NPR continues its Special Series "Insult To Injury: America's Vanishing Worker Protections" arguing that states have nationally eroded workers' compensation benefits to the point of shifting the burden on taxpayers. The current article features two California workers' compensation claims it asserts are evidence of how even California has changed its system into an intolerable and unacceptable debacle. One of the claimants, Frances Stevens has her case pending in the Court of Appeal and if successful, will end the IMR process created by SB 863.
NPR reports that "Stevens tripped on a rug and broke her foot as she carried boxes of magazines. The relatively simple break triggered serious nerve damage and she was eventually diagnosed with chronic or complex regional pain syndrome." She claims to be mostly confined to a wheelchair and the NPR photograph shows her using a custom wheelchair ramp leading to her van. She was awarded total permanent disability.
A dispute arose between Stevens and SCIF about two years ago over her medical care. For several years applicant had the assistance of a home health aide and used certain medications prescribed by Dr. Jamasbi to relieve her symptoms. In late 2012, the home health aide assisting applicant was injured and was unable to continue to provide those services. This led Dr. Jamasbi to submit a Request For Authorization (RFA) to defendant for a new home health aide along with a request to refill four prescriptions which were submitted to UR and denied. The request was also denied after the IMR process which took seven months to complete. In this case, the IMR determination states that that "Medical treatment does not include home maker services like shopping, cleaning, and laundry, and personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care needed."
The applicant appealed and the WCJ found there was no provision for a reversal of the IMR finding since the labor code provides only limited circumstances upon which IMR can be reversed. The WCAB denied reconsideration in the panel decision of Stevens vs Outspoken Enterprises Inc. One of the key aspects of the Stevens argument was the constitutionality of the IMR process, an issue the California Applicants Attorney Association has been making since passage of SB 863. In response to this challenge, the WCJ found "While the Constitution confers on the Legislature the power to establish a system of workers' compensation, section 3.5 of article III of the Constitution withholds from administrative agencies the power to determine the constitutional validity of any statute." The WCAB agreed that it could not rule on the constitutional issue, and denied reconsideration saying "In sum, for purposes of appeal to the WCAB it does not matter whether the reasons given for an IMR determination support the determination unless the appealing party proves one or more of five grounds for appeal listed by the Legislature in section 4610(h) by clear and convincing evidence. Applicant did not do that in this case. The WCJ's May 27, 2014 denial of applicant's IMR appeal is affirmed."
The First District Court of appeal has agreed to hear the case, and this will be the first appellate court to address the constitutional challenge to the IMR process. Briefs have been filed by a great number of Amicus parties including the California Workers' Compensation Institute, the Property Casualty Insurers Association of America, the California Chamber of Commerce, Voters Injured at Work and the California Applicants' Attorneys Association.
By the end of January, 2015 the Court of Appeal asked the parties to address some of the constitutional questions. "Under Article XIV, section 4 of the California Constitution, the Legislature "is expressly vested with plenary power, unlimited by any provision of this Constitution, to create, and enforce a complete system of workers' compensation, by appropriate legislation. . . ." (Cal. Const., art. XIV, § 4 [italics added].) Meanwhile, Article III, section 3 of the California Constitution, governing Separation of Powers, provides: "The powers of state government are legislative, executive, and judicial. Persons charged with the exercise of one power may not exercise either of the others except as permitted by this Constitution." (Cal. Const., art. III, § 3 [italics added].) And Article I, section 7 of the California Constitution provides: "A person may not be deprived of life, liberty or property without due process of law." ((Cal. Const., art. I, § 7(a).) With these sections of the California Constitution in mind, the Court invites simultaneous supplemental briefing from the parties and amicus curiae on the following issues: 1. Is the plenary power to enact workers compensation statutes vested in the Legislature by the California Constitution limited by the Separation of Powers Clause of the California Constitution? 2. Does the plenary power to enact workers compensation statutes vested in the Legislature by the California Constitution effect our analysis in evaluating petitioner's claims under the California Constitution's Due Process Clause?"
Oral arguments have not yet been scheduled in this case, and it will be months before a resolution. This is however the case to watch for 2015 as the stakes are high. Should IMR be declared unconstitutional a major provision of SB 863 sought by employers will evaporate, and medical disputes will return to the level of the WCAB, ...
NPR reports that "Stevens tripped on a rug and broke her foot as she carried boxes of magazines. The relatively simple break triggered serious nerve damage and she was eventually diagnosed with chronic or complex regional pain syndrome." She claims to be mostly confined to a wheelchair and the NPR photograph shows her using a custom wheelchair ramp leading to her van. She was awarded total permanent disability.
A dispute arose between Stevens and SCIF about two years ago over her medical care. For several years applicant had the assistance of a home health aide and used certain medications prescribed by Dr. Jamasbi to relieve her symptoms. In late 2012, the home health aide assisting applicant was injured and was unable to continue to provide those services. This led Dr. Jamasbi to submit a Request For Authorization (RFA) to defendant for a new home health aide along with a request to refill four prescriptions which were submitted to UR and denied. The request was also denied after the IMR process which took seven months to complete. In this case, the IMR determination states that that "Medical treatment does not include home maker services like shopping, cleaning, and laundry, and personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care needed."
The applicant appealed and the WCJ found there was no provision for a reversal of the IMR finding since the labor code provides only limited circumstances upon which IMR can be reversed. The WCAB denied reconsideration in the panel decision of Stevens vs Outspoken Enterprises Inc. One of the key aspects of the Stevens argument was the constitutionality of the IMR process, an issue the California Applicants Attorney Association has been making since passage of SB 863. In response to this challenge, the WCJ found "While the Constitution confers on the Legislature the power to establish a system of workers' compensation, section 3.5 of article III of the Constitution withholds from administrative agencies the power to determine the constitutional validity of any statute." The WCAB agreed that it could not rule on the constitutional issue, and denied reconsideration saying "In sum, for purposes of appeal to the WCAB it does not matter whether the reasons given for an IMR determination support the determination unless the appealing party proves one or more of five grounds for appeal listed by the Legislature in section 4610(h) by clear and convincing evidence. Applicant did not do that in this case. The WCJ's May 27, 2014 denial of applicant's IMR appeal is affirmed."
The First District Court of appeal has agreed to hear the case, and this will be the first appellate court to address the constitutional challenge to the IMR process. Briefs have been filed by a great number of Amicus parties including the California Workers' Compensation Institute, the Property Casualty Insurers Association of America, the California Chamber of Commerce, Voters Injured at Work and the California Applicants' Attorneys Association.
By the end of January, 2015 the Court of Appeal asked the parties to address some of the constitutional questions. "Under Article XIV, section 4 of the California Constitution, the Legislature "is expressly vested with plenary power, unlimited by any provision of this Constitution, to create, and enforce a complete system of workers' compensation, by appropriate legislation. . . ." (Cal. Const., art. XIV, § 4 [italics added].) Meanwhile, Article III, section 3 of the California Constitution, governing Separation of Powers, provides: "The powers of state government are legislative, executive, and judicial. Persons charged with the exercise of one power may not exercise either of the others except as permitted by this Constitution." (Cal. Const., art. III, § 3 [italics added].) And Article I, section 7 of the California Constitution provides: "A person may not be deprived of life, liberty or property without due process of law." ((Cal. Const., art. I, § 7(a).) With these sections of the California Constitution in mind, the Court invites simultaneous supplemental briefing from the parties and amicus curiae on the following issues: 1. Is the plenary power to enact workers compensation statutes vested in the Legislature by the California Constitution limited by the Separation of Powers Clause of the California Constitution? 2. Does the plenary power to enact workers compensation statutes vested in the Legislature by the California Constitution effect our analysis in evaluating petitioner's claims under the California Constitution's Due Process Clause?"
Oral arguments have not yet been scheduled in this case, and it will be months before a resolution. This is however the case to watch for 2015 as the stakes are high. Should IMR be declared unconstitutional a major provision of SB 863 sought by employers will evaporate, and medical disputes will return to the level of the WCAB, ...
The Social Security Administration has published its proposed 2016 budget, which also includes as an appendix, several legislative proposals. The legislative agenda includes a proposal that would require states, local governments and private insurers to report to the Social Security Administration workers’ compensation benefits that would affect the offset of social security disability benefits.
The proposal states: "Current law requires SSA to reduce an individual’s Disability Insurance (DI) benefit if he or she receives workers’ compensation (WC) or public disability benefits (PDB). SSA currently relies upon beneficiaries to report when they receive these benefits. This proposal would improve program integrity by requiring states, local governments, and private insurers that administer WC and PDB to provide this information to SSA. Furthermore, this proposal would provide for the development and implementation of a system to collect such information from states, local governments, and insurers."
When social security disability recipients also receive workers’ compensation benefits, the Social Security Administration is entitled to offset those benefits pursuant to the Social Security Act, 42 U.S.C. §424a. Generally, the Social Security Act requires that the total amount of social security disability and workers’ compensation or public disability benefits be reduced by an amount necessary to insure that the sum of the benefits does not exceed 80 percent of the individuals pre-disability average current earnings. 42 U.S.C. §424a(a)(5).
Currently, the Social Security Administration does not have a means to independently determine whether a disability beneficiary is also receiving workers’ compensation benefits or governmental disability benefits. The Social Security Administration relies upon the beneficiary to report when they are receiving such benefits. The potential for fraud or under reporting is very apparent.
The proposal would call for the creation of a system for governments and insurers to report the nature and amount of the benefit received by the social security disability beneficiary. The proposal does not address the issue of how the insurers or governmental entities are to determine whether the claimant is, in fact, a social security disability beneficiary. This proposal is substantially similar in principle to the MMSEA §111 mandatory reporting requirement for reporting benefits and settlements to Medicare.
While the goal of reducing fraud is certainly meritorious, the proposal will shift the burden of reporting workers’ compensation and public disability benefits from the claimant/beneficiary to government entities and workers’ compensation insurers. The burden may be increased if the Social Security Administration requires insurers and public entities to acquire releases from the claimant/beneficiaries prior to disclosure of their workers’ compensation or public disability benefit. It is likely that this proposal will receive widespread support. The proposal does not suggest an effective date; however, it is quite likely that the effective date would be approximately 12-18 months after any such legislative proposal became law ...
The proposal states: "Current law requires SSA to reduce an individual’s Disability Insurance (DI) benefit if he or she receives workers’ compensation (WC) or public disability benefits (PDB). SSA currently relies upon beneficiaries to report when they receive these benefits. This proposal would improve program integrity by requiring states, local governments, and private insurers that administer WC and PDB to provide this information to SSA. Furthermore, this proposal would provide for the development and implementation of a system to collect such information from states, local governments, and insurers."
When social security disability recipients also receive workers’ compensation benefits, the Social Security Administration is entitled to offset those benefits pursuant to the Social Security Act, 42 U.S.C. §424a. Generally, the Social Security Act requires that the total amount of social security disability and workers’ compensation or public disability benefits be reduced by an amount necessary to insure that the sum of the benefits does not exceed 80 percent of the individuals pre-disability average current earnings. 42 U.S.C. §424a(a)(5).
Currently, the Social Security Administration does not have a means to independently determine whether a disability beneficiary is also receiving workers’ compensation benefits or governmental disability benefits. The Social Security Administration relies upon the beneficiary to report when they are receiving such benefits. The potential for fraud or under reporting is very apparent.
The proposal would call for the creation of a system for governments and insurers to report the nature and amount of the benefit received by the social security disability beneficiary. The proposal does not address the issue of how the insurers or governmental entities are to determine whether the claimant is, in fact, a social security disability beneficiary. This proposal is substantially similar in principle to the MMSEA §111 mandatory reporting requirement for reporting benefits and settlements to Medicare.
While the goal of reducing fraud is certainly meritorious, the proposal will shift the burden of reporting workers’ compensation and public disability benefits from the claimant/beneficiary to government entities and workers’ compensation insurers. The burden may be increased if the Social Security Administration requires insurers and public entities to acquire releases from the claimant/beneficiaries prior to disclosure of their workers’ compensation or public disability benefit. It is likely that this proposal will receive widespread support. The proposal does not suggest an effective date; however, it is quite likely that the effective date would be approximately 12-18 months after any such legislative proposal became law ...
Time is running out to enroll in the Floyd, Skeren and Kelly 5th Annual Southern California Employment Law Conference to be held at the Disneyland Hotel on June 19, 2015. Last year more than 300 professional attended this conference. This year guest speakers include Steve Jones, Deputy Labor Commissioner from the California Department of Industrial Relations, Phoebe Liu, Senior Staff Counsel IV Department of Fair Employment and Housing and Shaddi Kamiabipour, Deputy District Attorney with the Insurance Fraud Unit, Orange County DA’s Office.
This full day conference that will offer topics on both Employment Laws and Workers' Compensation. Some of the topics we will cover are:
1) Mastering California Leave Laws: A Closer Look at Disability Related Leave Laws, Interactive Process, and Accommodation
2) The Latest Information on California’s Paid Sick Leave-Ensure Compliance Before July 1, 2015
3) Preventing Work Comp Fraud in the Workplace
4) Identifying the Key Features of a Successful Interactive Process in Work Comp Cases
5) Understanding and Complying With the New California Family Rights Act Regulations in Effect as of July 1, 2015
6) A Work Comp Case Law and Legislative Update
7) Understanding, Preventing and Responding to Sexual Harassment Claims in the Workplace
8) How to Effectively Manage and Defend Work Comp Claims-Advanced Techniques From the Experts
9) Performance, Discipline and Termination-Best Practices for Avoiding Liability with These Vital HR Actions
10) Work Comp Resignations and Compromise and Release-What are the Legal Implications?
12) Is Your Company Committing Costly Wage and Hour Violations-Important Tips for Ensuring Compliance
13) An Update on the UR and IMR Process
14) Seven Habits of Frequently Sued Employers-Avoid These Costly Mistakes
15) Illegal Drug and Substance Abuse in the Workplace: Key Prevention and Response Strategies
16) Common Employer Mistakes Leading to Work Comp Claims
17) Reviewing Medical Reports and Defending Erroneous Ratings
Early Bird discounted registration is now available online. For further information please visit our event website, or call us at (818) 854-3239 ...
This full day conference that will offer topics on both Employment Laws and Workers' Compensation. Some of the topics we will cover are:
1) Mastering California Leave Laws: A Closer Look at Disability Related Leave Laws, Interactive Process, and Accommodation
2) The Latest Information on California’s Paid Sick Leave-Ensure Compliance Before July 1, 2015
3) Preventing Work Comp Fraud in the Workplace
4) Identifying the Key Features of a Successful Interactive Process in Work Comp Cases
5) Understanding and Complying With the New California Family Rights Act Regulations in Effect as of July 1, 2015
6) A Work Comp Case Law and Legislative Update
7) Understanding, Preventing and Responding to Sexual Harassment Claims in the Workplace
8) How to Effectively Manage and Defend Work Comp Claims-Advanced Techniques From the Experts
9) Performance, Discipline and Termination-Best Practices for Avoiding Liability with These Vital HR Actions
10) Work Comp Resignations and Compromise and Release-What are the Legal Implications?
12) Is Your Company Committing Costly Wage and Hour Violations-Important Tips for Ensuring Compliance
13) An Update on the UR and IMR Process
14) Seven Habits of Frequently Sued Employers-Avoid These Costly Mistakes
15) Illegal Drug and Substance Abuse in the Workplace: Key Prevention and Response Strategies
16) Common Employer Mistakes Leading to Work Comp Claims
17) Reviewing Medical Reports and Defending Erroneous Ratings
Early Bird discounted registration is now available online. For further information please visit our event website, or call us at (818) 854-3239 ...
The increasing risk of drug resistant superbug infections have been the focus of attention over the last several months as major hospitals such as UCLA report patient infections, and other health organizations are calculating what might occur should no new antibiotic be developed to combat these infections. The predicted costs to the economy and to the insurance industry are expected to be substantial. One of the several superbugs is MRSA or Methicillin-resistant Staphylococcus aureus.
Now, as strange as it may seem, a story published in Forbes and other major news media today reports that a 1,200-year-old Anglo-Saxon remedy called Bald’s Eye Salve has proven "astonishingly" effective in battling the MRSA superbug, which kills more than 5,000 people a year in the US. The potion, composed of garlic, onion or leeks, wine, and ox bile, kills up to 90 per cent of antibiotic-resistant Staphylococcus aureus bacteria in mice, according to scientists at the University of Nottingham.
The Mediaeval treatment was rediscovered by Christina Lee, an associate professor who specializes in disease and disability in the Anglo-Saxon and Viking eras, who translated it from old English. The one thousand year old Anglo-Saxon remedy for eye infections which originates from a manuscript in the British Library has been found to kill the modern-day superbug MRSA in an unusual research collaboration at The University of Nottingham.
Dr Lee, an Anglo-Saxon expert from the School of English has enlisted the help of microbiologists from University’s Centre for Biomolecular Sciences to recreate a 10th century potion for eye infections from Bald’s Leechbook an Old English leatherbound volume in the British Library, to see if it really works as an antibacterial remedy. The Leechbook is widely thought of as one of the earliest known medical textbooks and contains Anglo-Saxon medical advice and recipes for medicines, salves and treatments.
Early results on the 'potion', tested in vitro at Nottingham and backed up by mouse model tests at a university in the United States, are, in the words of the US collaborator, "astonishing". The solution has had remarkable effects on Methicillin-resistant Staphylococcus aureus (MRSA) which is one of the most antibiotic-resistant bugs costing modern health services billions.
The recipe, including detailed instructions on how long to chill the ingredients (nine days at 4C), was found in the leather-bound medical textbook from the 9th Century held in the British Library. "Medieval leech books and herbaria contain many remedies designed to treat what are clearly bacterial infections," said Dr Lee.
Microbiologists recreated Bald’s Eye Salve as faithfully as possible, even using a wine from a historic vineyard near Glastonbury, and tested it both in vitro and on wounds in mice. They compared the results to those achieved previously with the individual ingredients. "We thought that Bald’s eye salve might show a small amount of antibiotic activity, because each of the ingredients has been shown by other researchers to have some effect on bacteria in the lab," said microbiologist Freya Harrison. "We were absolutely blown away by just how effective the combination of ingredients was."
Although developed long before the formal scientific method emerged, such remedies could have benefited from extensive trial-and-error research to determine what worked best. Many other books survive from the period with other treatments that might be similarly effective, Dr Lee said. A global hunt for new weapons against antibiotic-resistant infections was launched last year, spearheaded by British Prime Minister David Cameron. The results of the research on Bald’s Eye Salve were presented at the Annual Conference of the Society for General Microbiology, in Birmingham yesterday ...
Now, as strange as it may seem, a story published in Forbes and other major news media today reports that a 1,200-year-old Anglo-Saxon remedy called Bald’s Eye Salve has proven "astonishingly" effective in battling the MRSA superbug, which kills more than 5,000 people a year in the US. The potion, composed of garlic, onion or leeks, wine, and ox bile, kills up to 90 per cent of antibiotic-resistant Staphylococcus aureus bacteria in mice, according to scientists at the University of Nottingham.
The Mediaeval treatment was rediscovered by Christina Lee, an associate professor who specializes in disease and disability in the Anglo-Saxon and Viking eras, who translated it from old English. The one thousand year old Anglo-Saxon remedy for eye infections which originates from a manuscript in the British Library has been found to kill the modern-day superbug MRSA in an unusual research collaboration at The University of Nottingham.
Dr Lee, an Anglo-Saxon expert from the School of English has enlisted the help of microbiologists from University’s Centre for Biomolecular Sciences to recreate a 10th century potion for eye infections from Bald’s Leechbook an Old English leatherbound volume in the British Library, to see if it really works as an antibacterial remedy. The Leechbook is widely thought of as one of the earliest known medical textbooks and contains Anglo-Saxon medical advice and recipes for medicines, salves and treatments.
Early results on the 'potion', tested in vitro at Nottingham and backed up by mouse model tests at a university in the United States, are, in the words of the US collaborator, "astonishing". The solution has had remarkable effects on Methicillin-resistant Staphylococcus aureus (MRSA) which is one of the most antibiotic-resistant bugs costing modern health services billions.
The recipe, including detailed instructions on how long to chill the ingredients (nine days at 4C), was found in the leather-bound medical textbook from the 9th Century held in the British Library. "Medieval leech books and herbaria contain many remedies designed to treat what are clearly bacterial infections," said Dr Lee.
Microbiologists recreated Bald’s Eye Salve as faithfully as possible, even using a wine from a historic vineyard near Glastonbury, and tested it both in vitro and on wounds in mice. They compared the results to those achieved previously with the individual ingredients. "We thought that Bald’s eye salve might show a small amount of antibiotic activity, because each of the ingredients has been shown by other researchers to have some effect on bacteria in the lab," said microbiologist Freya Harrison. "We were absolutely blown away by just how effective the combination of ingredients was."
Although developed long before the formal scientific method emerged, such remedies could have benefited from extensive trial-and-error research to determine what worked best. Many other books survive from the period with other treatments that might be similarly effective, Dr Lee said. A global hunt for new weapons against antibiotic-resistant infections was launched last year, spearheaded by British Prime Minister David Cameron. The results of the research on Bald’s Eye Salve were presented at the Annual Conference of the Society for General Microbiology, in Birmingham yesterday ...
Detectives from the California Department of Insurance arrested Gonzalo Sandoval, 51, and his ex-wife Socorro Lopez, 65, of Paramount, on multiple felony counts of workers' compensation fraud including making a false claim to obtain compensation and attempted perjury.
Lopez allegedly submitted fraudulent claims close to $100,000 for in-home health care services she claimed she provided to Sandoval years after he injured his back at work. The couple both testified that the claims were true, although video footage taken of Sandoval contradicted the testimony.
In 2000, Sandoval sustained a work related injury to his back. In 2012, Sandoval's ex-wife Socorro Lopez filed a lien with the Workers' Compensation Appeals Board against Liberty Mutual Insurance Company for $47,500 claiming she provided home health care services for Sandoval from 2010 to 2012. After filing the lien, Lopez and Sandoval both provided sworn statements regarding the home health care services performed. Video footage obtained by Liberty Mutual showed Sandoval performing activity that contradicted their testimony. A year later, in 2013, Lopez submitted an additional invoice to Liberty Mutual in the amount of $85,440 for services she provided from 2010 to 2013. Lopez received $41,000 she was not owed.
Sandoval was booked at the Inmate Reception Center in Los Angeles and Lopez was booked at Century Regional Detention Facility in Lynwood. Their bail is set at $30,000 each and both individuals are facing five years in state prison if convicted.
This case is being prosecuted by the Los Angeles County District Attorney's Office ...
Lopez allegedly submitted fraudulent claims close to $100,000 for in-home health care services she claimed she provided to Sandoval years after he injured his back at work. The couple both testified that the claims were true, although video footage taken of Sandoval contradicted the testimony.
In 2000, Sandoval sustained a work related injury to his back. In 2012, Sandoval's ex-wife Socorro Lopez filed a lien with the Workers' Compensation Appeals Board against Liberty Mutual Insurance Company for $47,500 claiming she provided home health care services for Sandoval from 2010 to 2012. After filing the lien, Lopez and Sandoval both provided sworn statements regarding the home health care services performed. Video footage obtained by Liberty Mutual showed Sandoval performing activity that contradicted their testimony. A year later, in 2013, Lopez submitted an additional invoice to Liberty Mutual in the amount of $85,440 for services she provided from 2010 to 2013. Lopez received $41,000 she was not owed.
Sandoval was booked at the Inmate Reception Center in Los Angeles and Lopez was booked at Century Regional Detention Facility in Lynwood. Their bail is set at $30,000 each and both individuals are facing five years in state prison if convicted.
This case is being prosecuted by the Los Angeles County District Attorney's Office ...
On March 20, 2015 Kimberly Evans was arrested by Los Angeles County Probation Department’s Special Projects Team on three felony counts (550 (a)(6) PC Insurance Fraud, Count (2) 487 PC Grand Theft of Personal Property, Count (3) 72 PC Presentation of Fraudulent Claim Count) and one misdemeanor count (471.5 PC Alteration of a medical record). Evans’ actions resulted in obtaining compensation that she would not otherwise be entitled to.
Evans is a sworn peace officer with the Los Angeles County Probation Department and is assigned to a Juvenile Detention Facility as a Detention Services Officer. An investigation by the Special Projects Team revealed that Evans allegedly altered medical documentation resulting in a loss of $1,707.20 during the time period she claimed as "sick time" on her time card.
This is the latest arrest as the Los Angeles County Probation Department continues to beef up its Professional Standards Bureau to crack down on insurance fraud and employee misconduct. "Within the last year the Department added a Special Projects Team comprised of four supervisory level investigators" says Jennifer Kaufman, Senior Director, "These investigators are specially trained to recognize the signs of workers compensation and/or medical fraud."
Evans was arrested on three felony counts and one misdemeanor count of Fraud. She was booked at the Santa Clarita Sheriff’s station in Santa Clarita and bail was set at $30,000. The Arraignment date is pending ...
Evans is a sworn peace officer with the Los Angeles County Probation Department and is assigned to a Juvenile Detention Facility as a Detention Services Officer. An investigation by the Special Projects Team revealed that Evans allegedly altered medical documentation resulting in a loss of $1,707.20 during the time period she claimed as "sick time" on her time card.
This is the latest arrest as the Los Angeles County Probation Department continues to beef up its Professional Standards Bureau to crack down on insurance fraud and employee misconduct. "Within the last year the Department added a Special Projects Team comprised of four supervisory level investigators" says Jennifer Kaufman, Senior Director, "These investigators are specially trained to recognize the signs of workers compensation and/or medical fraud."
Evans was arrested on three felony counts and one misdemeanor count of Fraud. She was booked at the Santa Clarita Sheriff’s station in Santa Clarita and bail was set at $30,000. The Arraignment date is pending ...
Nearly two dozen major corporations including Walmart, Nordstrom, and Safeway are listed as founding members of the Association for Responsible Alternatives to Workers' Compensation (ARAWC), that has already helped write legislation in Tennessee. Richard Evans, the group's executive director, told an insurance journal in November that the corporations ultimately want to change workers' comp laws in all 50 states.
According to its website the group focuses on ensuring that employees receive the best possible care and employers have the choice to provide what is best for their employees. We call it an "Option." "Option is our term for allowing employers to elect an alternative to traditional workers' compensation insurance. Each state may have different requirements for employers that choose to exercise an Option, but the fundamental principles of any alternative are to improve access to quality health care, increase employee accountability, improve medical and return-to-work outcomes, and reduce claim costs. Allowing an Option creates competition that can reduce rates and drive improvements to the workers’ compensation system."
Employers that opt out would still be compelled to purchase workers' comp plans. But they would be allowed to write their own rules governing when, for how long, and for which reasons an injured employee can access medical benefits and wages. Two states, Texas and Oklahoma, already allow employers to opt out of state-mandated workers' comp. In Texas, the only state that has never required employers to provide workers' comp.
Now Sen. Mark Green, introduced the opt-out bill for Tennessee. Green's proposal, which supporters are calling the Tennessee Option, bears many of the hallmarks of the Texas and Oklahoma system: It allows businesses to place strict spending caps on each injured worker and to pick and choose which medical expenses to cover. "We took the best of both and put it together to make it work for Tennessee businesses," Green reported in an article published in the Insurance Journal. Oklahoma's Legislature took four years to create its opt-out system. ARAWC hopes to achieve the same thing in Tennessee in a single legislative session and then it's on to the next state.
These initiatives have spawned expected heated controversy. Mary Elizabeth Maddox, a Tennessee workers' compensation attorney who represents both employers and employees and opposes Green's bill, recalls a case in which a workplace accident paralyzed a 23-year-old man and confined him to a wheelchair. He sued her client, the employer. "For him, $300,000 is not going to go very far." Gary Moore, president of the Tennessee AFL-CIO Labor Council, claims "This piece of legislation is designed as a cost-saving measure for the employer, Anywhere they save a dollar, it costs the employees a dollar. It's just a shift in costs."
Businesses can save millions of dollars by opting out and writing plans with narrow benefits, putting pressure on their competitors to do the same. "It creates a race to the bottom," says Michael Clingman, a workers' advocate in Oklahoma, which passed an opt-out measure in January 2014.
California has had for years its own "Carve-Out" program which allows some employers to opt out of the Workers' Compensation system. "Carve-out" programs allow employers and unions to create their own alternatives for workers' compensation benefit delivery and dispute resolution under a collective bargaining agreement. Eligibility of parties to participate in a program must be approved by the administrative director of the Division of Workers' Compensation. The requirements to participate and the elements required to be in "carve-out" programs are contained in Labor Code section 3201.5 (for the construction industry) and Labor Code section 3201.7 (for all other industries), as well as California Code of Regulations, title 8, sections 10200-10204.
It remains to be seen if Opt Out programs gain traction nationally ...
According to its website the group focuses on ensuring that employees receive the best possible care and employers have the choice to provide what is best for their employees. We call it an "Option." "Option is our term for allowing employers to elect an alternative to traditional workers' compensation insurance. Each state may have different requirements for employers that choose to exercise an Option, but the fundamental principles of any alternative are to improve access to quality health care, increase employee accountability, improve medical and return-to-work outcomes, and reduce claim costs. Allowing an Option creates competition that can reduce rates and drive improvements to the workers’ compensation system."
Employers that opt out would still be compelled to purchase workers' comp plans. But they would be allowed to write their own rules governing when, for how long, and for which reasons an injured employee can access medical benefits and wages. Two states, Texas and Oklahoma, already allow employers to opt out of state-mandated workers' comp. In Texas, the only state that has never required employers to provide workers' comp.
Now Sen. Mark Green, introduced the opt-out bill for Tennessee. Green's proposal, which supporters are calling the Tennessee Option, bears many of the hallmarks of the Texas and Oklahoma system: It allows businesses to place strict spending caps on each injured worker and to pick and choose which medical expenses to cover. "We took the best of both and put it together to make it work for Tennessee businesses," Green reported in an article published in the Insurance Journal. Oklahoma's Legislature took four years to create its opt-out system. ARAWC hopes to achieve the same thing in Tennessee in a single legislative session and then it's on to the next state.
These initiatives have spawned expected heated controversy. Mary Elizabeth Maddox, a Tennessee workers' compensation attorney who represents both employers and employees and opposes Green's bill, recalls a case in which a workplace accident paralyzed a 23-year-old man and confined him to a wheelchair. He sued her client, the employer. "For him, $300,000 is not going to go very far." Gary Moore, president of the Tennessee AFL-CIO Labor Council, claims "This piece of legislation is designed as a cost-saving measure for the employer, Anywhere they save a dollar, it costs the employees a dollar. It's just a shift in costs."
Businesses can save millions of dollars by opting out and writing plans with narrow benefits, putting pressure on their competitors to do the same. "It creates a race to the bottom," says Michael Clingman, a workers' advocate in Oklahoma, which passed an opt-out measure in January 2014.
California has had for years its own "Carve-Out" program which allows some employers to opt out of the Workers' Compensation system. "Carve-out" programs allow employers and unions to create their own alternatives for workers' compensation benefit delivery and dispute resolution under a collective bargaining agreement. Eligibility of parties to participate in a program must be approved by the administrative director of the Division of Workers' Compensation. The requirements to participate and the elements required to be in "carve-out" programs are contained in Labor Code section 3201.5 (for the construction industry) and Labor Code section 3201.7 (for all other industries), as well as California Code of Regulations, title 8, sections 10200-10204.
It remains to be seen if Opt Out programs gain traction nationally ...
Los Angeles police and firefighters work in a culture that encourages filing "excessive" workers’ compensation claims, according to a pair of city audits released Thursday and reported by the Los Angeles Times. And taxpayers are doling out up to $28 million a year for what amount to preventable injuries. The majority of injuries claimed by firefighters in recent years occurred while doing things other than responding to emergencies, including maintaining equipment, playing racquetball and preparing food at their fire stations, according to one of the audits by City Controller Ron Galperin.
L.A. police, meanwhile, are paid for on-the-job injuries more often than officers in comparable departments, the other audit found, at least in part because other departments don’t recognize sports injuries as "job-related." Two-thirds of city firefighters and 60% of police officers filed an on-the-job injury claim in the last three years, the auditors found, and nearly half of those employees have filed more than one claim during that time.
The city audits come months after a Los Angeles Times investigation found steep increases in payments to injured police and firefighters, who receive 100% of their salaries, tax-free, for up to a year while off work recovering from seemingly job-related injuries. Only a small percentage of claims in recent years were attributed to injuries suffered fighting fires or confronting combative suspects, The most common cause was cumulative trauma claims that are not linked to a specific on-the-job injury. A disproportionate amount of injury pay was going to employees who filed consecutive claims, reporting a new injury just as a previous leave is about to end.
The city audits found, in all, that workers' compensation costs for sworn employees have increased by 35% over the last five years to $141 million in 2014, including salary payments while the employees were off work, medical bills and other related expenses. Surveys sent to police officers by the auditors showed 45% agreed that there is an "excessive" number of workers’ compensation claims filed at the department, while a third of firefighters believed "questionable" claims had been filed by their colleagues.
The police and fire departments are shielded from the full cost of workers’ compensation claims because they don’t have to pay the medical bills, the auditors found. Those costs, nearly $85 million over the last four years, are covered by a separate city fund. The auditors recommended that the departments be made to pay medical bills out of their own budgets because "management may not be sufficiently aware of, or held accountable for, the impact of rising claims and costs."
The departments suffer in other ways, however. Last year, fire officials told The Times they were spending more than $51,000 per day - or nearly $19 million annually - on overtime to cover shifts left vacant by firefighters out with injuries. At the Police Department, where overtime has been severely restricted, the rising number of injury leaves meant fewer officers on the street, officials said.
California legislators granted 100% pay for injured public safety employees during the Great Depression to ensure that those protecting the public wouldn't hesitate to chase a criminal or run into a burning building for fear of losing their livelihood. But the design of the program invites abuse, city officials across the state told The Times. Because injury pay is exempt from federal and state income taxes, the employees typically take home significantly more money when they're not working. And time spent on leave counts toward pension benefits. That creates a perverse financial incentive to file injury claims for relatively minor ailments and to stay out as long as possible, experts said ...
L.A. police, meanwhile, are paid for on-the-job injuries more often than officers in comparable departments, the other audit found, at least in part because other departments don’t recognize sports injuries as "job-related." Two-thirds of city firefighters and 60% of police officers filed an on-the-job injury claim in the last three years, the auditors found, and nearly half of those employees have filed more than one claim during that time.
The city audits come months after a Los Angeles Times investigation found steep increases in payments to injured police and firefighters, who receive 100% of their salaries, tax-free, for up to a year while off work recovering from seemingly job-related injuries. Only a small percentage of claims in recent years were attributed to injuries suffered fighting fires or confronting combative suspects, The most common cause was cumulative trauma claims that are not linked to a specific on-the-job injury. A disproportionate amount of injury pay was going to employees who filed consecutive claims, reporting a new injury just as a previous leave is about to end.
The city audits found, in all, that workers' compensation costs for sworn employees have increased by 35% over the last five years to $141 million in 2014, including salary payments while the employees were off work, medical bills and other related expenses. Surveys sent to police officers by the auditors showed 45% agreed that there is an "excessive" number of workers’ compensation claims filed at the department, while a third of firefighters believed "questionable" claims had been filed by their colleagues.
The police and fire departments are shielded from the full cost of workers’ compensation claims because they don’t have to pay the medical bills, the auditors found. Those costs, nearly $85 million over the last four years, are covered by a separate city fund. The auditors recommended that the departments be made to pay medical bills out of their own budgets because "management may not be sufficiently aware of, or held accountable for, the impact of rising claims and costs."
The departments suffer in other ways, however. Last year, fire officials told The Times they were spending more than $51,000 per day - or nearly $19 million annually - on overtime to cover shifts left vacant by firefighters out with injuries. At the Police Department, where overtime has been severely restricted, the rising number of injury leaves meant fewer officers on the street, officials said.
California legislators granted 100% pay for injured public safety employees during the Great Depression to ensure that those protecting the public wouldn't hesitate to chase a criminal or run into a burning building for fear of losing their livelihood. But the design of the program invites abuse, city officials across the state told The Times. Because injury pay is exempt from federal and state income taxes, the employees typically take home significantly more money when they're not working. And time spent on leave counts toward pension benefits. That creates a perverse financial incentive to file injury claims for relatively minor ailments and to stay out as long as possible, experts said ...
The U.S. Supreme Court today sided with a former driver for UPS Inc by giving her another chance to argue that the package delivery company discriminated against her when it refused to lighten her work duties while she was pregnant. In a 6-3 decision, the justices revived Peggy Young's discrimination claim against the company by sending the case back to a lower court. A federal district court judge and an appeals court had earlier ruled in favor of UPS, which was backed by business groups in the case. "This is a big win for Peggy Young and other women in the workplace," said Sam Bagenstos, Young's lawyer.
The case focused on whether, under a federal law called the Pregnancy Discrimination Act, employers must provide accommodations for pregnant workers who may have physical limitations on tasks they can perform. Young, who worked at a Maryland facility, became pregnant in 2006. She made her request for an accommodation after a midwife advised that she not be required to lift packages weighing more than 20 pounds (9 kg).
Writing for the majority, liberal Justice Stephen Breyer said the lower court failed to consider the effects of UPS policies that covered non-pregnant workers who might have disabilities, injuries or otherwise might need accommodations. Breyer said there is a "genuine dispute as to whether UPS provided more favorable treatment to at least some employees whose situation cannot reasonably be distinguished from Young's."
Bagenstos said the court "made clear that employers may not refuse to accommodate pregnant workers based on considerations of cost or convenience when they accommodate other workers."
UPS said it was confident it would ultimately win the case. "UPS is pleased that the Supreme Court rejected the argument that UPS’s pregnancy-neutral policy was inherently discriminatory," a company statement said.
Conservative Justice Antonin Scalia, joined by Anthony Kennedy and Clarence Thomas, wrote a dissenting opinion accusing the court majority of coming up with "an interpretation that is as dubious in principle as it is senseless in practice."
UPS said last October that starting this past January it would begin providing accommodations for pregnant women.
The impact of the ruling could be limited in part because a 2008 amendment to the Americans with Disabilities Act could now protect women in Young’s situation. The U.S. Equal Employment Opportunity Commission has said employees must offer accommodations to pregnant women just as they do for other workers with similar physical limitations. The case is Young v. UPS, U.S. Supreme Court, No. 12-1226 ...
The case focused on whether, under a federal law called the Pregnancy Discrimination Act, employers must provide accommodations for pregnant workers who may have physical limitations on tasks they can perform. Young, who worked at a Maryland facility, became pregnant in 2006. She made her request for an accommodation after a midwife advised that she not be required to lift packages weighing more than 20 pounds (9 kg).
Writing for the majority, liberal Justice Stephen Breyer said the lower court failed to consider the effects of UPS policies that covered non-pregnant workers who might have disabilities, injuries or otherwise might need accommodations. Breyer said there is a "genuine dispute as to whether UPS provided more favorable treatment to at least some employees whose situation cannot reasonably be distinguished from Young's."
Bagenstos said the court "made clear that employers may not refuse to accommodate pregnant workers based on considerations of cost or convenience when they accommodate other workers."
UPS said it was confident it would ultimately win the case. "UPS is pleased that the Supreme Court rejected the argument that UPS’s pregnancy-neutral policy was inherently discriminatory," a company statement said.
Conservative Justice Antonin Scalia, joined by Anthony Kennedy and Clarence Thomas, wrote a dissenting opinion accusing the court majority of coming up with "an interpretation that is as dubious in principle as it is senseless in practice."
UPS said last October that starting this past January it would begin providing accommodations for pregnant women.
The impact of the ruling could be limited in part because a 2008 amendment to the Americans with Disabilities Act could now protect women in Young’s situation. The U.S. Equal Employment Opportunity Commission has said employees must offer accommodations to pregnant women just as they do for other workers with similar physical limitations. The case is Young v. UPS, U.S. Supreme Court, No. 12-1226 ...
Beverly Myres was hired by the San Francisco Housing Authority (SFHA) in 2006 as a claims assistant. In 2007 she was promoted to workers’ compensation analyst. Myres was a member of the San Francisco Municipal Executives’ Association, and her employment with SFHA was governed by a union memorandum of understanding (MOU).
In 2009, Myres injured her right knee at work and filed a workers’ compensation claim in June 2009. She continued to work full-time without any restrictions until she had surgery on her right knee, Myres was then released to return to modified work with the following restrictions: "Seated work - stand/walk for personal needs only. No lift over 10 lbs. No drive for work. Must work in location free from tripping hazards." Her employer indicated it would accommodate her restrictions.
Upon returning to work she experienced increased pain in her left knee. It was at first disputed that the left knee was injured as a result of employment. While seeking clarification of the cause of her left knee pain SFHA had advised the entire department that they were being laid off as a result of departmental restructuring. Myres then sued SFHA. Her first three causes of action are each titled "Disability Discrimination." and she filed a fourth and fifth cause of action for hostile work environment harassment and wrongful discharge in violation of public policy premised on her allegations of retaliation for taking workers’ compensation leave.
According to SFHA, Myres and the rest of the department were laid off for a legitimate reason, "to restructure the department for improved efficiency" and due to reduced federal funding and a budget shortfall. Myres, on the other hand, asserted that SFHA retaliated against her for taking workers’ compensation leave. In support of this contention she called SFHA’s former special assistant to the executive director, who testified that "[t]here were a number of people in the department . . . that [her supervisors] were having trouble with. So they decided to deal with the problem by restructuring and laying everybody off." As a result of the layoff, Myres testified that she suffered a loss of her annual salary of approximately $81,000 for almost three years, as well as fringe and retirement benefits.
After trial, the jury returned verdicts in favor of the employer on four of the five causes of action. With respect to hostile work environment harassment, the jury found in Myres’s favor and awarded her $35,000 in noneconomic damages. Post judgment interest was awarded in the amount of 10% and Myers was awarded attorney fees and costs. Both parties appealed. SFHA primarily contends on appeal that that the jury’s harassment verdict is not supported by substantial evidence. Myres also appeals from the judgment, arguing that various evidentiary and instructional errors affected the jury’s verdicts in favor of SFHA on her causes of action for failure to reasonably accommodate her disability. With the exception of post judgment interest in the amount of 10%, the Court of Appeal found no prejudicial errors, and after reducing the interest to 7% affirmed the judgment in the unpublished case of Myres v SFHA.
One of the issues raised by Myres was the collateral source rule. Myres filed a motion in limine to exclude evidence of collateral sources of income. She argued that any such evidence of post injury sources of income was irrelevant, as it could not be used to offset a backpay award on her retaliation and wrongful discharge causes of action. The trial court denied the motion. Over Myres’s "collateral source" objection, SFHA’s expert economist detailed the payments Myres received from retirement, social security disability, and worker’s compensation disability between September 1, 2010, and the date of trial. Ultimately, he opined that there was only a $500 difference between Myres’s expected compensation, had she remained employed by SFHA, versus the compensation she received in retirement and disability benefits after separation.
The Court of Appeal agreed that some of the collateral source income should not have been admitted. However, it was not prejudicial error. "In this case, however, we find it unnecessary to remand for a new trial. Under section 12940, subdivision (h), it is an unlawful employment practice '[f]or any employer . . . to discharge, expel, or otherwise discriminate against any person because the person has opposed any practices forbidden under this part or because the person has filed a complaint, testified, or assisted in any proceeding under this part.' We agree with SFHA that, as a matter of law, Myres could not recover for FEHA retaliation on the basis that she was terminated for taking workers’ compensation leave. Taking workers’ compensation leave is not protected activity under FEHA." Thus the verdicts against her on the discrimination causes of action were affirmed.
But, the Court of Appeal agreed there was evidence in support of her claim of a hostile work environment. Her employer made comments before her injury such as "that other SFHA employees taking workers’ compensation leave were "malingerers," abused the system, and filed "fraudulent claims." Another comment was "How can the workers’ comp person be out on workers’ comp?" ...
In 2009, Myres injured her right knee at work and filed a workers’ compensation claim in June 2009. She continued to work full-time without any restrictions until she had surgery on her right knee, Myres was then released to return to modified work with the following restrictions: "Seated work - stand/walk for personal needs only. No lift over 10 lbs. No drive for work. Must work in location free from tripping hazards." Her employer indicated it would accommodate her restrictions.
Upon returning to work she experienced increased pain in her left knee. It was at first disputed that the left knee was injured as a result of employment. While seeking clarification of the cause of her left knee pain SFHA had advised the entire department that they were being laid off as a result of departmental restructuring. Myres then sued SFHA. Her first three causes of action are each titled "Disability Discrimination." and she filed a fourth and fifth cause of action for hostile work environment harassment and wrongful discharge in violation of public policy premised on her allegations of retaliation for taking workers’ compensation leave.
According to SFHA, Myres and the rest of the department were laid off for a legitimate reason, "to restructure the department for improved efficiency" and due to reduced federal funding and a budget shortfall. Myres, on the other hand, asserted that SFHA retaliated against her for taking workers’ compensation leave. In support of this contention she called SFHA’s former special assistant to the executive director, who testified that "[t]here were a number of people in the department . . . that [her supervisors] were having trouble with. So they decided to deal with the problem by restructuring and laying everybody off." As a result of the layoff, Myres testified that she suffered a loss of her annual salary of approximately $81,000 for almost three years, as well as fringe and retirement benefits.
After trial, the jury returned verdicts in favor of the employer on four of the five causes of action. With respect to hostile work environment harassment, the jury found in Myres’s favor and awarded her $35,000 in noneconomic damages. Post judgment interest was awarded in the amount of 10% and Myers was awarded attorney fees and costs. Both parties appealed. SFHA primarily contends on appeal that that the jury’s harassment verdict is not supported by substantial evidence. Myres also appeals from the judgment, arguing that various evidentiary and instructional errors affected the jury’s verdicts in favor of SFHA on her causes of action for failure to reasonably accommodate her disability. With the exception of post judgment interest in the amount of 10%, the Court of Appeal found no prejudicial errors, and after reducing the interest to 7% affirmed the judgment in the unpublished case of Myres v SFHA.
One of the issues raised by Myres was the collateral source rule. Myres filed a motion in limine to exclude evidence of collateral sources of income. She argued that any such evidence of post injury sources of income was irrelevant, as it could not be used to offset a backpay award on her retaliation and wrongful discharge causes of action. The trial court denied the motion. Over Myres’s "collateral source" objection, SFHA’s expert economist detailed the payments Myres received from retirement, social security disability, and worker’s compensation disability between September 1, 2010, and the date of trial. Ultimately, he opined that there was only a $500 difference between Myres’s expected compensation, had she remained employed by SFHA, versus the compensation she received in retirement and disability benefits after separation.
The Court of Appeal agreed that some of the collateral source income should not have been admitted. However, it was not prejudicial error. "In this case, however, we find it unnecessary to remand for a new trial. Under section 12940, subdivision (h), it is an unlawful employment practice '[f]or any employer . . . to discharge, expel, or otherwise discriminate against any person because the person has opposed any practices forbidden under this part or because the person has filed a complaint, testified, or assisted in any proceeding under this part.' We agree with SFHA that, as a matter of law, Myres could not recover for FEHA retaliation on the basis that she was terminated for taking workers’ compensation leave. Taking workers’ compensation leave is not protected activity under FEHA." Thus the verdicts against her on the discrimination causes of action were affirmed.
But, the Court of Appeal agreed there was evidence in support of her claim of a hostile work environment. Her employer made comments before her injury such as "that other SFHA employees taking workers’ compensation leave were "malingerers," abused the system, and filed "fraudulent claims." Another comment was "How can the workers’ comp person be out on workers’ comp?" ...
A federal jury in Los Angeles found the owner of a medical supply company guilty of four counts of health care fraud this week in connection with a $3.3 million Medicare fraud scheme.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephanie Yonekura of the Central District of California, Special Agent in Charge Glenn R. Ferry of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Los Angeles Region and Assistant Director in Charge David L. Bowdich of the FBI’s Los Angeles Field Office made the announcement.
Hakop Gambaryan, 55, of East Hollywood, the owner of Colonial Medical Supply, was convicted of four counts of health care fraud. A sentencing hearing will take place before U.S. District Judge Otis D. Wright II of the Central District of California, and will be scheduled at a later date.
According to evidence presented at trial, between March 2006 and December 2012, Gambaryan paid cash kickbacks to medical clinics for fraudulent prescriptions for durable medical equipment, such as expensive power wheelchairs, which the patients did not need. Gambaryan then used these prescriptions to bill Medicare for the unnecessary power wheelchairs and other equipment. The evidence established that Gambaryan personally delivered power wheelchairs to many beneficiaries who were able to walk without assistance. In one instance, Gambaryan carried a power wheelchair up a flight of stairs for a woman who lived in a second floor apartment with no elevator. In another instance, the power wheelchair would not fit inside the beneficiary’s home so Gambaryan put it in the beneficiary’s garage.
The evidence also demonstrated that Gambaryan generated false documentation to support the fraudulent claims, including fake home assessments that made it appear home assessments had occurred when they had not. In addition, Gambaryan photocopied beneficiary signatures hundreds of times to create the appearance that the beneficiaries consented to ongoing durable medical equipment rentals, when in reality, at least two of the beneficiaries had passed away prior to the date they supposedly signed the rental agreements.
The evidence showed that Gambaryan submitted approximately $3.3 million in false and fraudulent claims to Medicare, and received more than $1.7 million on those claims.
The case was investigated by the FBI and HHS-OIG. The case is being prosecuted by Trial Attorneys Fred Medick and Ritesh Srivastava of the Criminal Division’s Fraud Section ...
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephanie Yonekura of the Central District of California, Special Agent in Charge Glenn R. Ferry of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Los Angeles Region and Assistant Director in Charge David L. Bowdich of the FBI’s Los Angeles Field Office made the announcement.
Hakop Gambaryan, 55, of East Hollywood, the owner of Colonial Medical Supply, was convicted of four counts of health care fraud. A sentencing hearing will take place before U.S. District Judge Otis D. Wright II of the Central District of California, and will be scheduled at a later date.
According to evidence presented at trial, between March 2006 and December 2012, Gambaryan paid cash kickbacks to medical clinics for fraudulent prescriptions for durable medical equipment, such as expensive power wheelchairs, which the patients did not need. Gambaryan then used these prescriptions to bill Medicare for the unnecessary power wheelchairs and other equipment. The evidence established that Gambaryan personally delivered power wheelchairs to many beneficiaries who were able to walk without assistance. In one instance, Gambaryan carried a power wheelchair up a flight of stairs for a woman who lived in a second floor apartment with no elevator. In another instance, the power wheelchair would not fit inside the beneficiary’s home so Gambaryan put it in the beneficiary’s garage.
The evidence also demonstrated that Gambaryan generated false documentation to support the fraudulent claims, including fake home assessments that made it appear home assessments had occurred when they had not. In addition, Gambaryan photocopied beneficiary signatures hundreds of times to create the appearance that the beneficiaries consented to ongoing durable medical equipment rentals, when in reality, at least two of the beneficiaries had passed away prior to the date they supposedly signed the rental agreements.
The evidence showed that Gambaryan submitted approximately $3.3 million in false and fraudulent claims to Medicare, and received more than $1.7 million on those claims.
The case was investigated by the FBI and HHS-OIG. The case is being prosecuted by Trial Attorneys Fred Medick and Ritesh Srivastava of the Criminal Division’s Fraud Section ...
Over the next 35 years, multidrug-resistant tuberculosis will kill 75 million people and could cost the global economy a cumulative $16.7 trillion - the equivalent of the European Union’s annual output, a UK parliamentary group said on Tuesday. If left untackled, the spread of drug-resistant TB superbugs threatens to shrink the world economy by 0.63 percent annually, the UK All Party Parliamentary Group on Global Tuberculosis (APPG TB) said, urging governments to do more to improve research and cooperation.
According to the report in Reuters Health, "the rising global burden of multidrug-resistant TB and other drug-resistant infections will come at a human and economic cost which the global community simply cannot afford to ignore", economist Jim O'Neill said in a statement. O'Neill, a former chief at investment bank Goldman Sachs, was appointed last year by British Prime Minister David Cameron to head a review into antimicrobial resistance.
The bacteria that cause TB can develop resistance to drugs used to cure the disease. Multidrug-resistant TB fails to respond to at least isoniazid and rifampicin, the two most powerful anti-TB drugs, according to the World Health Organization (WHO). The UK parliamentary group's cost projections are based on a scenario in which an additional 40 percent of all TB cases are resistant to first-line drugs, leading to a doubling of the infection rate. The WHO said last year multidrug-resistant TB was at "crisis levels", with about 480,000 new cases in 2013. It is a manmade problem caused by regular TB patients given the wrong medicines or doses, or failing to complete their treatment, which is highly toxic and can take up two years.
The group urged governments to set up a research and development fund, target investments into basic research and increase support for bilateral TB programs. "We need better tools to deal with this new threat, but since TB primarily affects the poorest and most vulnerable in society, there is little commercial incentive to develop new drugs," said Nick Herbert, co-chairman of the APPG TB. The fight against TB, the world's second deadliest infectious disease after HIV, is also hampered by a lack of an effective vaccine, the APPG TB said. The only TB vaccine, BCG, protects some children from severe forms of TB - including one that affects the brain - but is unreliable in preventing TB in the lung, which is the most common form of the disease.
TB, which spreads through the coughs and sneezes of an infected person, killed 1.5 million people worldwide in 2013, according to the WHO. Putting that number into perspective can be done by comparing the death rate for Ebola, the infection that has caused recent international media panic. The CDC reports the entire Ebola international death count as of this month to be less than 11,000. The risk of death by TB is magnitudes higher than the risk of death by Ebola infection.
The workers' compensation community is not immune to the cost effects of out-of-control superbugs. Infectious diseases can become a costly problem in worker's compensation claims. Claims can arise as a result of infections on the job, infections during treatment for an industrial injury, or infections to health care workers ...
According to the report in Reuters Health, "the rising global burden of multidrug-resistant TB and other drug-resistant infections will come at a human and economic cost which the global community simply cannot afford to ignore", economist Jim O'Neill said in a statement. O'Neill, a former chief at investment bank Goldman Sachs, was appointed last year by British Prime Minister David Cameron to head a review into antimicrobial resistance.
The bacteria that cause TB can develop resistance to drugs used to cure the disease. Multidrug-resistant TB fails to respond to at least isoniazid and rifampicin, the two most powerful anti-TB drugs, according to the World Health Organization (WHO). The UK parliamentary group's cost projections are based on a scenario in which an additional 40 percent of all TB cases are resistant to first-line drugs, leading to a doubling of the infection rate. The WHO said last year multidrug-resistant TB was at "crisis levels", with about 480,000 new cases in 2013. It is a manmade problem caused by regular TB patients given the wrong medicines or doses, or failing to complete their treatment, which is highly toxic and can take up two years.
The group urged governments to set up a research and development fund, target investments into basic research and increase support for bilateral TB programs. "We need better tools to deal with this new threat, but since TB primarily affects the poorest and most vulnerable in society, there is little commercial incentive to develop new drugs," said Nick Herbert, co-chairman of the APPG TB. The fight against TB, the world's second deadliest infectious disease after HIV, is also hampered by a lack of an effective vaccine, the APPG TB said. The only TB vaccine, BCG, protects some children from severe forms of TB - including one that affects the brain - but is unreliable in preventing TB in the lung, which is the most common form of the disease.
TB, which spreads through the coughs and sneezes of an infected person, killed 1.5 million people worldwide in 2013, according to the WHO. Putting that number into perspective can be done by comparing the death rate for Ebola, the infection that has caused recent international media panic. The CDC reports the entire Ebola international death count as of this month to be less than 11,000. The risk of death by TB is magnitudes higher than the risk of death by Ebola infection.
The workers' compensation community is not immune to the cost effects of out-of-control superbugs. Infectious diseases can become a costly problem in worker's compensation claims. Claims can arise as a result of infections on the job, infections during treatment for an industrial injury, or infections to health care workers ...
Detectives from the California Department of Insurance (CDI) arrested Los Angeles Doctor Glenn Neil Ledesma, 63, owner of California Dermatology Center, Inc. CEO Jonathan Ledesma, 49, Glenn Ledesma's adopted son, was also arrested. Both are charged with multiple felony counts of health care disability fraud for presenting false claims. The suspects allegedly collected disability benefits totaling more than $1.8 million while continuing to work and practice medicine.
"The Ledesmas knew it was illegal to file for and collect disability benefits while still working," said Insurance Commissioner Dave Jones. "Their criminal activity is part of the health insurance fraud epidemic that totals billions of dollars annually and results in higher premiums for all consumers."
Dr. Ledesma first submitted a disability claim in 1997 stating he was unable to treat patients due to his medical condition. His insurer told him he could receive disability benefits while running his corporation, but was not allowed to treat patients or practice medicine. In 2008, Dr. Ledesma continued collecting disability payments while resuming his medical practice and treating patients. From 2008 to 2013, he treated more than 2,900 patients while simultaneously collecting $1,605,464 in disability benefits.
In 2008, Jonathan Ledesma filed a disability claim with UNUM Life Insurance Company of America indicating he was also unable to work due to medical reasons. He denied knowing Dr. Glenn Ledesma even though he listed the doctor as his employer and investigators discovered Jonathan Ledesma was in fact the CEO of one of eight of Dr. Ledesma's medical corporations, California Dermatology Center, Inc and his adopted son. From 2010 to 2013, Jonathan Ledesma collected more than $200,000 in disability benefits while performing administrative duties as CEO.
Both suspects have been arrested and booked into the Inmate Reception Center in Los Angeles. Bail is set at $50,000 for each and they may face 20 years in state prison if convicted on all counts. This case is being prosecuted by the Los Angeles County District Attorney's Office ...
"The Ledesmas knew it was illegal to file for and collect disability benefits while still working," said Insurance Commissioner Dave Jones. "Their criminal activity is part of the health insurance fraud epidemic that totals billions of dollars annually and results in higher premiums for all consumers."
Dr. Ledesma first submitted a disability claim in 1997 stating he was unable to treat patients due to his medical condition. His insurer told him he could receive disability benefits while running his corporation, but was not allowed to treat patients or practice medicine. In 2008, Dr. Ledesma continued collecting disability payments while resuming his medical practice and treating patients. From 2008 to 2013, he treated more than 2,900 patients while simultaneously collecting $1,605,464 in disability benefits.
In 2008, Jonathan Ledesma filed a disability claim with UNUM Life Insurance Company of America indicating he was also unable to work due to medical reasons. He denied knowing Dr. Glenn Ledesma even though he listed the doctor as his employer and investigators discovered Jonathan Ledesma was in fact the CEO of one of eight of Dr. Ledesma's medical corporations, California Dermatology Center, Inc and his adopted son. From 2010 to 2013, Jonathan Ledesma collected more than $200,000 in disability benefits while performing administrative duties as CEO.
Both suspects have been arrested and booked into the Inmate Reception Center in Los Angeles. Bail is set at $50,000 for each and they may face 20 years in state prison if convicted on all counts. This case is being prosecuted by the Los Angeles County District Attorney's Office ...
Harry Minassian, 55, of Granada Hills and owner of Pacific Construction was arrested on four felony counts of workers' compensation insurance fraud after refusing to report an employee's serious injury to the State Compensation Insurance Fund.
A Pacific Construction employee received a puncture wound to his foot while on a jobsite, which became infected. Unfortunately, the seriousness of the infection led to the employee's leg being amputated below the knee. The employee reported the injury to his employer but Minassian refused to report it to the State Compensation Insurance Fund, his workers' compensation carrier and denied workers' compensation coverage for his employee.
"Employers are responsible for ensuring their employees receive the benefits and treatment they are entitled to when they are injured on the job," said Commissioner Dave Jones. "In this case, the employer was negligent and allowed his employee to suffer unnecessarily and end up with a permanent disability."
The employee was awarded permanent disability after he filed a claim with the insurer. The department's investigation began after the State Compensation Insurance Fund reported Minassian and that he had a history of failing to report employee injuries. The investigation revealed Minassian owed nearly $12,000 in workers' compensation insurance premiums and failed to deduct required payroll taxes and social security for all of his employees.
Minassian was booked at the Los Angeles County Jail Twin Towers Inmate Reception Center. His bail has been set at $120,000. If convicted on all counts, Minassian faces a maximum of five years in county jail. This case is being prosecuted by the Los Angeles District Attorney's Office ...
A Pacific Construction employee received a puncture wound to his foot while on a jobsite, which became infected. Unfortunately, the seriousness of the infection led to the employee's leg being amputated below the knee. The employee reported the injury to his employer but Minassian refused to report it to the State Compensation Insurance Fund, his workers' compensation carrier and denied workers' compensation coverage for his employee.
"Employers are responsible for ensuring their employees receive the benefits and treatment they are entitled to when they are injured on the job," said Commissioner Dave Jones. "In this case, the employer was negligent and allowed his employee to suffer unnecessarily and end up with a permanent disability."
The employee was awarded permanent disability after he filed a claim with the insurer. The department's investigation began after the State Compensation Insurance Fund reported Minassian and that he had a history of failing to report employee injuries. The investigation revealed Minassian owed nearly $12,000 in workers' compensation insurance premiums and failed to deduct required payroll taxes and social security for all of his employees.
Minassian was booked at the Los Angeles County Jail Twin Towers Inmate Reception Center. His bail has been set at $120,000. If convicted on all counts, Minassian faces a maximum of five years in county jail. This case is being prosecuted by the Los Angeles District Attorney's Office ...
Early this month, ProPublica/NPR published an article "The Demolition of Workers’ Comp" that asserted that "over the past decade, states have slashed workers’ compensation benefits, denying injured workers help when they need it most and shifting the costs of workplace accidents to taxpayers." The story has triggered heated response from the workers' compensation community.
Robert P. Hartwig, Ph.D., CPCU, president of the Insurance Information Institute responded to the criticism of with a letter he sent to ProPublica/NPR that began by saying "it’s necessary that the record be set straight using facts - verifiable, incontrovertible facts - rather than the unsubstantiated assertions, incorrect interpretations and subsequent erroneous conclusions upon which the basic premise of this series is built."
He goes on to say "The very title ... is at best misleading and at worst erroneous. "The Demolition of Workers Comp" is hyperbole of the highest order. The fact of the matter is that workers compensation insurers today provide some $40 billion in benefits annually to hundreds of thousands of injured workers and to the families of those killed on the job - a basic and important fact that is somehow omitted by the authors. Also omitted from the piece is the indisputable fact that the workplace has become safer - much safer - in no small part due to the relentless loss control efforts of insurers and employers in partnership with state and federal government. The incidence rate of fatal occupational injuries plunged by 36 percent over the past two decades and by 90 percent over the past century - precisely coincident with the dawn of modern workers compensation systems."
He later notes that "Your story asserts that 33 states have "cut" benefits since 2003 through legislation which is characterized as having been passed under the guise of reform. This is far too sweeping of a statement. A system as large as workers compensation, where costs are driven primarily by the same complex factors driving healthcare costs across the United States, is in constant need of monitoring and fine tuning. Many of the changes simply mirror changes in the health care system overall."
After pointing out other arguments he concludes by saying "Workers compensation, a century after its inception, remains as vital as ever to virtually every worker in the America. Benefits can and do vary from state to state but in no state are workers left without the important safety net that workers compensation provides. Though large, the workers comp system continues to adapt to rapid changes in the workforce, the workplace, the economy and the U.S. health care system. Insurers, employers and workers are united in their agreement that that the safety of workers is paramount and that for those who are injured there is a system that works for their benefit, helping them to achieve maximum medical recovery and return to work as quickly as possible."
ProPublica/NPR published his letter in its entirety, and then published its rebuttal.
"ProPublica titled its story 'The Demolition of Workers’ Comp,' to signify how recent reform laws were dismantling some of the fundamental protections workers’ comp historically provided: The guarantee that workers would receive enough of their wages so they wouldn’t fall into poverty, the promise of the medical care they need to return to as normal a life as possible and the expectation that injured workers would have a voice and be treated with dignity."
"ProPublica and NPR do not dispute that the workplace has become safer. But the focus of our story was on how changes in workers’ comp laws have affected people who are injured on the job. Workers’ comp is a vital safety net whose costs give employers an incentive to keep their workplaces safe. This is precisely why we felt it was critical to investigate the rollback of benefits by many states."
"Over the century that workers’ comp has been in effect, workplace injuries have gone both up and down. The decline in fatalities and injuries has multiple causes, including the creation of the Occupational Safety and Health Administration (OSHA), improvements in auto safety and health research, the growth in automation and a changing economy which has reduced jobs in dangerous manufacturing and mining industries and expanded them in the safer service and office sectors."
The finding that workers’ comp rates have fallen was substantiated by multiple data sources. ProPublica and NPR relied on three separate studies to examine the cost that employers pay for workers’ comp insurance premiums. All three are widely respected and used by the workers’ comp industry, and all three come to the same conclusion: Workers’ comp rates are the lowest they’ve been in decades. The sources, which were included in the graphic, are the Oregon Workers’ Compensation Division, the U.S. Bureau of Labor Statistics and the National Academy of Social Insurance ...
Robert P. Hartwig, Ph.D., CPCU, president of the Insurance Information Institute responded to the criticism of with a letter he sent to ProPublica/NPR that began by saying "it’s necessary that the record be set straight using facts - verifiable, incontrovertible facts - rather than the unsubstantiated assertions, incorrect interpretations and subsequent erroneous conclusions upon which the basic premise of this series is built."
He goes on to say "The very title ... is at best misleading and at worst erroneous. "The Demolition of Workers Comp" is hyperbole of the highest order. The fact of the matter is that workers compensation insurers today provide some $40 billion in benefits annually to hundreds of thousands of injured workers and to the families of those killed on the job - a basic and important fact that is somehow omitted by the authors. Also omitted from the piece is the indisputable fact that the workplace has become safer - much safer - in no small part due to the relentless loss control efforts of insurers and employers in partnership with state and federal government. The incidence rate of fatal occupational injuries plunged by 36 percent over the past two decades and by 90 percent over the past century - precisely coincident with the dawn of modern workers compensation systems."
He later notes that "Your story asserts that 33 states have "cut" benefits since 2003 through legislation which is characterized as having been passed under the guise of reform. This is far too sweeping of a statement. A system as large as workers compensation, where costs are driven primarily by the same complex factors driving healthcare costs across the United States, is in constant need of monitoring and fine tuning. Many of the changes simply mirror changes in the health care system overall."
After pointing out other arguments he concludes by saying "Workers compensation, a century after its inception, remains as vital as ever to virtually every worker in the America. Benefits can and do vary from state to state but in no state are workers left without the important safety net that workers compensation provides. Though large, the workers comp system continues to adapt to rapid changes in the workforce, the workplace, the economy and the U.S. health care system. Insurers, employers and workers are united in their agreement that that the safety of workers is paramount and that for those who are injured there is a system that works for their benefit, helping them to achieve maximum medical recovery and return to work as quickly as possible."
ProPublica/NPR published his letter in its entirety, and then published its rebuttal.
"ProPublica titled its story 'The Demolition of Workers’ Comp,' to signify how recent reform laws were dismantling some of the fundamental protections workers’ comp historically provided: The guarantee that workers would receive enough of their wages so they wouldn’t fall into poverty, the promise of the medical care they need to return to as normal a life as possible and the expectation that injured workers would have a voice and be treated with dignity."
"ProPublica and NPR do not dispute that the workplace has become safer. But the focus of our story was on how changes in workers’ comp laws have affected people who are injured on the job. Workers’ comp is a vital safety net whose costs give employers an incentive to keep their workplaces safe. This is precisely why we felt it was critical to investigate the rollback of benefits by many states."
"Over the century that workers’ comp has been in effect, workplace injuries have gone both up and down. The decline in fatalities and injuries has multiple causes, including the creation of the Occupational Safety and Health Administration (OSHA), improvements in auto safety and health research, the growth in automation and a changing economy which has reduced jobs in dangerous manufacturing and mining industries and expanded them in the safer service and office sectors."
The finding that workers’ comp rates have fallen was substantiated by multiple data sources. ProPublica and NPR relied on three separate studies to examine the cost that employers pay for workers’ comp insurance premiums. All three are widely respected and used by the workers’ comp industry, and all three come to the same conclusion: Workers’ comp rates are the lowest they’ve been in decades. The sources, which were included in the graphic, are the Oregon Workers’ Compensation Division, the U.S. Bureau of Labor Statistics and the National Academy of Social Insurance ...
Premera Blue Cross, a health insurer based in the Seattle suburbs, announced Tuesday it was the victim of a cyberattack that may have exposed the personal data of 11 million customers - including medical information. According to the story in the Washington Post, the company said it discovered the attack on Jan. 29 but that hackers initially penetrated their security system May 5, 2014. The attack affected customers of Premera, which operates primarily in Washington, Premera's Alaskan branch as well as its affiliated brands Vivacity and Connexion Insurance Solutions, according to a Web site created by the company for customers. "Members of other Blue Cross Blue Shield plans who have sought treatment in Washington or Alaska may be affected," according to the site.
The company said its investigation has not determined if data was removed from their systems. But the information attackers had access to may have included names, street addresses, e-mail addresses, telephone numbers, dates of birth, Social Security numbers, member identification numbers, medical claims information and bank account information, according to the company's Web site. The company said it does not store credit card information. According to a message on the company's Web site from Premera President and chief executive Jeff Roe, the medical claims data accessible to the attackers included "clinical information."
"This is potentially one of the largest breaches that has ever been reported involving health-care information," said Dave Kennedy, the chief executive of TrustedSEC and an expert on health-care security.
The company is offering two years of free credit monitoring and identity theft protection services to those affected by this incident. Premera is currently working with cybersecurity company Mandiant to investigate the breach, as well as law enforcement.
"The FBI is investigating the Premera cyber intrusion and is working with the victim company in order to determine the nature and scope of this incident," FBI spokesman Joshua Campbell told The Post.
News of the Premera hack comes just two months after Anthem, a fellow Blue Cross Blue Shield associated company and the second largest insurer in the country, announced a cyberattack resulted in the data breach affecting tens of millions of customers. But in that case, hackers are not believed to have obtained medical information, making the breach of Premera particularly concerning for consumers.
Health-care companies have become attractive to hackers because of the premium paid on the black market for insurance credentials. A complete health insurance credentials cost ten to twenty times more than a credit card numbers with security code on underground black markets in 2013, according to Dell SecureWorks. The information can be used for identity theft, but also medical fraud such as purchasing expensive medical equipment or obtaining pricey medical care. This type of fraud often takes longer to detect, security experts have said.
Workers' compensation insurers also store personal medical information on claimants, and it is more likely than not that industry computers are somewhere on the hacker's radar ...
The company said its investigation has not determined if data was removed from their systems. But the information attackers had access to may have included names, street addresses, e-mail addresses, telephone numbers, dates of birth, Social Security numbers, member identification numbers, medical claims information and bank account information, according to the company's Web site. The company said it does not store credit card information. According to a message on the company's Web site from Premera President and chief executive Jeff Roe, the medical claims data accessible to the attackers included "clinical information."
"This is potentially one of the largest breaches that has ever been reported involving health-care information," said Dave Kennedy, the chief executive of TrustedSEC and an expert on health-care security.
The company is offering two years of free credit monitoring and identity theft protection services to those affected by this incident. Premera is currently working with cybersecurity company Mandiant to investigate the breach, as well as law enforcement.
"The FBI is investigating the Premera cyber intrusion and is working with the victim company in order to determine the nature and scope of this incident," FBI spokesman Joshua Campbell told The Post.
News of the Premera hack comes just two months after Anthem, a fellow Blue Cross Blue Shield associated company and the second largest insurer in the country, announced a cyberattack resulted in the data breach affecting tens of millions of customers. But in that case, hackers are not believed to have obtained medical information, making the breach of Premera particularly concerning for consumers.
Health-care companies have become attractive to hackers because of the premium paid on the black market for insurance credentials. A complete health insurance credentials cost ten to twenty times more than a credit card numbers with security code on underground black markets in 2013, according to Dell SecureWorks. The information can be used for identity theft, but also medical fraud such as purchasing expensive medical equipment or obtaining pricey medical care. This type of fraud often takes longer to detect, security experts have said.
Workers' compensation insurers also store personal medical information on claimants, and it is more likely than not that industry computers are somewhere on the hacker's radar ...
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephanie Yonekura of the Central District of California and Assistant Director in Charge David Bowdich of the FBI’s Los Angeles Field Office announced that a pharmacist who owned and operated a pharmacy in Los Angeles pleaded guilty this week in connection with a Medicare fraud scheme.
Rouzbeh Javaherian, 34, of Beverly Grove, California, pleaded guilty to health care fraud in connection with a scheme to defraud the Medicare Part D program through a pharmacy called Emoonah Inc., doing business as Westaid Pharmacy and Medical Supply. According to admissions in the plea agreement, Javaherian was a licensed pharmacist and owner of Westaid, which was located in Los Angeles. From January 2008 to November 2014, Javaherian devised and executed a scheme to defraud the Medicare Part D program by paying illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid. Javaherian then filled some of those prescriptions, but also submitted false and fraudulent claims to Medicare Part D plan sponsors for prescriptions that he did not actually fill.
From January 2008 to November 2014, Javaherian received approximately $644,060 in overpayments from Medicare as the result of the fraud scheme.
Sentencing is scheduled for June 1, 2015, before U.S. District Judge Stephen V. Wilson of the Central District of California. Unfortunately, the California Board of Pharmacy still reports that Javaherian is licensed as a pharmacist in California with no apparent restrictions on his license. The status is reflected as "clear."
The case was investigated by the FBI, and was brought as part of the Medicare Fraud Strike Force, supervised by 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 Trial Attorney Alexander F. Porter of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers ...
Rouzbeh Javaherian, 34, of Beverly Grove, California, pleaded guilty to health care fraud in connection with a scheme to defraud the Medicare Part D program through a pharmacy called Emoonah Inc., doing business as Westaid Pharmacy and Medical Supply. According to admissions in the plea agreement, Javaherian was a licensed pharmacist and owner of Westaid, which was located in Los Angeles. From January 2008 to November 2014, Javaherian devised and executed a scheme to defraud the Medicare Part D program by paying illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid. Javaherian then filled some of those prescriptions, but also submitted false and fraudulent claims to Medicare Part D plan sponsors for prescriptions that he did not actually fill.
From January 2008 to November 2014, Javaherian received approximately $644,060 in overpayments from Medicare as the result of the fraud scheme.
Sentencing is scheduled for June 1, 2015, before U.S. District Judge Stephen V. Wilson of the Central District of California. Unfortunately, the California Board of Pharmacy still reports that Javaherian is licensed as a pharmacist in California with no apparent restrictions on his license. The status is reflected as "clear."
The case was investigated by the FBI, and was brought as part of the Medicare Fraud Strike Force, supervised by 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 Trial Attorney Alexander F. Porter of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers ...
Following two public hearings on the proposed regulations which took place on December 8, 2014 in Oakland, and December 9, 2014, in Los Angeles, the Department of Industrial Relations has made revisions to the proposed California Code of Regulations to implement the Return to Work Supplement Program. Members of the public are invited to present written comments regarding the proposed modifications to LC139.48@dir.ca.gov until 5 p.m., April 1, 2015.
Diane Worley, the Director of Policy Implementation from the California Applicants' Attorneys Association was present at the Northern California hearing, along with her colleague, Bert Arnold, who is President-Elect of the California Applicants' Attorneys Association. According to the Northern California transcript, he was concerned that the Notice to Injured Workers is on the sixth page of the Voucher notice and would not likely be read and understood by the Injured worker. He suggested that the notice be moved to page 1 or to a cover letter. He was also concerned that there was nothing in the regulations to have the notices written in Spanish.
According to the transcript of the Southern California hearing, Robert McLaughlin, an attorney representing injured workers in San Diego, and a member of the California Applicant Attorney's Association presented comments on December 9. He was concerned that there would be approximately three years of back-payments by the time applicants start getting paid. He also was concerned about the limited notice that would be given to applicants after their injuries, and that the application should be filled out on-line.
Christel Schoenfelder. an applicant attorney, and also a representative of the California Applicant Attorney's Association presented an example of a worker who qualifies for the benefits, and who has now settled her underlying case due to lack of funds, yet now several years after SB 863 there is still no process in place for her to get this benefit. The statute of limitations starts to run on these claimants one year after the regulations take effect, and she is concerned that these claimants will never be notified since their cases are settled and closed.
Brent Graham on behalf of Latino Comp pointed out that current supplement job displacement benefit requirement, requiring the Return-to-Work form that has to be filled out by medical professionals at the time the worker is permanent stationary is not being filled out by "the vast majority of treating doctors" and thus is an impediment to obtaining benefits. .
The new proposed regulations in section 17303 now require "a cover sheet prepared by the claims administrator" that summarizes the Return to Work Supplement claim process apparently in response to the comments made by Bert Arnold.
The notice, revised initial statement of reasons, and modified text of the proposed regulations can be found on the DIR website ...
Diane Worley, the Director of Policy Implementation from the California Applicants' Attorneys Association was present at the Northern California hearing, along with her colleague, Bert Arnold, who is President-Elect of the California Applicants' Attorneys Association. According to the Northern California transcript, he was concerned that the Notice to Injured Workers is on the sixth page of the Voucher notice and would not likely be read and understood by the Injured worker. He suggested that the notice be moved to page 1 or to a cover letter. He was also concerned that there was nothing in the regulations to have the notices written in Spanish.
According to the transcript of the Southern California hearing, Robert McLaughlin, an attorney representing injured workers in San Diego, and a member of the California Applicant Attorney's Association presented comments on December 9. He was concerned that there would be approximately three years of back-payments by the time applicants start getting paid. He also was concerned about the limited notice that would be given to applicants after their injuries, and that the application should be filled out on-line.
Christel Schoenfelder. an applicant attorney, and also a representative of the California Applicant Attorney's Association presented an example of a worker who qualifies for the benefits, and who has now settled her underlying case due to lack of funds, yet now several years after SB 863 there is still no process in place for her to get this benefit. The statute of limitations starts to run on these claimants one year after the regulations take effect, and she is concerned that these claimants will never be notified since their cases are settled and closed.
Brent Graham on behalf of Latino Comp pointed out that current supplement job displacement benefit requirement, requiring the Return-to-Work form that has to be filled out by medical professionals at the time the worker is permanent stationary is not being filled out by "the vast majority of treating doctors" and thus is an impediment to obtaining benefits. .
The new proposed regulations in section 17303 now require "a cover sheet prepared by the claims administrator" that summarizes the Return to Work Supplement claim process apparently in response to the comments made by Bert Arnold.
The notice, revised initial statement of reasons, and modified text of the proposed regulations can be found on the DIR website ...
New research suggests that older people with a new episode of back pain should not be sent right away for x-rays or other imaging studies. According to the report in Reuters health, they will not be any better off, and they’ will just end up with bigger bills, the researchers say. "We found that they didn’t have worse or better outcomes, and yet they were certainly getting more things done to them downstream," said Dr. Jeffrey Jarvik, the study’s lead author from the University of Washington in Seattle.
Guidelines (including the ACOEM Guideline) suggest that young people with new back pain should wait a while before getting X-rays, magnetic resonance imaging (MRI) or computed tomography (CT), but the same guidelines make exceptions for older people since there could be more serious underlying conditions. Based on the new results, however, people of every age should not routinely get early imaging studies, the researchers write in JAMA. Jarvik told Reuters Health by phone that older people who get early imaging studies might receive treatments for abnormalities on the tests that ultimately have nothing to do with their back pain.
The researchers looked at data from 5,239 patients age 65 and older who visited their primary care doctor complaining of new back pain and returned for a follow-up visit a year later. Within six weeks of the first visit, 1,523 patients had X-rays, MRIs or CT scans of their backs.
After one year, there was no difference in the disability related to back or leg pain between those who did or did not have early imaging studies, the researchers found. Those who had the X-rays, MRIs or CT scans, however, ended up with medical bills averaging $1,300 higher than for those who didn't have early imaging studies. Those costs include out-of-pocket payments.
Imaging accounts for most of the $35 billion spent on medical care for lower back pain each year in the U.S., said Manuela Ferreira, associate professor at The George Institute for Global Health and the Institute of Bone and Joint Research of Sydney Medical School at The University of Sydney in Australia. "Adults with sudden back pain do not need to rush to get an X-ray or magnetic resonance imaging (MRI), unless the clinician suspects the patient has a more serious condition, such as fracture or cancer," Ferreira told Reuters Health by email. "Less than 5 percent of patients with low back pain, however, will fall into this category," she added. Most of the time, back pain develops from stress and strain on muscles or joints.
"Older adults don’t really need to be treated differently than younger adults," Jarvik said. Most of the time, the cause of back pain is probably never discovered, he said. "That’s not necessarily a bad thing because most people get better," he added. "It’s probably not necessary to try and discover exactly why somebody’s back starts hurting, the various investigations you can do often won’t reveal the cause."
A thorough physical exam and medical history should help doctors distinguish between more benign forms of back strain or a more serious cause, Ferreira said. In the meantime, people can take over-the-counter painkillers and may try physical therapy, which may help overcome a sudden episode of pain, Jarvik said ...
Guidelines (including the ACOEM Guideline) suggest that young people with new back pain should wait a while before getting X-rays, magnetic resonance imaging (MRI) or computed tomography (CT), but the same guidelines make exceptions for older people since there could be more serious underlying conditions. Based on the new results, however, people of every age should not routinely get early imaging studies, the researchers write in JAMA. Jarvik told Reuters Health by phone that older people who get early imaging studies might receive treatments for abnormalities on the tests that ultimately have nothing to do with their back pain.
The researchers looked at data from 5,239 patients age 65 and older who visited their primary care doctor complaining of new back pain and returned for a follow-up visit a year later. Within six weeks of the first visit, 1,523 patients had X-rays, MRIs or CT scans of their backs.
After one year, there was no difference in the disability related to back or leg pain between those who did or did not have early imaging studies, the researchers found. Those who had the X-rays, MRIs or CT scans, however, ended up with medical bills averaging $1,300 higher than for those who didn't have early imaging studies. Those costs include out-of-pocket payments.
Imaging accounts for most of the $35 billion spent on medical care for lower back pain each year in the U.S., said Manuela Ferreira, associate professor at The George Institute for Global Health and the Institute of Bone and Joint Research of Sydney Medical School at The University of Sydney in Australia. "Adults with sudden back pain do not need to rush to get an X-ray or magnetic resonance imaging (MRI), unless the clinician suspects the patient has a more serious condition, such as fracture or cancer," Ferreira told Reuters Health by email. "Less than 5 percent of patients with low back pain, however, will fall into this category," she added. Most of the time, back pain develops from stress and strain on muscles or joints.
"Older adults don’t really need to be treated differently than younger adults," Jarvik said. Most of the time, the cause of back pain is probably never discovered, he said. "That’s not necessarily a bad thing because most people get better," he added. "It’s probably not necessary to try and discover exactly why somebody’s back starts hurting, the various investigations you can do often won’t reveal the cause."
A thorough physical exam and medical history should help doctors distinguish between more benign forms of back strain or a more serious cause, Ferreira said. In the meantime, people can take over-the-counter painkillers and may try physical therapy, which may help overcome a sudden episode of pain, Jarvik said ...
Tablet use has rocketed. Last year in the US, for example, 42% of under 18's owned one and more than half of 35-49 year olds used them regularly. This figure seems unlikely to decrease and yet only limited guidance is available on minimizing health risks. Tablet use requires significant head and neck flexion and has implications for potential neck injury to users. In an article in Ergonomics, researchers from Washington State University evaluate the head-neck biomechanics during tablet use, the implications for the neck musculature and future ergonomics recommendations.
Past research has highlighted a link between increased head and neck flexion and pain. Increased activation of neck extensor muscles leave them vulnerable to fatigue and therefore pain. It is not clear though if more risk is associated with type of computer, activity (web browsing, emailing etc.) or if differences in head mass, height and/ or neck muscle strength, often associated with gender, are pivotal.
In the article Gravitational demand on the neck musculature during tablet computer use, Anita N. Vasavada, Derek D. Nevins, Steven M. Monda, Ellis Hughes & David C. Lin, Ergonomics, DOI:10.1080/00140139.2015.1005166, published online 2 February 2015 the authors conducted a study of 33 university students and staff who use regularly used tablets. Users were tested in a variety of usage positions and whilst reading and typing for 2-5 minutes. Radiographs and a biomechanical model were used to assess gravitational demand on the neck and biomechanical ergonomics of the head-neck system during tablet use. The authors hypothesised that tablet use would result in greater gravitational demand than a neutral posture, particularly when used on a lap or flat on a desk. They also speculate that demand will be different for reading vs. typing and finally that gravitational demand will be greater for female users.
The authors discovered that tablet use increases mechanical demand on neck muscles by 3-5 times more than a neutral position.
Using a tablet flat or on lap also had this effect as compared to propped up but whether subject was reading or typing had little effect on level of neck strain; head-neck demand is independent of hand position. A minimal increase in gravitational demand was seen in males but not enough to be significant.
The authors conclude "Our findings are important for developing ergonomics guidelines for tablet computer use because they provide quantitative information about the mechanical requirements of the head-neck musculature, which are directly linked to mechanisms of pain-related problems, under several tablet computer usage conditions." They urge more research to include further variables such as extent and frequency of use and posture, all of which could be significant in inducing neck pain after tablet use.
...
Past research has highlighted a link between increased head and neck flexion and pain. Increased activation of neck extensor muscles leave them vulnerable to fatigue and therefore pain. It is not clear though if more risk is associated with type of computer, activity (web browsing, emailing etc.) or if differences in head mass, height and/ or neck muscle strength, often associated with gender, are pivotal.
In the article Gravitational demand on the neck musculature during tablet computer use, Anita N. Vasavada, Derek D. Nevins, Steven M. Monda, Ellis Hughes & David C. Lin, Ergonomics, DOI:10.1080/00140139.2015.1005166, published online 2 February 2015 the authors conducted a study of 33 university students and staff who use regularly used tablets. Users were tested in a variety of usage positions and whilst reading and typing for 2-5 minutes. Radiographs and a biomechanical model were used to assess gravitational demand on the neck and biomechanical ergonomics of the head-neck system during tablet use. The authors hypothesised that tablet use would result in greater gravitational demand than a neutral posture, particularly when used on a lap or flat on a desk. They also speculate that demand will be different for reading vs. typing and finally that gravitational demand will be greater for female users.
The authors discovered that tablet use increases mechanical demand on neck muscles by 3-5 times more than a neutral position.
Using a tablet flat or on lap also had this effect as compared to propped up but whether subject was reading or typing had little effect on level of neck strain; head-neck demand is independent of hand position. A minimal increase in gravitational demand was seen in males but not enough to be significant.
The authors conclude "Our findings are important for developing ergonomics guidelines for tablet computer use because they provide quantitative information about the mechanical requirements of the head-neck musculature, which are directly linked to mechanisms of pain-related problems, under several tablet computer usage conditions." They urge more research to include further variables such as extent and frequency of use and posture, all of which could be significant in inducing neck pain after tablet use.
...
