver’s license during the course of the fraudulent scheme.Tahmasian submitted a total of $1,584,640 in claims to Medicare and received approximately $994,036 on those claims.
Mkhitarian, Tahmasian’s alleged co-conspirator, remains a fugitive.
The case was investigated by the FBI and the Los Angeles Region of HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. The case is being prosecuted by Assistant Chief Benton Curtis and Trial Attorney Alexander Porter of the Fraud Section.
Tahmasian's prosecution is one of a steady stream of cases moving through the justice system that underscore the need to make DME fraud and abuse a high enforcement priority.
Besides the frequent combination of medical identity theft and fraudulent billing, other DME-related schemes to watch for include billing for high-end products but delivering inferior ones, forging product prescriptions and paying kickbacks to professionals authorized to prescribe DME, according to a commentary by former U.S. Health and Human Services Inspector General Richard P. Kusserow ...
The evidence introduced at trial showed that between April 2009 and February 2011, Tahmasian operated a Medicare fraud scheme at Orthomed Appliance Inc. (Orthomed), a DME supply company in West Hollywood, Calif. Tahmasian and his co-conspirator, Eric Mkhitarian, purchased Orthomed from the previous owners and put the company in the name of a straw owner.The defendant and his co-conspirator then stole the personal identifying information of Medicare beneficiaries and doctors in the company’s patient files and used that information to submit a large volume of fraudulent claims to Medicare. The evidence showed that during a three-month period in late 2010, Tahmasian submitted more than $1.2 million in fraudulent claims to Medicare for services that were never prescribed by a physician and never provided to the Medicare beneficiaries. Tahmasian and his co-conspirator then took out more than $622,000 in cash from the company over a six-week period in early 2011. The evidence at trial showed that Tahmasian used a fake California driver’s license during the course of the fraudulent scheme.Tahmasian submitted a total of $1,584,640 in claims to Medicare and received approximately $994,036 on those claims.
Mkhitarian, Tahmasian’s alleged co-conspirator, remains a fugitive.
The case was investigated by the FBI and the Los Angeles Region of HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. The case is being prosecuted by Assistant Chief Benton Curtis and Trial Attorney Alexander Porter of the Fraud Section.
Tahmasian's prosecution is one of a steady stream of cases moving through the justice system that underscore the need to make DME fraud and abuse a high enforcement priority.
Besides the frequent combination of medical identity theft and fraudulent billing, other DME-related schemes to watch for include billing for high-end products but delivering inferior ones, forging product prescriptions and paying kickbacks to professionals authorized to prescribe DME, according to a commentary by former U.S. Health and Human Services Inspector General Richard P. Kusserow ...
On any given day, one in 25 hospitalized patients - 4 percent - is battling an infection picked up in a hospital or other healthcare facility, according to a new survey by the Centers for Disease Control and Prevention (CDC). That translates to more than 600,000 hospital patients each year. Roughly 74,000 of them have to fight more than one hospital-acquired infection, researchers found. About half of those infections were either linked to a device attached to the patient, like a catheter or ventilator, or occurred after a surgical procedure at the site of the surgery. An infection acquired in this manner in an industrial case would also be covered as a compensable consequence of the initial injury.
Previous estimates had pegged the annual number of infections at 2.1 million in the 1970s and 1.7 million from 1990 through 2002. "The trend, in magnitude, seems to be going in the right direction," Dr. Mike Bell, deputy director of the Division of Healthcare Quality Promotion at the CDC, told Reuters Health. Despite continuing concern about hospital-acquired infections, especially ones that are resistant to antibiotics, the U.S. does not have a national system for collecting information on the problem.
The new study, led by Dr. Shelley S. Magill of the CDC and published in the New England Journal of Medicine, was based on an analysis of 11,282 patients treated at 183 hospitals in 10 states. The survey in each hospital was done over the course of a day, involving as many as 100 patients per facility. Pneumonia accounted for about 22 percent of the hospital-acquired infections. Another 22 percent were infections at the surgical site, and 17 percent were stomach or intestinal illnesses. Urinary tract and bloodstream infections ranked fourth and fifth, respectively. The most common bacterium responsible was Clostridium difficile, which kills an estimated 14,000 people in the U.S. each year. It was detected in 12 percent of the hospital-acquired illnesses and was responsible for 71 percent of gastrointestinal infections in particular. Nursing homes, emergency departments, rehabilitation hospitals and outpatient treatment centers were not included in the tally.
The researchers estimated that in 2011, 648,000 hospitalized patients had to battle at least one hospital-acquired infection. The total number of infections was estimated at 721,800. To put that number in perspective, about 34 million people are admitted to 5,000 community hospitals in the U.S. each year. The new report "validates the work we've been doing, focusing on some of the severe infections related to intensive care, related to devices such as catheters in the bloodstream or the bladder, mechanical ventilation or surgical procedures," Bell said.
To prevent infections, the National Patient Safety Foundation recommends patients wash their hands regularly and remind their doctors and nurses to do the same. Patients should also make sure both bandages and the skin around any catheters are kept clean and dry, it says ...
Previous estimates had pegged the annual number of infections at 2.1 million in the 1970s and 1.7 million from 1990 through 2002. "The trend, in magnitude, seems to be going in the right direction," Dr. Mike Bell, deputy director of the Division of Healthcare Quality Promotion at the CDC, told Reuters Health. Despite continuing concern about hospital-acquired infections, especially ones that are resistant to antibiotics, the U.S. does not have a national system for collecting information on the problem.
The new study, led by Dr. Shelley S. Magill of the CDC and published in the New England Journal of Medicine, was based on an analysis of 11,282 patients treated at 183 hospitals in 10 states. The survey in each hospital was done over the course of a day, involving as many as 100 patients per facility. Pneumonia accounted for about 22 percent of the hospital-acquired infections. Another 22 percent were infections at the surgical site, and 17 percent were stomach or intestinal illnesses. Urinary tract and bloodstream infections ranked fourth and fifth, respectively. The most common bacterium responsible was Clostridium difficile, which kills an estimated 14,000 people in the U.S. each year. It was detected in 12 percent of the hospital-acquired illnesses and was responsible for 71 percent of gastrointestinal infections in particular. Nursing homes, emergency departments, rehabilitation hospitals and outpatient treatment centers were not included in the tally.
The researchers estimated that in 2011, 648,000 hospitalized patients had to battle at least one hospital-acquired infection. The total number of infections was estimated at 721,800. To put that number in perspective, about 34 million people are admitted to 5,000 community hospitals in the U.S. each year. The new report "validates the work we've been doing, focusing on some of the severe infections related to intensive care, related to devices such as catheters in the bloodstream or the bladder, mechanical ventilation or surgical procedures," Bell said.
To prevent infections, the National Patient Safety Foundation recommends patients wash their hands regularly and remind their doctors and nurses to do the same. Patients should also make sure both bandages and the skin around any catheters are kept clean and dry, it says ...
State Senator Leland Yee has been indicted for public corruption as part of another major FBI operation. San Francisco Police Chief Greg Suhr described the raids to KCBS as "massive." "Hundreds of officers are involved in this," he said.
Yee was taken into San Francisco's Federal Building wearing handcuffs FBI agents and local police are serving arrest and search warrants throughout the Bay Area, with agents seen in locations in San Francisco and San Mateo, as well as Yee's Capitol office in Sacramento. Targets of the raid are expected to appear in federal court in San Francisco this afternoon. Yee's indictment likely ruins his candidacy for Secretary of State, and threatens Democrats' ability to restore the state Senate supermajority that already has been broken by two other lawmakers' paid leaves of absence to deal with criminal charges.
Yee represents San Francisco and a portion of San Mateo County. Before becoming the first Chinese-American ever elected to the state Senate in 2006, Yee was an Assemblyman from 2002 to 2006; a San Francisco supervisor from 1997 to 2002; and had been a member and president of the San Francisco Unified School District board. While in the Assembly, he was the first Asian-American to be named Speaker pro Tempore, essentially making him the chamber's second-most-powerful Democrat.
Yee is the state's third Democratic legislator recently tied to corruption allegations. In February, State Sen. Ron Calderon, D-Montebello, surrendered to authorities after being indicted on bribery charges surrounding proposed workers' compensation law and Pacific Hospital in Long Beach. In January, Assemblyman Roderick Wright, D-Inglewood, was convicted of voter fraud and perjury stemming from a 2010 indictment.
Derek Cressman, who until last June was vice president of the non-partisan government watchdog group Common Cause, issued a statement Wednesday morning saying that Yee's indictment must be "a wake-up call" given other Senate Democrats' criminal charges. "We are clearly beyond the point of looking at one bad apple and instead looking at a corrupt institution in the California senate," Cressman said. "The constant begging for campaign cash clearly has a corrosive effect on a person's soul and the only solution is to get big money out of our politics once and for all."
...
Yee was taken into San Francisco's Federal Building wearing handcuffs FBI agents and local police are serving arrest and search warrants throughout the Bay Area, with agents seen in locations in San Francisco and San Mateo, as well as Yee's Capitol office in Sacramento. Targets of the raid are expected to appear in federal court in San Francisco this afternoon. Yee's indictment likely ruins his candidacy for Secretary of State, and threatens Democrats' ability to restore the state Senate supermajority that already has been broken by two other lawmakers' paid leaves of absence to deal with criminal charges.
Yee represents San Francisco and a portion of San Mateo County. Before becoming the first Chinese-American ever elected to the state Senate in 2006, Yee was an Assemblyman from 2002 to 2006; a San Francisco supervisor from 1997 to 2002; and had been a member and president of the San Francisco Unified School District board. While in the Assembly, he was the first Asian-American to be named Speaker pro Tempore, essentially making him the chamber's second-most-powerful Democrat.
Yee is the state's third Democratic legislator recently tied to corruption allegations. In February, State Sen. Ron Calderon, D-Montebello, surrendered to authorities after being indicted on bribery charges surrounding proposed workers' compensation law and Pacific Hospital in Long Beach. In January, Assemblyman Roderick Wright, D-Inglewood, was convicted of voter fraud and perjury stemming from a 2010 indictment.
Derek Cressman, who until last June was vice president of the non-partisan government watchdog group Common Cause, issued a statement Wednesday morning saying that Yee's indictment must be "a wake-up call" given other Senate Democrats' criminal charges. "We are clearly beyond the point of looking at one bad apple and instead looking at a corrupt institution in the California senate," Cressman said. "The constant begging for campaign cash clearly has a corrosive effect on a person's soul and the only solution is to get big money out of our politics once and for all."
...
A former Rancho Cucamonga attorney who once handled some of the Metropolitan Transportation Authority's toughest legal cases was convicted of stealing nearly $2 million from the transit agency by submitting phony invoices and pocketing settlement money. James Vincent Reiss, who also was convicted of stealing more than $1 million from other clients, pleaded no contest to two felony counts of grand theft. For 15 years, Reiss defended Metro in multimillion-dollar injury lawsuits involving rail and bus passengers until officials realized he was defrauding the agency, said Jane Robison, an L.A. County district attorney's spokeswoman. Reiss, 52, made the plea as part of a deal in which prosecutors agreed to drop nine other felony counts of theft, forgery and fraud. He is set to be sentenced March 26, and the court is expected to require that he pay more $3 million in restitution and serve a decade in prison.
Reiss created fraudulent documents that led Metro to write checks that he ultimately kept for himself instead of paying plaintiffs who sued the agency. Karen Gorman, acting inspector general for Metro, said a State Bar of California investigation into problems with Reiss' other clients in 2012 tipped off the agency to the potential for trouble, and officials immediately began auditing his cases. "We aggressively began to investigate - and working with the district attorney's office we were able to bring Mr. Reiss to justice for his crimes."
According to a Metro lawsuit filed against Reiss' law firm in January for malpractice, forgery and negligence, Reiss cost the agency as much as $2.5 million. In 2011, Reiss allegedly told the MTA that it had negotiated a $2.5-million jury award down to $1.765 million. But when the Metro board authorized the settlement and ordered that two checks totaling $1.765 million be written, Reiss kept the money, according to the suit. Reiss then filed an appeal, delaying the case. Metro eventually resolved the case by paying $2.5 million. The suit alleges Reiss also submitted "numerous falsified invoices totaling at least $754,000," for costs and kept the money.
Prosecutors said that in addition to the MTA, Reiss also took advantage of other clients. In one case, he settled a suit without the client's knowledge, forged signatures on paperwork and pocketed the money, prosecutors said. In another case involving a trust, he opened a bank account, deposited a client's money and wrote checks to himself, prosecutors said.
Reiss, was disbarred on March 16, 2013 after a state Bar Court judge called his case an illustration of the "disciplinary consequences of dishonesty," The State Bar case went on to conclude "the most serious aggravation is found in Reiss’s 10-year pattern of deception in order to cover up mismanagement of his clients’ cases or for his personal economic gain. ...Without a hint of remorse, Reiss has refused to acknowledge his misconduct despite overwhelming evidence of his dishonesty and the harm he caused to his clients. While the law does not require Reiss to be falsely penitent, it does require that [he] accept responsibility for his acts and come to grips with his culpability." ...
Reiss created fraudulent documents that led Metro to write checks that he ultimately kept for himself instead of paying plaintiffs who sued the agency. Karen Gorman, acting inspector general for Metro, said a State Bar of California investigation into problems with Reiss' other clients in 2012 tipped off the agency to the potential for trouble, and officials immediately began auditing his cases. "We aggressively began to investigate - and working with the district attorney's office we were able to bring Mr. Reiss to justice for his crimes."
According to a Metro lawsuit filed against Reiss' law firm in January for malpractice, forgery and negligence, Reiss cost the agency as much as $2.5 million. In 2011, Reiss allegedly told the MTA that it had negotiated a $2.5-million jury award down to $1.765 million. But when the Metro board authorized the settlement and ordered that two checks totaling $1.765 million be written, Reiss kept the money, according to the suit. Reiss then filed an appeal, delaying the case. Metro eventually resolved the case by paying $2.5 million. The suit alleges Reiss also submitted "numerous falsified invoices totaling at least $754,000," for costs and kept the money.
Prosecutors said that in addition to the MTA, Reiss also took advantage of other clients. In one case, he settled a suit without the client's knowledge, forged signatures on paperwork and pocketed the money, prosecutors said. In another case involving a trust, he opened a bank account, deposited a client's money and wrote checks to himself, prosecutors said.
Reiss, was disbarred on March 16, 2013 after a state Bar Court judge called his case an illustration of the "disciplinary consequences of dishonesty," The State Bar case went on to conclude "the most serious aggravation is found in Reiss’s 10-year pattern of deception in order to cover up mismanagement of his clients’ cases or for his personal economic gain. ...Without a hint of remorse, Reiss has refused to acknowledge his misconduct despite overwhelming evidence of his dishonesty and the harm he caused to his clients. While the law does not require Reiss to be falsely penitent, it does require that [he] accept responsibility for his acts and come to grips with his culpability." ...
Rates and premiums for workers’ compensation insurance are continuing to climb across the US, driven by factors including the prolonged low interest rate environment and rising medical costs. Meanwhile, implementation of the Affordable Care Act (ACA) and the potential expiration of the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) are two other factors that could make a significant impact on the workers’ comp market as 2014 unfolds.
As the U.S. unemployment rate shows modest declines and wages are slowly increasing, it’s no surprise that workers’ compensation premiums are continuing to show growth. A quick look back at the past 8 years tells us that the workers’ compensation market suffered through a 27% decline in premium from 2006 to 2010 before rebounding with growth in the past 3 years, including a 10% increase in 2012 to more than $39 billion according to an annual study by the National Council on Compensation Insurance (NCCI).
Wells Fargo took a look at what to expect through 2014 in the workers’ comp market in its 2014 Insurance Market Outlook, released at the end of January. In addition to concurring with the Marsh report regarding TRIPRA, the report forecasts continued rate increases for the first three quarters of this year, along with continued reduction in the combined loss ratio, resulting from higher prices seen over the past three years. The report includes several other predictions, such as continued movement away from guaranteed cost program structures into higher deductible program structures, either because they are a more appealing alternative or a necessity. One final prediction in the report says the continued use of predictive modeling analysis to improve risk selection, proper retention levels and pricing will result in more conservative underwriting by the insurers.
Health care reform hasn’t made a significant impact on the US workers’ comp market to date, but that isn’t expected to be the case for much longer. The effects could be both beneficial and detrimental. Ruth Estrich, chief strategy officer at Philadelphia-based MedRisk, a workers’ comp-focused managed care company, says the impact could come in a variety of forms. One way would be reduced severity in worker’s comp. If millions of people who were previously uninsured become insured, one would hope that these people will get healthier. For people that have chronic issues (such as asthma), having health insurance that allows them to manage their issues should impact how quickly they heal, become functional and get back in the workplace. Someone who is not getting care for their chronic issues will likely take longer to recover in a workers’ comp situation.
Estrich says another issue the industry is watching is access to primary care physicians (PCPs). "If you think about all of those folks who will start accessing health care through their PCP, we are headed toward a problem with access to primary care," Estrich says. "People were already predicting that access to primary care will be a problem. It could be a perfect storm." In worker’s comp, a lot of the treatment and first response in many cases comes via a person’s PCP. Estrich says it is conceivable that many PCPs, who are already in short supply, will elect to stop treating workers’ comp cases, which can be more challenging to deal with. This would obviously be a negative development for the workers’ comp market.
The third issue Estrich sees in the potential for a cost shift. People without health insurance have an incentive to ascribe their injury to a workplace event when it may well have happened away from the job, simply because they would be covered by workers’ comp and not covered if the injury occurs away from work. With more people being covered by health insurance, they would be less likely to claim an injury happened at work ...
As the U.S. unemployment rate shows modest declines and wages are slowly increasing, it’s no surprise that workers’ compensation premiums are continuing to show growth. A quick look back at the past 8 years tells us that the workers’ compensation market suffered through a 27% decline in premium from 2006 to 2010 before rebounding with growth in the past 3 years, including a 10% increase in 2012 to more than $39 billion according to an annual study by the National Council on Compensation Insurance (NCCI).
Wells Fargo took a look at what to expect through 2014 in the workers’ comp market in its 2014 Insurance Market Outlook, released at the end of January. In addition to concurring with the Marsh report regarding TRIPRA, the report forecasts continued rate increases for the first three quarters of this year, along with continued reduction in the combined loss ratio, resulting from higher prices seen over the past three years. The report includes several other predictions, such as continued movement away from guaranteed cost program structures into higher deductible program structures, either because they are a more appealing alternative or a necessity. One final prediction in the report says the continued use of predictive modeling analysis to improve risk selection, proper retention levels and pricing will result in more conservative underwriting by the insurers.
Health care reform hasn’t made a significant impact on the US workers’ comp market to date, but that isn’t expected to be the case for much longer. The effects could be both beneficial and detrimental. Ruth Estrich, chief strategy officer at Philadelphia-based MedRisk, a workers’ comp-focused managed care company, says the impact could come in a variety of forms. One way would be reduced severity in worker’s comp. If millions of people who were previously uninsured become insured, one would hope that these people will get healthier. For people that have chronic issues (such as asthma), having health insurance that allows them to manage their issues should impact how quickly they heal, become functional and get back in the workplace. Someone who is not getting care for their chronic issues will likely take longer to recover in a workers’ comp situation.
Estrich says another issue the industry is watching is access to primary care physicians (PCPs). "If you think about all of those folks who will start accessing health care through their PCP, we are headed toward a problem with access to primary care," Estrich says. "People were already predicting that access to primary care will be a problem. It could be a perfect storm." In worker’s comp, a lot of the treatment and first response in many cases comes via a person’s PCP. Estrich says it is conceivable that many PCPs, who are already in short supply, will elect to stop treating workers’ comp cases, which can be more challenging to deal with. This would obviously be a negative development for the workers’ comp market.
The third issue Estrich sees in the potential for a cost shift. People without health insurance have an incentive to ascribe their injury to a workplace event when it may well have happened away from the job, simply because they would be covered by workers’ comp and not covered if the injury occurs away from work. With more people being covered by health insurance, they would be less likely to claim an injury happened at work ...
More than 12 million Americans reported using prescription painkillers in 2010 without a prescription or just for the high that they cause. Nearly 3 out of 4 drug overdose deaths are now caused by prescription painkillers. In 2008, some 14,800 deaths were attributed to the pills - more than cocaine and heroin combined. More than 475,000 emergency room visits were directly linked to prescription painkiller misuse or abuse in 2009, roughly double the number of five years earlier.
The global production of oxycodone, marketed as OxyContin in the United States, increased from two tons in 1990 to 135 tons in 2009. More than two-thirds of that supply was manufactured in the US, which, according to the United Nations Office on Drugs and Crime, increases the risk of its subsequent overprescription and diversion into illicit channels. Experts trace the rise of painkiller misuse in the US to 1996. That's when the pharmaceutical company Purdue Pharma introduced OxyContin, a narcotic and derivative of opium. Andrew Kolodny, chief medical officer of Phoenix House, a national nonprofit treatment agency, describes OxyContin as essentially a "heroin pill." It was made of oxycodone, a narcotic used to treat pain at the end of life. But the new pill would allow the company to reach a much wider audience.
"[Purdue] wanted a product that would be prescribed for common, moderately painful chronic conditions," says Dr. Kolodny, who is also president of Physicians for Responsible Opioid Prescribing, an advocacy group. At first, the medical community balked. Using opioids for chronic problems seemed too risky given the nature of the pills' highly addictive properties. But Purdue Pharma launched an aggressive marketing campaign arguing that it was a compassionate way to treat patients and, because of its extended-release characteristics, would be less prone to abuse. But before long, numerous cases of addiction to the painkillers began to surface. In 2007, Purdue Pharma pleaded guilty in federal court to misleading doctors and the public about OxyContin's risks and paid a $600 million penalty. Kolodny says that the overprescribing of painkillers has now led to an "epidemic" of addictions, both among pain patients and recreational users.
And once a person becomes addicted to painkillers, it isn't a long journey to heroin - itself a derivative of morphine developed in the late 1800s as a painkiller. Joseph Gfroerer of SAMHSA co-wrote a recent study that found that, of those who had tried heroin, about 80 percent had previously used painkillers without a prescription. From Los Angeles to Long Island, Chicago to New Orleans, parents and police are struggling with a rise in heroin use in suburban neighborhoods. The rise is being driven by a large supply of cheap heroin in purer concentrations that can be inhaled or smoked, which often removes the stigma associated with injecting it with a needle. But much of the increase among suburban teens, as well as a growing number of adults, has also coincided with a sharp rise in the use of prescription painkiller pills, which medical experts say are essentially identical to heroin. These painkillers, or opioids, are prescribed for things such as sports injuries, dental procedures, or chronic back pain. Yet in a disturbing number of cases, experts say, they are leading to overdependence and often to addiction to the pills themselves, which can then lead to heroin use. Once hooked, users look for doctors who will sell them prescription drugs and, failing that, turn desperately to the street, where the price can be as high as $80 for a single pill. When that becomes too expensive, users often resort to the drug that produces the same kind of high that painkillers do but is far cheaper: heroin.
The latest rise in heroin abuse was made more visible by the recent overdose death of actor Philip Seymour Hoffman. But use of the drug has been growing steadily across many levels of society for at least the past five years. And unlike the heroin surge in the 1970s, the current use of opiates is far more concentrated among suburban and rural whites than among African-American and Latino communities. The heroin that addicts used to shoot up with was 2 or 3 percent pure. Today, the street purity of the drug can be as high as 80 percent. That potency helps explain both the drug's wider appeal and its new danger. Heroin once had to be injected for users to get the high they were looking to achieve, but it is now concentrated enough that they can smoke or snort it to get a similar effect - methods that make heroin easier for people to use it without feeling like a junkie. The higher purity is also more likely to trigger an overdose for those who do inject it ...
The global production of oxycodone, marketed as OxyContin in the United States, increased from two tons in 1990 to 135 tons in 2009. More than two-thirds of that supply was manufactured in the US, which, according to the United Nations Office on Drugs and Crime, increases the risk of its subsequent overprescription and diversion into illicit channels. Experts trace the rise of painkiller misuse in the US to 1996. That's when the pharmaceutical company Purdue Pharma introduced OxyContin, a narcotic and derivative of opium. Andrew Kolodny, chief medical officer of Phoenix House, a national nonprofit treatment agency, describes OxyContin as essentially a "heroin pill." It was made of oxycodone, a narcotic used to treat pain at the end of life. But the new pill would allow the company to reach a much wider audience.
"[Purdue] wanted a product that would be prescribed for common, moderately painful chronic conditions," says Dr. Kolodny, who is also president of Physicians for Responsible Opioid Prescribing, an advocacy group. At first, the medical community balked. Using opioids for chronic problems seemed too risky given the nature of the pills' highly addictive properties. But Purdue Pharma launched an aggressive marketing campaign arguing that it was a compassionate way to treat patients and, because of its extended-release characteristics, would be less prone to abuse. But before long, numerous cases of addiction to the painkillers began to surface. In 2007, Purdue Pharma pleaded guilty in federal court to misleading doctors and the public about OxyContin's risks and paid a $600 million penalty. Kolodny says that the overprescribing of painkillers has now led to an "epidemic" of addictions, both among pain patients and recreational users.
And once a person becomes addicted to painkillers, it isn't a long journey to heroin - itself a derivative of morphine developed in the late 1800s as a painkiller. Joseph Gfroerer of SAMHSA co-wrote a recent study that found that, of those who had tried heroin, about 80 percent had previously used painkillers without a prescription. From Los Angeles to Long Island, Chicago to New Orleans, parents and police are struggling with a rise in heroin use in suburban neighborhoods. The rise is being driven by a large supply of cheap heroin in purer concentrations that can be inhaled or smoked, which often removes the stigma associated with injecting it with a needle. But much of the increase among suburban teens, as well as a growing number of adults, has also coincided with a sharp rise in the use of prescription painkiller pills, which medical experts say are essentially identical to heroin. These painkillers, or opioids, are prescribed for things such as sports injuries, dental procedures, or chronic back pain. Yet in a disturbing number of cases, experts say, they are leading to overdependence and often to addiction to the pills themselves, which can then lead to heroin use. Once hooked, users look for doctors who will sell them prescription drugs and, failing that, turn desperately to the street, where the price can be as high as $80 for a single pill. When that becomes too expensive, users often resort to the drug that produces the same kind of high that painkillers do but is far cheaper: heroin.
The latest rise in heroin abuse was made more visible by the recent overdose death of actor Philip Seymour Hoffman. But use of the drug has been growing steadily across many levels of society for at least the past five years. And unlike the heroin surge in the 1970s, the current use of opiates is far more concentrated among suburban and rural whites than among African-American and Latino communities. The heroin that addicts used to shoot up with was 2 or 3 percent pure. Today, the street purity of the drug can be as high as 80 percent. That potency helps explain both the drug's wider appeal and its new danger. Heroin once had to be injected for users to get the high they were looking to achieve, but it is now concentrated enough that they can smoke or snort it to get a similar effect - methods that make heroin easier for people to use it without feeling like a junkie. The higher purity is also more likely to trigger an overdose for those who do inject it ...
Central Basin Municipal Water District is a public agency that purchases imported water from the Metropolitan Water District of Southern California and wholesales the imported water to cities, mutual water companies, investor-owned utilities and private companies in southeast Los Angeles County. There are 24 cities in Central Basin’s service area. The company is headquartered in Commerce California. The politically explosive District appears to be within a few days of financial armageddon after the agency was officially put on notice that its public insurance carrier is dropping them as a client.
According to the report by Hews Media Group-Community Newspaper, the Association of California Water Agencies and the Joint Powers Insurance Authority (ACWA-JPIA) officially informed Central Basin officials that their insurance coverage has been discontinued citing the "workings of a dysfunctional Board of Directors." The District claims it is now "proactively reviewing all its available insurance options and alternative providers, in light of a pending decision by ACWA-JPIA regarding the District’s future relationship with the insurance provider.
During the past year, HMG-CN has published dozens of exclusive investigative reports documenting deep legal problems allegedly caused by Directors Robert Apodaca, James Roybal and Leticia Vasquez that could be the reasons for JPIA dropping the agency. HMG-CN disclosed the details of a sordid sexual harassment complaint lodged by a female employee against Apodaca;The newspaper has learned that the alleged victim in the case could be handed a high seven-figure settlement. Sources also tell HMG-CN that other females may be in the process of coming forward to file additional cases of sexual harassment activities against Apodaca.
HMG-CN also was the first news outlet to confirm and disclose the details of Director Leticia Vasquez’ filing of a highly controversial whistleblower lawsuit against her own agency. Vasquez, who denied she would be filing the lawsuit until it was revealed by HMG-CN, claims to have been "victimized" by many parties, individuals and law firms who have banked millions in questionable contracts with the agency during the past decade. Vasquez’s lawsuit also goes after her top political alley and heavy campaign contributor Ernest "Ernie" Camacho who is the owner of Pacifica Services. It also cited the Calderons, and other companies. Camacho and his company have banked millions in exclusive contracts with Central Basin.
Vasquez staged a bizarre press conference two weeks ago where she demanded that another director, Art Chacon resign his seat after it was learned that he had been involved in one accident while performing district business. The accident is in litigation, JPIA is fighting the fact that Chacon was working despite multiple sources coming forward to HMG-CN saying he was working, and is set for arbitration August of this year.
Former Central Basin District executive Ron Beilke also filed a complaint alleging wrongfully termination, retaliation, and harassment during his short tenure at the agency. Beilke confirmed to HMG-CN that he is plans to file a seven-figure lawsuit and plans to name Roybal, Apodaca and Vasquez individually in the complaint.
Phil Hawkins, who recently took over as President of the Board of Directors after Roybal was removed with the support of Apodaca and Chacon also chimed in on the current insurance crisis. "This District is hanging on by a thread and our General Manager and staff has done amazing things to right this ship. Our General Manager (Perez) just completed the biggest water sale in our District’s history and has aggressively been identifying potential long term recycled water customers, but somehow our Board continues to drag this agency through the mud," said Hawkins a former state assemblyman from Cerritos. "What I will say to this Board is that the cancellation of our insurance is the ultimate wake-up call. Let’s settle down, let staff do their jobs and try to remember that it’s not about us, it’s about our 2 million customers," Hawkins continued.
The agency is also being investigated by the Federal Bureau of Investigation, the Los Angeles County District Attorney’s Office, the Internal Revenue Service and the United States Attorney’s Office in connection with a case involving current State Senator Ronald Calderon and former Assemblyman Thomas Calderon ...
According to the report by Hews Media Group-Community Newspaper, the Association of California Water Agencies and the Joint Powers Insurance Authority (ACWA-JPIA) officially informed Central Basin officials that their insurance coverage has been discontinued citing the "workings of a dysfunctional Board of Directors." The District claims it is now "proactively reviewing all its available insurance options and alternative providers, in light of a pending decision by ACWA-JPIA regarding the District’s future relationship with the insurance provider.
During the past year, HMG-CN has published dozens of exclusive investigative reports documenting deep legal problems allegedly caused by Directors Robert Apodaca, James Roybal and Leticia Vasquez that could be the reasons for JPIA dropping the agency. HMG-CN disclosed the details of a sordid sexual harassment complaint lodged by a female employee against Apodaca;The newspaper has learned that the alleged victim in the case could be handed a high seven-figure settlement. Sources also tell HMG-CN that other females may be in the process of coming forward to file additional cases of sexual harassment activities against Apodaca.
HMG-CN also was the first news outlet to confirm and disclose the details of Director Leticia Vasquez’ filing of a highly controversial whistleblower lawsuit against her own agency. Vasquez, who denied she would be filing the lawsuit until it was revealed by HMG-CN, claims to have been "victimized" by many parties, individuals and law firms who have banked millions in questionable contracts with the agency during the past decade. Vasquez’s lawsuit also goes after her top political alley and heavy campaign contributor Ernest "Ernie" Camacho who is the owner of Pacifica Services. It also cited the Calderons, and other companies. Camacho and his company have banked millions in exclusive contracts with Central Basin.
Vasquez staged a bizarre press conference two weeks ago where she demanded that another director, Art Chacon resign his seat after it was learned that he had been involved in one accident while performing district business. The accident is in litigation, JPIA is fighting the fact that Chacon was working despite multiple sources coming forward to HMG-CN saying he was working, and is set for arbitration August of this year.
Former Central Basin District executive Ron Beilke also filed a complaint alleging wrongfully termination, retaliation, and harassment during his short tenure at the agency. Beilke confirmed to HMG-CN that he is plans to file a seven-figure lawsuit and plans to name Roybal, Apodaca and Vasquez individually in the complaint.
Phil Hawkins, who recently took over as President of the Board of Directors after Roybal was removed with the support of Apodaca and Chacon also chimed in on the current insurance crisis. "This District is hanging on by a thread and our General Manager and staff has done amazing things to right this ship. Our General Manager (Perez) just completed the biggest water sale in our District’s history and has aggressively been identifying potential long term recycled water customers, but somehow our Board continues to drag this agency through the mud," said Hawkins a former state assemblyman from Cerritos. "What I will say to this Board is that the cancellation of our insurance is the ultimate wake-up call. Let’s settle down, let staff do their jobs and try to remember that it’s not about us, it’s about our 2 million customers," Hawkins continued.
The agency is also being investigated by the Federal Bureau of Investigation, the Los Angeles County District Attorney’s Office, the Internal Revenue Service and the United States Attorney’s Office in connection with a case involving current State Senator Ronald Calderon and former Assemblyman Thomas Calderon ...
California has long been known as one of the epicenters of insurance fraud, medical fraud, and other organized crimes. And now, according to a new 118 page report by California Attorney General Kamala Harris, California leads all states in the number of computer systems hacked or infected by malware, the number of victims of Internet crimes, the amount of financial losses suffered as a result and the number of victims of identity fraud. The report says the state also is particularly vulnerable to thefts of intellectual property because of its leading role in developing new technologies and mass-media entertainment. The report should serve as a wake up call to any California businesses that maintain data on individuals such as insurance companies that digitize claim files, and third party administrators.
Between 2009 and 2012, the number of intentional breaches of computer networks and databases in the U.S. jumped by 280 percent, with California’s share leading the nation. Many of these breaches have been tied to transnational criminal organizations operating from Russia, Ukraine, Romania, Israel, Egypt, China, and Nigeria, among other places.
The report claims that transnational criminal organizations are increasingly taking advantage of new communications technology and the interconnectedness of the globalized world to further their trafficking activities in California. This creates new challenges for law enforcement. But transnational organized crime in California extends beyond drugs, weapons, and human trafficking. In the 21st century, the problem posed by transnational criminal organizations threatens the security of computer and data networks, the integrity of online bank accounts, and the rights of intellectual property holders. By virtue of its population and knowledge-powered economy, "California is the top target in the nation for this new generation of transnational criminal organizations - originating in significant numbers from Eastern Europe, but also Africa and China - whose purpose is to commit highly profitable hacking, fraud, and digital piracy crimes."
California’s gross domestic product of $2 trillion, significant foreign trade activity and border with Mexico also makes the state an easy target for international money-laundering schemes, the report says. It estimates that more than $30 billion is laundered through California’s economy each year. Some is filtered through legitimate businesses or by using virtual currencies such as Bitcoin. But the report says backpacks and duffel bags stuffed with cash have been seized more frequently since Mexico began toughening its money-laundering laws in 2010. Seizures of bulk cash increased 40 percent by 2011 in California, which now leads the nation in the number of currency seizures.
Transnational criminal organizations are taking advantage of new communications technologies and social media to facilitate criminal activity, recruit new members, and intimidate or harass their rivals - even from inside prison walls. In 2011, for example, over 15,000 cell phones were seized from inmates in California prisons. The public safety threat posed by Mexico-based drug trafficking organizations has been amplified as cartels have formed alliances with California prison and streetgangs to control trafficking routes, distribute drugs, and kidnap, extort, and kill as necessary to protect their criminal activities. The Mexican Mafia, for example, provides protection for members of numerous cartels both inside and outside prison, and various Hispanic Sureño and Norteño gangs in Southern and Northern California have teamed up with Sinaloa, La Familia Michoacana, The Knights Templar, and other Mexico-based drug trafficking organizations ...
Between 2009 and 2012, the number of intentional breaches of computer networks and databases in the U.S. jumped by 280 percent, with California’s share leading the nation. Many of these breaches have been tied to transnational criminal organizations operating from Russia, Ukraine, Romania, Israel, Egypt, China, and Nigeria, among other places.
The report claims that transnational criminal organizations are increasingly taking advantage of new communications technology and the interconnectedness of the globalized world to further their trafficking activities in California. This creates new challenges for law enforcement. But transnational organized crime in California extends beyond drugs, weapons, and human trafficking. In the 21st century, the problem posed by transnational criminal organizations threatens the security of computer and data networks, the integrity of online bank accounts, and the rights of intellectual property holders. By virtue of its population and knowledge-powered economy, "California is the top target in the nation for this new generation of transnational criminal organizations - originating in significant numbers from Eastern Europe, but also Africa and China - whose purpose is to commit highly profitable hacking, fraud, and digital piracy crimes."
California’s gross domestic product of $2 trillion, significant foreign trade activity and border with Mexico also makes the state an easy target for international money-laundering schemes, the report says. It estimates that more than $30 billion is laundered through California’s economy each year. Some is filtered through legitimate businesses or by using virtual currencies such as Bitcoin. But the report says backpacks and duffel bags stuffed with cash have been seized more frequently since Mexico began toughening its money-laundering laws in 2010. Seizures of bulk cash increased 40 percent by 2011 in California, which now leads the nation in the number of currency seizures.
Transnational criminal organizations are taking advantage of new communications technologies and social media to facilitate criminal activity, recruit new members, and intimidate or harass their rivals - even from inside prison walls. In 2011, for example, over 15,000 cell phones were seized from inmates in California prisons. The public safety threat posed by Mexico-based drug trafficking organizations has been amplified as cartels have formed alliances with California prison and streetgangs to control trafficking routes, distribute drugs, and kidnap, extort, and kill as necessary to protect their criminal activities. The Mexican Mafia, for example, provides protection for members of numerous cartels both inside and outside prison, and various Hispanic Sureño and Norteño gangs in Southern and Northern California have teamed up with Sinaloa, La Familia Michoacana, The Knights Templar, and other Mexico-based drug trafficking organizations ...
Sacramento Lopez was injured while working for Elena Delgadillo and and Jesus Cortez. He sued them in superior court, seeking damages for the injury and also alleging violations of various wage and hour laws. In response to an interrogatory request propounded during discovery, the employer admitted they did not have workers’ compensation insurance covering Lopez’s injury. The employer later reversed course and contended they did have insurance, relying on a workers’ compensation policy purchased for a different employment site, which they argued also covered the employment site where Lopez was injured. Their insurance company denied coverage and the employer filed a separate lawsuit against the insurance company and others (the insurance action), naming Lopez as an indispensable party. The employer voluntarily dismissed with prejudice the insurance action prior to trial in Lopez’s lawsuit.
After a jury verdict in Lopez’s favor, the trial court entered judgment awarding Lopez unpaid wages and penalties for the wage and hour violations, and damages (medical expenses and noneconomic losses) for the workplace injury. The trial court subsequently awarded Lopez attorney fees, including fees for work performed in the insurance action "because that action was closely related with this action and useful to its resolution." The employer appealed, and the court of appeal sustained the judgment in the unpublished case of Lopez v. Delgadillo.
With respect to the arguments about the exclusive remedy under workers compensation, if an employer has failed to obtain workers’ compensation insurance or permission from the state to self-insure, the employee may bring a civil action for damages. (Labor Code, §§ 3700, 3706.). In this case the employer failed to properly plead and prove that it had proper workers' compensation insurance.
The employer sought, over Lopez’s objection, to present evidence at trial of Lopez’s drug and alcohol use at the time of his injury. The trial court excluded the evidence as more prejudicial than probative under Evidence Code section 352, and refused appellants’ request for a jury instruction regarding intoxication. The court of appeal agreed with the ruling. In lawsuits seeking damages for workplace injuries when the employer failed to obtain workers’ compensation insurance (§ 3706), "it is presumed that the injury to the employee was a direct result and grew out of the negligence of the employer, and the burden of proof is upon the employer, to rebut the presumption of negligence. It is not a defense to the employer that the employee was guilty of contributory negligence" (§ 3708). After the California Supreme Court replaced contributory negligence with comparative negligence, this statute was construed to preclude a defense of the employee’s comparative negligence. (Logan v. Masters (1981) 120 Cal.App.3d 145, 147-148 ["[c]omparative negligence, like contributory negligence, is unavailable to the employer," otherwise "uninsured employers would have a potential advantage over insured employers, a result clearly contrary to the Legislature’s intent"].) Accordingly, any evidence of Lopez’s drug and alcohol use to show his negligence was properly excluded.
...
After a jury verdict in Lopez’s favor, the trial court entered judgment awarding Lopez unpaid wages and penalties for the wage and hour violations, and damages (medical expenses and noneconomic losses) for the workplace injury. The trial court subsequently awarded Lopez attorney fees, including fees for work performed in the insurance action "because that action was closely related with this action and useful to its resolution." The employer appealed, and the court of appeal sustained the judgment in the unpublished case of Lopez v. Delgadillo.
With respect to the arguments about the exclusive remedy under workers compensation, if an employer has failed to obtain workers’ compensation insurance or permission from the state to self-insure, the employee may bring a civil action for damages. (Labor Code, §§ 3700, 3706.). In this case the employer failed to properly plead and prove that it had proper workers' compensation insurance.
The employer sought, over Lopez’s objection, to present evidence at trial of Lopez’s drug and alcohol use at the time of his injury. The trial court excluded the evidence as more prejudicial than probative under Evidence Code section 352, and refused appellants’ request for a jury instruction regarding intoxication. The court of appeal agreed with the ruling. In lawsuits seeking damages for workplace injuries when the employer failed to obtain workers’ compensation insurance (§ 3706), "it is presumed that the injury to the employee was a direct result and grew out of the negligence of the employer, and the burden of proof is upon the employer, to rebut the presumption of negligence. It is not a defense to the employer that the employee was guilty of contributory negligence" (§ 3708). After the California Supreme Court replaced contributory negligence with comparative negligence, this statute was construed to preclude a defense of the employee’s comparative negligence. (Logan v. Masters (1981) 120 Cal.App.3d 145, 147-148 ["[c]omparative negligence, like contributory negligence, is unavailable to the employer," otherwise "uninsured employers would have a potential advantage over insured employers, a result clearly contrary to the Legislature’s intent"].) Accordingly, any evidence of Lopez’s drug and alcohol use to show his negligence was properly excluded.
...
Hundreds of thousands of doctors who participate in traditional Medicare face a 24 percent pay cut on April 1, as part of a 1990s initiative to restrain federal spending on the government healthcare program, which today serves nearly 50 million elderly and disabled people.
Using language seldom reserved for Congress, the nation’s most powerful lobbies for physicians are heaping praise on rare bipartisan legislation heading to the floors of the U.S. Senate and House of Representatives perhaps within the next month to fix a flaw in how doctors are paid by the federal Medicare health insurance program for the elderly. After years of watching Congress delay, debate and dither on the repeal of Medicare’s "sustainable growth rate," or SGR, reimbursement formula, a solution has passed three powerful Congressional committees and is headed possibly next month to likely passage.
According to the story in Forbes, the deal, which both the American Medical Association and the American Academy of Family Physicians have called a "bicameral, bipartisan" agreement to repeal SGR would bring an end to stopgap corrections to dramatic cuts in doctor payments from Medicare in what has since been labeled the "doc fix." At the same time, the legislation heading for Senate and House votes would tie more physician reimbursement to quality and outcomes measures. "Legislators and staff have shown a Herculean effort in crafting this proposal," Dr. Jeffrey Cain, chair of the American Academy of Family Physicians board said in a letter Monday to Congressional leaders including House Speaker John Boehner and Senate Majority Leader Harry Reid.
Congress has several times for a decade now merely made stopgap corrections to avert drastic payment cuts to Medicare payments under SGR, which was created by the Balanced Budget Act of 1997 in an effort to slow the growth of Medicare spending. Last year alone, Congress averted a fee cut of nearly 27 percent to physician payments. The AMA, family doctor group and other physician lobbies say Congress needs to act before March 31 when the latest stopgap measure that extends "the Medicare payment formula that includes the Sustainable Growth Rate expires," Cain said. "The looming threat of frequent reductions also stifles innovation in case delivery and hinders the transformation of primary care practices," Cain said. "Investments in process and quality improvement have proven difficult for most physicians under the current unpredictable payment structure."
Should the legislation pass, it will increase payments 0.5 percent annually through 2018. Meanwhile, more Medicare payments would be tied to quality measures that include "clinical care, safety, care coordination, patient and caregiver experience and population health." To get bonus payments, physicians would be compared to their peers and measures would be updated every year by the U.S. Secretary of Health and Human Services.
The move to new payment could also be good news to the health insurance industry with companies like Aetna, UnitedHealth Group, Humana and others seeing greater numbers of seniors flocking to their Medicare Advantage plans that contract with the Medicare program to provide seniors with health benefits. They need doctors to participate if they are going to provide seniors with adequate medical care provider networks ...
Using language seldom reserved for Congress, the nation’s most powerful lobbies for physicians are heaping praise on rare bipartisan legislation heading to the floors of the U.S. Senate and House of Representatives perhaps within the next month to fix a flaw in how doctors are paid by the federal Medicare health insurance program for the elderly. After years of watching Congress delay, debate and dither on the repeal of Medicare’s "sustainable growth rate," or SGR, reimbursement formula, a solution has passed three powerful Congressional committees and is headed possibly next month to likely passage.
According to the story in Forbes, the deal, which both the American Medical Association and the American Academy of Family Physicians have called a "bicameral, bipartisan" agreement to repeal SGR would bring an end to stopgap corrections to dramatic cuts in doctor payments from Medicare in what has since been labeled the "doc fix." At the same time, the legislation heading for Senate and House votes would tie more physician reimbursement to quality and outcomes measures. "Legislators and staff have shown a Herculean effort in crafting this proposal," Dr. Jeffrey Cain, chair of the American Academy of Family Physicians board said in a letter Monday to Congressional leaders including House Speaker John Boehner and Senate Majority Leader Harry Reid.
Congress has several times for a decade now merely made stopgap corrections to avert drastic payment cuts to Medicare payments under SGR, which was created by the Balanced Budget Act of 1997 in an effort to slow the growth of Medicare spending. Last year alone, Congress averted a fee cut of nearly 27 percent to physician payments. The AMA, family doctor group and other physician lobbies say Congress needs to act before March 31 when the latest stopgap measure that extends "the Medicare payment formula that includes the Sustainable Growth Rate expires," Cain said. "The looming threat of frequent reductions also stifles innovation in case delivery and hinders the transformation of primary care practices," Cain said. "Investments in process and quality improvement have proven difficult for most physicians under the current unpredictable payment structure."
Should the legislation pass, it will increase payments 0.5 percent annually through 2018. Meanwhile, more Medicare payments would be tied to quality measures that include "clinical care, safety, care coordination, patient and caregiver experience and population health." To get bonus payments, physicians would be compared to their peers and measures would be updated every year by the U.S. Secretary of Health and Human Services.
The move to new payment could also be good news to the health insurance industry with companies like Aetna, UnitedHealth Group, Humana and others seeing greater numbers of seniors flocking to their Medicare Advantage plans that contract with the Medicare program to provide seniors with health benefits. They need doctors to participate if they are going to provide seniors with adequate medical care provider networks ...
Public Service Insurance Co.’s newly announced exit from California’s workers’ compensation market is not a reflection of the health of the state’s workers’ comp system, according to the California Department of Insurance. The workers’ comp carrier is part of the Magna Carta Cos.
A.M. Best this week downgraded the financial strength rating to B+ (Good) from B++ (Good) and the issuer credit ratings to "bbb-" from "bbb" of Public Service Insurance Co. and its affiliates, Paramount Insurance Co. (New York, NY) and Western Select Insurance Co.(Los Angeles, CA) The companies are collectively referred to as Magna Carta Cos., which operate through an intercompany pooling reinsurance agreement, according to A.M. Best.
The rating downgrades reflect the significant deterioration in Magna Carta Companies' operating performance during the fourth quarter of 2013, due to a $57 million charge to strengthen reserves. Approximately $31.9 million of the group's reserve strengthening actions were related to its workers' compensation line of business. To provide protection against further unexpected adverse reserve development, management plans to implement an ADC, which will cover 100 percent of net losses within the ADC coverage limit. Inclusive of the benefit of the additional reinsurance protection, Magna Carta Companies' overall risk-adjusted capitalization adequately supports its current obligations and those anticipated by its near-term business plans. While risk-adjusted capitalization is expected to remain at a level that supports the current ratings in the near to midterm, A.M. Best is concerned about the lack of clarity regarding Magna Carta Companies' risk appetite and business strategy, which has contributed to the below-average underwriting and operating results in recent years. A.M. Best expects management will focus on these critical issues to return the group to profitability in the near term.
According to the story in the Insurance Journal, a call to Magna Carta wasn’t immediately returned, and spokespersons for Magna Carta or Public Service couldn’t be located.
Bryant Henley, assistant chief council for CDI, said the department has been aware of the exit. "We certainly were aware the Public Service Insurance Co. was planning to exit the market," Henley said. Aside from that Henley declined to comment specifically on Public Service’s exit, but he said that it would have a negligible impact on the state. "The short answer there is that Public Service Insurance Co. was a very small part of the market share of California," he said. According to CDI, the company wrote less than "One-half of 1 percent" of California’s workers’ comp business. Henley said the exit doesn’t portend any developing problems for California’s workers’ comp carriers. "No, we would not consider this a trend," he said. "We don’t have a lot of workers’ comp business leaving California. We don’t anticipate it to be a larger trend of things to come." He added: "the California market, it’s very vibrant and thriving."
A spokesman for the state’s Workers’ Compensation Insurance Rating Bureau said the bureau wouldn’t offer a comment on the announced exit of the company, and a spokesman for the California Workers’ Compensation Institute also declined comment.
It’s estimated the company wrote less than $29 million in direct premiums amid the state’s $9 billion market ...
A.M. Best this week downgraded the financial strength rating to B+ (Good) from B++ (Good) and the issuer credit ratings to "bbb-" from "bbb" of Public Service Insurance Co. and its affiliates, Paramount Insurance Co. (New York, NY) and Western Select Insurance Co.(Los Angeles, CA) The companies are collectively referred to as Magna Carta Cos., which operate through an intercompany pooling reinsurance agreement, according to A.M. Best.
The rating downgrades reflect the significant deterioration in Magna Carta Companies' operating performance during the fourth quarter of 2013, due to a $57 million charge to strengthen reserves. Approximately $31.9 million of the group's reserve strengthening actions were related to its workers' compensation line of business. To provide protection against further unexpected adverse reserve development, management plans to implement an ADC, which will cover 100 percent of net losses within the ADC coverage limit. Inclusive of the benefit of the additional reinsurance protection, Magna Carta Companies' overall risk-adjusted capitalization adequately supports its current obligations and those anticipated by its near-term business plans. While risk-adjusted capitalization is expected to remain at a level that supports the current ratings in the near to midterm, A.M. Best is concerned about the lack of clarity regarding Magna Carta Companies' risk appetite and business strategy, which has contributed to the below-average underwriting and operating results in recent years. A.M. Best expects management will focus on these critical issues to return the group to profitability in the near term.
According to the story in the Insurance Journal, a call to Magna Carta wasn’t immediately returned, and spokespersons for Magna Carta or Public Service couldn’t be located.
Bryant Henley, assistant chief council for CDI, said the department has been aware of the exit. "We certainly were aware the Public Service Insurance Co. was planning to exit the market," Henley said. Aside from that Henley declined to comment specifically on Public Service’s exit, but he said that it would have a negligible impact on the state. "The short answer there is that Public Service Insurance Co. was a very small part of the market share of California," he said. According to CDI, the company wrote less than "One-half of 1 percent" of California’s workers’ comp business. Henley said the exit doesn’t portend any developing problems for California’s workers’ comp carriers. "No, we would not consider this a trend," he said. "We don’t have a lot of workers’ comp business leaving California. We don’t anticipate it to be a larger trend of things to come." He added: "the California market, it’s very vibrant and thriving."
A spokesman for the state’s Workers’ Compensation Insurance Rating Bureau said the bureau wouldn’t offer a comment on the announced exit of the company, and a spokesman for the California Workers’ Compensation Institute also declined comment.
It’s estimated the company wrote less than $29 million in direct premiums amid the state’s $9 billion market ...
The Division of Workers’ Compensation (DWC) has posted proposed changes to regulations reflecting transition from ICD-9 to ICD-10 to the online forum where members of the public may review and comment on the proposals.
Work on ICD-10 began in 1983 and was completed in 1992. ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). ICD-10 is already in use in about 25 countries. The United States continues to use ICD-9, the prior edition of ICD. The new code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes can be expanded to over 16,000 codes by using optional sub-classifications. The detail reported by ICD can be further increased, with a simplified multi-axial approach, by using codes meant to be reported in a separate data field.
The deadline for the United States to begin using Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding is currently October 1, 2014. The deadline was previously October 1, 2013. In preparation for this deadline, it is necessary for the DWC to update regulations and forms to refer to ICD-10, rather than ICD-9. Affected regulations are 8 C.C.R. §§ 9702(e), 9770(g) and 9789.16.2(a).
Affected forms are DLSR 5021 (Doctor’s First Report of Injury), PR-2 (Primary Treating Physician’s Progress Report), PR-3 and PR-4 (Primary Treating Physician’s Permanent and Stationary Reports).
The forum can be found online on the DWC forums web page under "current forums." Comments will be accepted on the forum until 5 p.m. on Friday, March 28, 2014/ ...
Work on ICD-10 began in 1983 and was completed in 1992. ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). ICD-10 is already in use in about 25 countries. The United States continues to use ICD-9, the prior edition of ICD. The new code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes can be expanded to over 16,000 codes by using optional sub-classifications. The detail reported by ICD can be further increased, with a simplified multi-axial approach, by using codes meant to be reported in a separate data field.
The deadline for the United States to begin using Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding is currently October 1, 2014. The deadline was previously October 1, 2013. In preparation for this deadline, it is necessary for the DWC to update regulations and forms to refer to ICD-10, rather than ICD-9. Affected regulations are 8 C.C.R. §§ 9702(e), 9770(g) and 9789.16.2(a).
Affected forms are DLSR 5021 (Doctor’s First Report of Injury), PR-2 (Primary Treating Physician’s Progress Report), PR-3 and PR-4 (Primary Treating Physician’s Permanent and Stationary Reports).
The forum can be found online on the DWC forums web page under "current forums." Comments will be accepted on the forum until 5 p.m. on Friday, March 28, 2014/ ...
Ron Davis, while employed as a laborer by Walt Disney Company,suffered industrial injury while pulling a heavy file cabinet on 1/3/2008 to the cervical spine, with resulting psyche, sleep disorder, sexual dysfunction and GERD. He was provided industrial benefits and treatment. He underwent cervical spine surgery on 3/11/2008 and 5/19/2009. To resolve disputed medical issues the parties obtained AME orthopedic reports of Dr. Roger Sohn, AME psychiatric reports of Dr. Perry Maloff, PQME internal reports of Dr.Revels Cayton. Also placed in evidence at trial were treating physician reports of Dr. Sam Bakshian and Dr.Dan Nairn.
The psychiatric AME, Dr. Maloff, found 8% whole person impairment for the applicant's psyche, with 90% apportionment to industrial causes. The internal PQME, Dr. Cayton, found that the applicant's sexual dysfunction was related to his psyche, with no independent ratable impairment. He found 9% whole person impairment for sleep maintenance insomnia, and 6% whole person impairment for GERO.
The orthopedic AME, Dr. Sohn found the applicant had a work restriction limiting him to light work only, precluding repetitive motions of the cervical spine and he should not do overhead work or keep his neck in a fixed position. Also he found 23 %. whole person impairment using the ROM method of the AMA Guides because of the multi-level cervical disc involvement in this case. He also found under DRE Category IV he would have a 26% WP!, plus 3% for chronic pain producing a 28% WP!. The AME explained why he felt this did not-accurately reflect the applicant's impairment rating and attempted to apply an Almaraz/Guzman rebuttal rating as follows: "However, I do not think this accurately rates the applicant's impairment rating. Under AMA guidelines, work activities are not taken into account. This accounts only for activities of daily living. I think to get an accurate rating in this person, work activities certainly must be taken into account in this workers' compensation setting. Not to do so would lead to an obvious inaccurate rating. This is a gentleman who has virtually no extension of his cervical spine. He has 0% extension and only 40% of normal flexion. He has moderate spasm. He has significant diminution in his ability to lift, as well as his ability to move his neck. All-in-all, in my opinion, the applicant has lost 60% of his capacity for function of the cervical spine. Taking into consideration of Figure 15-19, which provides for 80% whole person impairment for complete loss of cervical spine fusion, the applicant's whole person impairment is best rated, therefore, at 48 % impairment whole person. Adding 3% for his chronic pain level, the applicant's whole person impairment is thus rated at 50% whole person. This in my opinion, is a more accurate rating under Almaraz/Guzman, and is far more accurate than the above rating using traditional AMA guidelines."
The WCJ awarded 62% PD, after apportionment based strictly upon the AMA guides. He did not apply the attempted Almaraz./Guzman analysis by the orthopedic AME Dr. Sohn. The applicant's Petition for Reconsideration was denied in the panel decision of Davis v Walt Disney Company..
The WCJ reasoned that the AME attempts to rebut the Guides by referring to Figure 15-19 of the Guides, attempting to stay within the four comers of the AMA Guides. However, the AME fails to provide sufficient explanation as to why rating applicant's WPI using Figure 15-19 is more appropriate than the ROM or DRE method for rating the WPI under the spinal chapter, other than to achieve a desired result because he views the AMA Guides as not considering work functions. The AME's attempt to rebut the AMA Guides whole person impairment rating of the cervical spine factors of disability by reference to Figure 15-19 to produce a 48% WP! cervical spine disability is not substantial evidence. In the instant case, Dr. Sohn did not utilize any other chapter, table; or method in the AMA Guides. Rather, he referenced Figure 15-19. Figure 15-19 is a pictorial diagram of the side view of the spinal column. There is no rating methodology described therein. Figure 15-19 simply states, "the whole spine divided into regions indicating the maximum whole person impairment represented by a total impairment .of one region of the spine. Lumbar 90%, thoracic 40%, cervical 80%." The figure is provided ONLY for a discussion of Chapter 15.which explains how to convert whole person impairment into regional spine impairment, NOT VICE-VERSA." ...
The psychiatric AME, Dr. Maloff, found 8% whole person impairment for the applicant's psyche, with 90% apportionment to industrial causes. The internal PQME, Dr. Cayton, found that the applicant's sexual dysfunction was related to his psyche, with no independent ratable impairment. He found 9% whole person impairment for sleep maintenance insomnia, and 6% whole person impairment for GERO.
The orthopedic AME, Dr. Sohn found the applicant had a work restriction limiting him to light work only, precluding repetitive motions of the cervical spine and he should not do overhead work or keep his neck in a fixed position. Also he found 23 %. whole person impairment using the ROM method of the AMA Guides because of the multi-level cervical disc involvement in this case. He also found under DRE Category IV he would have a 26% WP!, plus 3% for chronic pain producing a 28% WP!. The AME explained why he felt this did not-accurately reflect the applicant's impairment rating and attempted to apply an Almaraz/Guzman rebuttal rating as follows: "However, I do not think this accurately rates the applicant's impairment rating. Under AMA guidelines, work activities are not taken into account. This accounts only for activities of daily living. I think to get an accurate rating in this person, work activities certainly must be taken into account in this workers' compensation setting. Not to do so would lead to an obvious inaccurate rating. This is a gentleman who has virtually no extension of his cervical spine. He has 0% extension and only 40% of normal flexion. He has moderate spasm. He has significant diminution in his ability to lift, as well as his ability to move his neck. All-in-all, in my opinion, the applicant has lost 60% of his capacity for function of the cervical spine. Taking into consideration of Figure 15-19, which provides for 80% whole person impairment for complete loss of cervical spine fusion, the applicant's whole person impairment is best rated, therefore, at 48 % impairment whole person. Adding 3% for his chronic pain level, the applicant's whole person impairment is thus rated at 50% whole person. This in my opinion, is a more accurate rating under Almaraz/Guzman, and is far more accurate than the above rating using traditional AMA guidelines."
The WCJ awarded 62% PD, after apportionment based strictly upon the AMA guides. He did not apply the attempted Almaraz./Guzman analysis by the orthopedic AME Dr. Sohn. The applicant's Petition for Reconsideration was denied in the panel decision of Davis v Walt Disney Company..
The WCJ reasoned that the AME attempts to rebut the Guides by referring to Figure 15-19 of the Guides, attempting to stay within the four comers of the AMA Guides. However, the AME fails to provide sufficient explanation as to why rating applicant's WPI using Figure 15-19 is more appropriate than the ROM or DRE method for rating the WPI under the spinal chapter, other than to achieve a desired result because he views the AMA Guides as not considering work functions. The AME's attempt to rebut the AMA Guides whole person impairment rating of the cervical spine factors of disability by reference to Figure 15-19 to produce a 48% WP! cervical spine disability is not substantial evidence. In the instant case, Dr. Sohn did not utilize any other chapter, table; or method in the AMA Guides. Rather, he referenced Figure 15-19. Figure 15-19 is a pictorial diagram of the side view of the spinal column. There is no rating methodology described therein. Figure 15-19 simply states, "the whole spine divided into regions indicating the maximum whole person impairment represented by a total impairment .of one region of the spine. Lumbar 90%, thoracic 40%, cervical 80%." The figure is provided ONLY for a discussion of Chapter 15.which explains how to convert whole person impairment into regional spine impairment, NOT VICE-VERSA." ...
Pearson Food Company owns and operates a large food and sundries distribution warehouse in Los Angeles County, employing between 35-40 employees. It was insured by the State Compensation Insurance Fund between 2003 and 2005. At the end of the policy period for 2004 - 2005 an audit of Pearson’s financial records by SCIF revealed that Pearson had under reported its payroll and therefore owed additional insurance premiums to SCIF in the amount of $8,341.61. SC IF ultimately assigned the collection of the unpaid premiums to a third party, Allied Interstate Incorporated. Allied subsequently brought a collection action in the superior court against Pearson on the claim.
Pearson filed the cross-complaint against SCIF. Pearson’s causes of action centered around three workers’ compensations claims that Pearson alleged SCIF failed to fully investigate, had mishandled, over-valued and negligently adjusted in various ways resulting in overpayment and setting improper reserves on those claims. Pearson also claimed that as a result of SCIF’s conduct Pearson was charged higher insurance premiums and was unable to secure less expensive insurance from another insurance company. Pearson’s second amended complaint alleged that SCIF breached the insurance contract, and engaged in bad faith in various ways.
The trial court ordered the matter to reference under Code of Civil Procedure section 639, subdivisions (a)(1)-(3). During the trial before the appointed Referee Pearson presented the testimony of William Wilson, the CEO of Pearson, and Adam Wilson, the Vice President of Pearson. Pearson presented expert testimony of Sam Smith, a claims handling expert, Susan Silberman, an attorney and expert on claims handling and legal support, and Duncan Prince. SCIF’s claim adjuster/employees George Ashkharian, Rosa Rodriguez-Cubero, and Christopher Punzalan also testified. The SCIF employees testified about handling of the claims as to the three claimants, setting medical evaluations, and obtaining medical reports, and the process of determining benefit payments and setting reserves. SCIF presented expert witness William Spiegel, who testified about the proper methods of claims handling for workers compensation claims.
After reviewing the evidence, including the expert testimony presented by both parties, the Referee found that Pearson failed to prove its claims. The Referee found that although certain claims may have warranted additional investigation, that Pearson’s complaints were trivial, and did not result in significant damage or demonstrate a pattern of negligence or bad faith. The statement of decision indicated that: Pearson failed to produced evidence that the employee Herzog was not injured" or that setting a lifetime reserve in that case affected Pearson’s "ex-mod" or future premiums. As to the alleged fabricated claim by employee Aguilar, the Referee concluded that although Pearson suspected fraud, it was never reported to SCIF and the evidence indicated that employee Quinones’s injury occurred and the applicant was telling the truth. The Referee rejected the testimony of Pearson’s experts on the handling of Herzog’s, Aguilar’s and Quinones’s claims. The Referee found Susan Silberman unqualified to give medical testimony and found Mr. Smith’s testimony on reserve amounts lacked foundation and was unpersuasive. The Referee further found Pearson failed to demonstrate SCIF’s conduct damaged Pearson as alleged.
Pearson appealed the decision. The Court of Appeal affirmed in the unpublished case of Pearson Food Co. v. State Compensation Ins. Fund
Pearson claimed on appeal that the judgment must be reversed because: (1) the statement of decision upon which the judgment is based did not resolve its causes of action for breach of contract and quantum meruit; (2) the Referee’s findings did not support a ruling in favor of SCIF on the other causes of action, the Referee applied the improper standard of care in assessing the case and incorrectly shifted the burden of proof onto Pearson; and (3) the trial court erred in denying Pearson a new trial. The Court of Appeal found no merit to any of these arguments.
The statement of decision summarized the evidence presented during the trial with respect to the three cases. Thereafter in the decision, the Referee assessed Pearson’s factual and legal contentions in light of the evidence presented about each case. With respect to the Herzog claim the Referee found that "no evidence was produced that Herzog was not injured" or that "he was playing golf during the time of his treatment." The Referee further found that SCIF’s adjuster’s setting of reverses was not unjustified or excessive in light of the evidence presented at trial. The Referee also noted that the impact of the reserves on Pearson’s "ex-mod, if calculable was not identified" even though the claim remained "open." The Referee concluded that "[a]t the end of the day, I am persuaded that Pearson’s dispute on this issue is a quibble that does not support significant damages." ...
Pearson filed the cross-complaint against SCIF. Pearson’s causes of action centered around three workers’ compensations claims that Pearson alleged SCIF failed to fully investigate, had mishandled, over-valued and negligently adjusted in various ways resulting in overpayment and setting improper reserves on those claims. Pearson also claimed that as a result of SCIF’s conduct Pearson was charged higher insurance premiums and was unable to secure less expensive insurance from another insurance company. Pearson’s second amended complaint alleged that SCIF breached the insurance contract, and engaged in bad faith in various ways.
The trial court ordered the matter to reference under Code of Civil Procedure section 639, subdivisions (a)(1)-(3). During the trial before the appointed Referee Pearson presented the testimony of William Wilson, the CEO of Pearson, and Adam Wilson, the Vice President of Pearson. Pearson presented expert testimony of Sam Smith, a claims handling expert, Susan Silberman, an attorney and expert on claims handling and legal support, and Duncan Prince. SCIF’s claim adjuster/employees George Ashkharian, Rosa Rodriguez-Cubero, and Christopher Punzalan also testified. The SCIF employees testified about handling of the claims as to the three claimants, setting medical evaluations, and obtaining medical reports, and the process of determining benefit payments and setting reserves. SCIF presented expert witness William Spiegel, who testified about the proper methods of claims handling for workers compensation claims.
After reviewing the evidence, including the expert testimony presented by both parties, the Referee found that Pearson failed to prove its claims. The Referee found that although certain claims may have warranted additional investigation, that Pearson’s complaints were trivial, and did not result in significant damage or demonstrate a pattern of negligence or bad faith. The statement of decision indicated that: Pearson failed to produced evidence that the employee Herzog was not injured" or that setting a lifetime reserve in that case affected Pearson’s "ex-mod" or future premiums. As to the alleged fabricated claim by employee Aguilar, the Referee concluded that although Pearson suspected fraud, it was never reported to SCIF and the evidence indicated that employee Quinones’s injury occurred and the applicant was telling the truth. The Referee rejected the testimony of Pearson’s experts on the handling of Herzog’s, Aguilar’s and Quinones’s claims. The Referee found Susan Silberman unqualified to give medical testimony and found Mr. Smith’s testimony on reserve amounts lacked foundation and was unpersuasive. The Referee further found Pearson failed to demonstrate SCIF’s conduct damaged Pearson as alleged.
Pearson appealed the decision. The Court of Appeal affirmed in the unpublished case of Pearson Food Co. v. State Compensation Ins. Fund
Pearson claimed on appeal that the judgment must be reversed because: (1) the statement of decision upon which the judgment is based did not resolve its causes of action for breach of contract and quantum meruit; (2) the Referee’s findings did not support a ruling in favor of SCIF on the other causes of action, the Referee applied the improper standard of care in assessing the case and incorrectly shifted the burden of proof onto Pearson; and (3) the trial court erred in denying Pearson a new trial. The Court of Appeal found no merit to any of these arguments.
The statement of decision summarized the evidence presented during the trial with respect to the three cases. Thereafter in the decision, the Referee assessed Pearson’s factual and legal contentions in light of the evidence presented about each case. With respect to the Herzog claim the Referee found that "no evidence was produced that Herzog was not injured" or that "he was playing golf during the time of his treatment." The Referee further found that SCIF’s adjuster’s setting of reverses was not unjustified or excessive in light of the evidence presented at trial. The Referee also noted that the impact of the reserves on Pearson’s "ex-mod, if calculable was not identified" even though the claim remained "open." The Referee concluded that "[a]t the end of the day, I am persuaded that Pearson’s dispute on this issue is a quibble that does not support significant damages." ...
Reuters Health reports that the head of the Food and Drug Administration on Thursday defended the agency's approval of Zohydro, a powerful prescription opioid made by Zogenix Inc, saying it offers a "unique" option to treat pain despite concerns about potential abuse. The FDA's approval of the drug has drawn a flood of criticism, including protests from the attorneys general of 28 states as well as dozens of groups representing doctors and addiction treatment specialists who are concerned that Zohydro will set off a wave of addiction similar to problems with the original form of OxyContin, another opioid. These critics have petitioned the FDA to consider pulling the drug's marketing approval.
FDA Commissioner Margaret Hamburg, testifying at a Senate hearing, acknowledged that Zohydro is "a powerful drug" but said "...that if appropriately used, it serves an important and unique niche with respect to pain medication and it meets the standards for safety and efficacy." Her comments to the Senate Health, Education, Labor and Pensions Committee come barely a week after Zogenix said it was making the painkiller available at "select pharmacies" following the drug's FDA approval in October. In approving the drug, the FDA overruled its panel of outside advisers, who had recommended against approval, citing safety concerns about the potential for abuse.
Senators at the committee's hearing echoed worries about abuse, noting the Zohydro is not made in a way to thwart crushing or chewing of such drugs to get a high. "The concern that I think a number of us have ... (are) about the implications of allowing this new product on the market without these abuse deterrent properties," said Senator Robert Casey, a Democrat from Pennsylvania on the panel. Senator Joe Manchin of West Virginia, whose state has been particularly hard-hit by prescription drug abuse, earlier this week called on U.S. Health and Human Secretary Kathleen Sebelius to overturn the FDA's approval. "Americans are abusing, and (in) many cases dying, at an alarming rate from highly addictive pain medicine, and it is shameful that the FDA would ignore its own experts to approve this drug," Manchin said in a statement after the hearing. He later introduced legislation that would ban Zohydro. Hamburg said unlike other approved hydrocodone drugs, Zohydro does not contain acetaminophen, which can be toxic to the liver. She also said other factors, including doctors' prescribing practices, play a role in drug abuse.
Abuse of OxyContin became so widespread that manufacturer Purdue Pharma changed its formula in 2010 so that the drug could not be injected or snorted as easily. On Wednesday, Purdue said it was moving ahead with an abuse-resistant rival to Zohydro. Zogenix last week also said it is making progress on another version of Zohydro to deter abuse. "I would love if we had abuse-deterrent formulations that were actually meaningful and effective at deterring abuse in all instances. We are moving in that direction," Hamburg told lawmakers. "Right now, unfortunately, the technology is poor." She added that the FDA is working on guidelines to help manufacturers come up with more effective abuse deterrents but gave no timeline for when the guidelines would be finalized. Developing more non-opioid pain drugs could also help prevent misuse, she said.
"Acute and chronic pain needs to be treated. Opiates are very effective for acute pain, less effective for chronic pain, but we don't have a lot of good alternatives at the present time," she told the Senate panel. Hamburg also said more attention needs to be paid to the overdose-reversal medication called naloxone, which could save more lives if it was easier to use and more widely available ...
FDA Commissioner Margaret Hamburg, testifying at a Senate hearing, acknowledged that Zohydro is "a powerful drug" but said "...that if appropriately used, it serves an important and unique niche with respect to pain medication and it meets the standards for safety and efficacy." Her comments to the Senate Health, Education, Labor and Pensions Committee come barely a week after Zogenix said it was making the painkiller available at "select pharmacies" following the drug's FDA approval in October. In approving the drug, the FDA overruled its panel of outside advisers, who had recommended against approval, citing safety concerns about the potential for abuse.
Senators at the committee's hearing echoed worries about abuse, noting the Zohydro is not made in a way to thwart crushing or chewing of such drugs to get a high. "The concern that I think a number of us have ... (are) about the implications of allowing this new product on the market without these abuse deterrent properties," said Senator Robert Casey, a Democrat from Pennsylvania on the panel. Senator Joe Manchin of West Virginia, whose state has been particularly hard-hit by prescription drug abuse, earlier this week called on U.S. Health and Human Secretary Kathleen Sebelius to overturn the FDA's approval. "Americans are abusing, and (in) many cases dying, at an alarming rate from highly addictive pain medicine, and it is shameful that the FDA would ignore its own experts to approve this drug," Manchin said in a statement after the hearing. He later introduced legislation that would ban Zohydro. Hamburg said unlike other approved hydrocodone drugs, Zohydro does not contain acetaminophen, which can be toxic to the liver. She also said other factors, including doctors' prescribing practices, play a role in drug abuse.
Abuse of OxyContin became so widespread that manufacturer Purdue Pharma changed its formula in 2010 so that the drug could not be injected or snorted as easily. On Wednesday, Purdue said it was moving ahead with an abuse-resistant rival to Zohydro. Zogenix last week also said it is making progress on another version of Zohydro to deter abuse. "I would love if we had abuse-deterrent formulations that were actually meaningful and effective at deterring abuse in all instances. We are moving in that direction," Hamburg told lawmakers. "Right now, unfortunately, the technology is poor." She added that the FDA is working on guidelines to help manufacturers come up with more effective abuse deterrents but gave no timeline for when the guidelines would be finalized. Developing more non-opioid pain drugs could also help prevent misuse, she said.
"Acute and chronic pain needs to be treated. Opiates are very effective for acute pain, less effective for chronic pain, but we don't have a lot of good alternatives at the present time," she told the Senate panel. Hamburg also said more attention needs to be paid to the overdose-reversal medication called naloxone, which could save more lives if it was easier to use and more widely available ...
Jose Fabian Ruiz, 61 of Los Angeles, is in custody and charged with multiple felony counts including allegedly filing a fraudulent insurance claim. Video surveillance revealed that Ruiz continued physically demanding work on a side job while receiving more than $150,000 in workers' compensation benefits after claiming an allegedly debilitating lower back injury which supposedly prevented him from working.
"I find Ruiz's actions reprehensible," said California Insurance Commissioner Dave Jones. "Not only did he attempt to cheat the system, but lies like his are the very reason that premiums rise as insurers are forced to pass the cost of fraud onto consumers."
In response to a complaint, the Department of Insurance opened an investigation and interviewed Ruiz on two occasions. In both interviews Ruiz stated that his injury left him unable to lift more than ten pounds, and resulted in a limited range of motion, preventing him from performing parts of his job, such as climbing into big rig trucks.
Department investigators obtained surveillance footage that showed Ruiz working on large trucks and showed him performing his regular work like, working on large trucks with a full range of motion. Two independent medical experts reviewed the video and both determined that Ruiz was not impaired by any major injury nor was he functioning with any significant level of pain.Ruiz was arrested February 27, 2014 by department investigators. He is currently being held on $80,000 bail at the Lynwood Detention Center ...
"I find Ruiz's actions reprehensible," said California Insurance Commissioner Dave Jones. "Not only did he attempt to cheat the system, but lies like his are the very reason that premiums rise as insurers are forced to pass the cost of fraud onto consumers."
In response to a complaint, the Department of Insurance opened an investigation and interviewed Ruiz on two occasions. In both interviews Ruiz stated that his injury left him unable to lift more than ten pounds, and resulted in a limited range of motion, preventing him from performing parts of his job, such as climbing into big rig trucks.
Department investigators obtained surveillance footage that showed Ruiz working on large trucks and showed him performing his regular work like, working on large trucks with a full range of motion. Two independent medical experts reviewed the video and both determined that Ruiz was not impaired by any major injury nor was he functioning with any significant level of pain.Ruiz was arrested February 27, 2014 by department investigators. He is currently being held on $80,000 bail at the Lynwood Detention Center ...
Most medical delivery systems, including treatment in the California workers' compensation program, have evolved to payment only for "evidence based" medicine. High quality medical science is supposed to be used to approve or disapprove UR and IMR treatment requests. Consequently, there needs to be some oversight of the medical science. Gatekeepers are needed who will scrutinize supposed medical science for foul play. As simple as that sounds, there are frustrating bureaucratic hurdles to overcome at the highest levels of federal government.
The director of the U.S. government office that monitors scientific misconduct in biomedical research has resigned after 2 years out of frustration with the "remarkably dysfunctional" federal bureaucracy. David Wright, director of the Office of Research Integrity (ORI), writes in a scathing resignation letter that the huge amount of time he spent trying to get things done made much of his time at ORI "the very worst job I have ever had."
ORI, which is part of the Department of Health and Human Services (HHS), monitors alleged research misconduct by researchers funded by the National Institutes of Health (NIH) and other Public Health Service (PHS) agencies. It runs education programs and reviews institutions’ misconduct investigations, each year posting a dozen or so findings of misconduct, defined as fabrication, falsification, or plagiarism. It also recommends PHS sanctions, such as barring researchers from receiving grants. ORI’s visibility has grown recently along with a rise in retracted research papers, some involving misconduct.
Observers lauded Wright’s appointment in December 2011, which ended 2 years in which the office had no permanent director. Wright, a historian of science at Michigan State University in East Lansing, had served as an ORI consultant and came in with plans to beef up training programs. But last February, he fired off a fiery resignation letter to his boss, HHS Assistant Secretary for Health (ASH) Howard Koh.
In his letter, David Wright writes that working with ORI’s "remarkable scientist-investigators" was "the best job I’ve ever had." But that was only 35% of his job; the rest of the time he spent "navigating the remarkably dysfunctional HHS bureaucracy" to run ORI. Tasks that took a couple of days as a university administrator required weeks or months, he says. He writes that ORI’s budget was micromanaged by more senior officials, and that Koh’s office had a "seriously flawed" culture, calling it "secretive, autocratic and unaccountable." For example, he told Wanda Jones, Koh’s deputy, that he urgently needed to appoint a director for ORI’s division of education. Jones told him the position was somewhere on a secret priority list of appointments. The position has not been filled 16 months later, David Wright notes.
OASH itself suffers from the tendency of bureaucracies to "focus on perpetuating themselves," David Wright writes. Officials spent "exorbitant amounts of time" in meetings and generating data and reports to make their divisions look productive, he writes. He asks whether OASH is the proper home for a regulatory office such as ORI, noting that Koh himself has described his office as an "intensely political environment."
David Wright makes no mention of a recent letter to ORI from Senator Charles Grassley, who has complained that ORI was not tough enough on an AIDS researcher at Iowa State University who faked data to obtain nearly $19 million in NIH funding. ORI barred the researcher, Dong-Pyou Han, from participating in PHS-funded research for 3 years, but Grassley has asked why ORI did not make him return federal grant money or impose harsher sanctions ...
The director of the U.S. government office that monitors scientific misconduct in biomedical research has resigned after 2 years out of frustration with the "remarkably dysfunctional" federal bureaucracy. David Wright, director of the Office of Research Integrity (ORI), writes in a scathing resignation letter that the huge amount of time he spent trying to get things done made much of his time at ORI "the very worst job I have ever had."
ORI, which is part of the Department of Health and Human Services (HHS), monitors alleged research misconduct by researchers funded by the National Institutes of Health (NIH) and other Public Health Service (PHS) agencies. It runs education programs and reviews institutions’ misconduct investigations, each year posting a dozen or so findings of misconduct, defined as fabrication, falsification, or plagiarism. It also recommends PHS sanctions, such as barring researchers from receiving grants. ORI’s visibility has grown recently along with a rise in retracted research papers, some involving misconduct.
Observers lauded Wright’s appointment in December 2011, which ended 2 years in which the office had no permanent director. Wright, a historian of science at Michigan State University in East Lansing, had served as an ORI consultant and came in with plans to beef up training programs. But last February, he fired off a fiery resignation letter to his boss, HHS Assistant Secretary for Health (ASH) Howard Koh.
In his letter, David Wright writes that working with ORI’s "remarkable scientist-investigators" was "the best job I’ve ever had." But that was only 35% of his job; the rest of the time he spent "navigating the remarkably dysfunctional HHS bureaucracy" to run ORI. Tasks that took a couple of days as a university administrator required weeks or months, he says. He writes that ORI’s budget was micromanaged by more senior officials, and that Koh’s office had a "seriously flawed" culture, calling it "secretive, autocratic and unaccountable." For example, he told Wanda Jones, Koh’s deputy, that he urgently needed to appoint a director for ORI’s division of education. Jones told him the position was somewhere on a secret priority list of appointments. The position has not been filled 16 months later, David Wright notes.
OASH itself suffers from the tendency of bureaucracies to "focus on perpetuating themselves," David Wright writes. Officials spent "exorbitant amounts of time" in meetings and generating data and reports to make their divisions look productive, he writes. He asks whether OASH is the proper home for a regulatory office such as ORI, noting that Koh himself has described his office as an "intensely political environment."
David Wright makes no mention of a recent letter to ORI from Senator Charles Grassley, who has complained that ORI was not tough enough on an AIDS researcher at Iowa State University who faked data to obtain nearly $19 million in NIH funding. ORI barred the researcher, Dong-Pyou Han, from participating in PHS-funded research for 3 years, but Grassley has asked why ORI did not make him return federal grant money or impose harsher sanctions ...
The Insurance Journal reports that Jonathan Gruber, professor of economics at the Massachusetts Institute of Technology (MIT), urged 400 attendees at the annual conference of the Workers Compensation Research Institute (WCRI) in Boston to consider where workers’ compensation is relative to the rest of the nation’s healthcare system. Fielding questions on the impact of Obamacare on workers’ compensation, Gruber said that while workers’ compensation carriers should see fewer claims as a result of more Americans obtaining health insurance, there are other forces at play that could mean higher costs and other challenges for workers’ compensation. "As more people have health insurance there is less need for them to have injuries covered by workers’ compensation and this should lower workers’ compensation costs," he said.
However, that effect could be offset by employers moving to high-deductible plans and limiting provider networks as well as by health plans capping reimbursements to medical care providers. "Other payors are going to get tougher at a quicker rate than workers’ compensation is and that is a challenge for this group and the workers’ compensation community," he said.. "Is workers’ compensation going to keep up with the pace at which the rest of the system is changing?"
He said workers’ compensation is already "anachronistic in so many ways and it’s becoming increasingly so. That is the fundamental challenge. "How do you get workers’ compensation to look more like the rest of the healthcare system?" Gruber said the nation is transitioning from open provider networks to limited networks and that higher deductible plans are appropriate for higher incomes. "That’s what we should be doing," he said. But he questioned where these trends in health care leave the workers’ compensation industry. "If the workers’ compensation system stays behind, it will have the broadest possible network and the lowest possible cost-sharing, and it’s going to have people migrating into it more and more," he said.
Gruber was asked about the effect on access to physicians of there being millions more Americans with health insurance. He said in Massachusetts the average wait for a doctor’s appointment went from 47 days to 51 days after the law went into affect. He said neither 47 nor 51 days is desirable but that the cause is really a shortage of family physicians across the country. "There are too many specialists," he said, blaming a reimbursement system that he said needs fixing.
Gruber was an adviser to former Massachusetts Governor Mitt Romney in the design of that state’s universal healthcare law. He was also a technical adviser to the Obama Administration and Congress on the Affordable Care Act, which was modeled after the Massachusetts system. Acknowledging his bias as one of the authors of health reform, the MIT professor said the Massachusetts law has had "spectacular" results, cutting the uninsured population down to three percent - compared to 18 percent nationally - and fixing a broken health insurance market.He said the Massachusetts law was not written to address health care costs but it has had some mitigating effect there also. As for Obamacare, he said it is too early to judge whether it is working. "Both the advocates who say it’s working great are saying too much and the opponents who say it is working terribly are saying too much. We simply don’t know yet and we just need to be patient and let it work out," he said. He said the law should be judged after about three years, not now while it is in progress ...
However, that effect could be offset by employers moving to high-deductible plans and limiting provider networks as well as by health plans capping reimbursements to medical care providers. "Other payors are going to get tougher at a quicker rate than workers’ compensation is and that is a challenge for this group and the workers’ compensation community," he said.. "Is workers’ compensation going to keep up with the pace at which the rest of the system is changing?"
He said workers’ compensation is already "anachronistic in so many ways and it’s becoming increasingly so. That is the fundamental challenge. "How do you get workers’ compensation to look more like the rest of the healthcare system?" Gruber said the nation is transitioning from open provider networks to limited networks and that higher deductible plans are appropriate for higher incomes. "That’s what we should be doing," he said. But he questioned where these trends in health care leave the workers’ compensation industry. "If the workers’ compensation system stays behind, it will have the broadest possible network and the lowest possible cost-sharing, and it’s going to have people migrating into it more and more," he said.
Gruber was asked about the effect on access to physicians of there being millions more Americans with health insurance. He said in Massachusetts the average wait for a doctor’s appointment went from 47 days to 51 days after the law went into affect. He said neither 47 nor 51 days is desirable but that the cause is really a shortage of family physicians across the country. "There are too many specialists," he said, blaming a reimbursement system that he said needs fixing.
Gruber was an adviser to former Massachusetts Governor Mitt Romney in the design of that state’s universal healthcare law. He was also a technical adviser to the Obama Administration and Congress on the Affordable Care Act, which was modeled after the Massachusetts system. Acknowledging his bias as one of the authors of health reform, the MIT professor said the Massachusetts law has had "spectacular" results, cutting the uninsured population down to three percent - compared to 18 percent nationally - and fixing a broken health insurance market.He said the Massachusetts law was not written to address health care costs but it has had some mitigating effect there also. As for Obamacare, he said it is too early to judge whether it is working. "Both the advocates who say it’s working great are saying too much and the opponents who say it is working terribly are saying too much. We simply don’t know yet and we just need to be patient and let it work out," he said. He said the law should be judged after about three years, not now while it is in progress ...
Federal officials’ healthcare fraud efforts recovered a record $4.3 billion in fiscal year 2013, up from $4.2 billion in 2012. Since 1997, the program has recovered nearly $26 billion to the Medicare trust funds.
Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius released the annual Health Care Fraud and Abuse Control Program report, showing that for every dollar spent on healthcare-related fraud and abuse investigations in the last three years, the government recovered $8.10, the highest three-year average return on investment in the 17-year history of the HCFAC program. "With these extraordinary recoveries, and the record-high rate of return on investment we've achieved on our comprehensive healthcare fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal healthcare programs," Holder said. "Thanks to initiatives like HEAT, our work to combat fraud has never been more cooperative or more effective. And our unprecedented commitment to holding criminals accountable, and securing remarkable results for American taxpayers, is paying dividends."
The Justice Department and HHS have improved their coordination through HEAT and are currently operating Medicare Fraud Strike Force teams in nine areas across the country. The strike force teams use advanced data analysis techniques to identify high-billing levels in healthcare fraud hot spots, so that interagency teams can target emerging or migrating schemes as well as chronic fraud by criminals posing as health professionals.
In FY 2013, the strike force secured records in the number of cases filed (137), individuals charged (345), guilty pleas secured (234), and jury trial convictions (46). Beyond that, the defendants who were charged and sentenced are facing significant time in prison - an average of 52 months in prison for those sentenced in FY 2013, and an average of 47 months in prison for those sentenced since 2007, officials said. Justice Department officials opened 1,013 new criminal healthcare fraud investigations involving 1,910 potential defendants in FY 2013, and a total of 718 defendants were convicted of healthcare fraud-related crimes during the year. The department also opened 1,083 new civil healthcare fraud investigations.
"These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act," said HHS Secretary Sebelius. "We’ve cracked down on tens of thousands health care providers suspected of Medicare fraud. New enrollment screening techniques are proving effective in preventing high risk providers from getting into the system, and the new computer analytics system that detects and stops fraudulent billing before money ever goes out the door is accomplishing positive results - all of which are adding to savings for the Medicare Trust Fund." ...
Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius released the annual Health Care Fraud and Abuse Control Program report, showing that for every dollar spent on healthcare-related fraud and abuse investigations in the last three years, the government recovered $8.10, the highest three-year average return on investment in the 17-year history of the HCFAC program. "With these extraordinary recoveries, and the record-high rate of return on investment we've achieved on our comprehensive healthcare fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal healthcare programs," Holder said. "Thanks to initiatives like HEAT, our work to combat fraud has never been more cooperative or more effective. And our unprecedented commitment to holding criminals accountable, and securing remarkable results for American taxpayers, is paying dividends."
The Justice Department and HHS have improved their coordination through HEAT and are currently operating Medicare Fraud Strike Force teams in nine areas across the country. The strike force teams use advanced data analysis techniques to identify high-billing levels in healthcare fraud hot spots, so that interagency teams can target emerging or migrating schemes as well as chronic fraud by criminals posing as health professionals.
In FY 2013, the strike force secured records in the number of cases filed (137), individuals charged (345), guilty pleas secured (234), and jury trial convictions (46). Beyond that, the defendants who were charged and sentenced are facing significant time in prison - an average of 52 months in prison for those sentenced in FY 2013, and an average of 47 months in prison for those sentenced since 2007, officials said. Justice Department officials opened 1,013 new criminal healthcare fraud investigations involving 1,910 potential defendants in FY 2013, and a total of 718 defendants were convicted of healthcare fraud-related crimes during the year. The department also opened 1,083 new civil healthcare fraud investigations.
"These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act," said HHS Secretary Sebelius. "We’ve cracked down on tens of thousands health care providers suspected of Medicare fraud. New enrollment screening techniques are proving effective in preventing high risk providers from getting into the system, and the new computer analytics system that detects and stops fraudulent billing before money ever goes out the door is accomplishing positive results - all of which are adding to savings for the Medicare Trust Fund." ...
