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A man was arraigned in Orange County Superior Court on charges of tax evasion and insurance fraud for failing to report over $5.6 million in payroll and failing to pay over $384,000 in taxes.

Darrin Shawn Wilson, 50, Newport Beach, is charged with 15 felony counts of misrepresenting facts to the State Compensation Insurance Fund (SCIF), five felony counts of misrepresenting facts to a workers’ compensation insurance company, 20 felony counts of failing to file a return with the intent to evade tax, 20 felony counts of willful failure to pay tax, and a sentencing enhancement for white collar crime and committing a theft exceeding $500,000 and a taking that exceeded $200,000. The defendant is out of custody on $500,000 bail and is scheduled for a pre-trial Feb. 9, 2016, at 8:30 a.m. in Department C-55, Central Justice Center, Santa Ana.

Wilson is the sole principal for American Blacktop Incorporated, dba Seal-It, an asphalt and paving company, and The Mavrick Company, a property management company.

Between Jan. 1, 2009, and July 31, 2012, Wilson is accused of obtaining a workers’ compensation policy of insurance for these companies and failing to report all of the payroll for his workers’ to SCIF in the amount of $4.3 million for the policy periods of 2009 to 2012. On Aug. 1, 2012, Wilson is accused of purchasing a workers’ compensation policy of insurance from the insurance company, AIG. He is accused of underreporting payroll for the AIG policy in an amount exceeding $1.3 million for the time period of Aug. 1, 2012, through Dec. 31, 2013. From January 2009 through Dec. 31, 2013, Wilson is accused of failing to report to the EDD, accurate payroll in quarterly reports and failed to collect, account for, and pay over taxes required by law.

The insurance fraud came to light when a claim was submitted to SCIF from an injured worker who reported that he had fallen approximately 12 feet from a ladder while working for the Mavrick Company and suffered work-related injuries. Wilson is accused of disputing the claim, stating that the worker was employed by a painting company subcontractor at the time of the injury. SCIF in attempting to determine whether to accept or deny the claim learned that the painting company subcontractor was unlicensed and uninsured.

In construction, to be a subcontractor, one must hold a valid Contractor’s State License and must have a workers’ compensation insurance policy for its employees. Without a valid license and insurance, the subcontractors would be in fact employees of the employing company, thus in this case Mavrick Company. Wilson was required to disclose all payroll to the insurance companies in order to determine the premium for the policy, and he is accused of hiring numerous unlicensed and uninsured workers asserting they were subcontractors in an attempt to avoid paying premium ...
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/ 2015 News, Daily News
In a series of related cases the former chief financial officer of Pacific Hospital of Long Beach, two orthopedic surgeons and two others have been charged in long-running health care fraud schemes that allegedly referred thousands of patients for spinal surgeries and generated nearly $600 million in fraudulent billings over an eight-year period.

Two of the defendants have pleaded guilty and three others have agreed to plead guilty in the coming weeks. All five defendants have agreed to cooperate in the government’s ongoing investigation into kickbacks for patient referrals and fraudulent bills for spinal surgeries.

The schemes involved tens of millions of dollars in illegal kickbacks to dozens of doctors, chiropractors and others.As a result of the illegal payments, thousands of patients were referred to Pacific Hospital in Long Beach, where they underwent spinal surgeries that led to more than $580 million in bills being fraudulently submitted during the last eight years of the scheme alone. Many of the fraudulent claims were paid by the California worker’s compensation system and the federal government.

In a second, similar scheme that also involved spinal surgeries, doctors received illegal kickbacks for referrals to a Hawaiian Gardens hospital.

Federal prosecutors filed two cases related to the scheme, and earlier three other cases were unsealed by a federal judge. Those named in the cases are:

1) James L. Canedo, 63, of San Pedro, California, the former CFO of Pacific Hospital in Long Beach, who pleaded guilty on Sept. 4 to a criminal information charging him with participating in a conspiracy that engaged in mail fraud, honest services fraud, money laundering, paying or receiving kickbacks in connection with a federal health care program and violating the Travel Act, specifically, interstate travel in aid of a racketeering enterprise. The case against Canedo was unsealed a few days ago by U.S. District Judge Josephine L. Staton of the Central District of California, who is scheduled to sentence the defendant on June 17, 2016.
2) Philip Sobol, 61, of Studio City, California, an orthopedic surgeon who has agreed to plead guilty to conspiracy to commit mail fraud, honest services fraud and violations of the Travel Act; as well as a separate, substantive Travel Act violation. The information against Sobol and a related plea agreement were filed in U.S. District Court, where the Sobol is expected to be arraigned next month.
3) Alan Ivar, 55, of Las Vegas, a chiropractor who formerly resided in San Juan Capistrano, California, and owned several businesses based in Costa Mesa, California, was charged in a criminal information that alleges one count of conspiracy to commit mail fraud, honest services fraud, money laundering and violations of the Travel Act. In a plea agreement also filed at the same time, Ivar admitted that for well over a decade, he had an agreement with the owner of Pacific Hospital to refer patients in exchange for a monthly retainer. Ivar, who also agreed to plead guilty, is expected to be arraigned next month.
4) Paul Richard Randall, 56, of Orange, California, a health care marketer previously affiliated with Pacific Hospital and Tri-City Regional Medical Center in Hawaiian Gardens, pleaded guilty on April 16, 2012, before Judge Staton to conspiracy to commit mail fraud. Randall, who admitted recruiting chiropractors and doctors to refer patients to Tri-City in exchange for kickbacks, is scheduled to be sentenced on April 8, 2016.
5) Mitchell Cohen, 55, of Irvine, California, an orthopedic surgeon, was charged last week with filing a false tax return. Cohen admits in a plea agreement filed on Nov. 16 that he failed to report income received from kickback payments and is expected to be arraigned next month.

All five defendants have agreed to cooperate with the government’s ongoing investigation, dubbed "Operation Spinal Cap," into the kickback schemes, which involved dozens of surgeons, orthopedic specialists, chiropractors, marketers and other medical professionals.

Under the terms of their plea agreements, Sobol faces a federal prison term of up to 10 years; Canedo, Ivar and Randall face up to five years in prison; and Cohen faces up to three years in prison on the tax charge. All of the defendants will be required to pay restitution to the victims of the scheme, which in Canedo’s case will be at least $20 million.

As part of the scheme, the conspirators typically paid a kickback of $15,000 for each lumbar fusion surgery and $10,000 for each cervical fusion surgery. Some of the patients lived hundreds of miles away from Pacific Hospital and closer to other qualified medical facilities. The patients were not informed that medical professionals had been offered kickbacks to induce them to refer the surgeries to Pacific Hospital. From 2005 through 2013, only part of the overall scheme, Pacific Hospital billed insurers more than $580 million for spinal surgeries on more than 4,400 patients. Insurers paid the hospital more than $226 million for the surgeries performed as a result of illegal kickbacks.

The conspirators in the Pacific Hospital scheme concealed the kickback payments by entering into bogus contracts to provide a "cover story" for the doctors, chiropractors and others who received illegal payments. For example, a number of doctors entered into agreements with a Pacific Specialty Physician Management (PSPM), a company owned by Drobot, under which the doctors received as much as $100,000 per month from PSPM in return for the right to purchase their medical practices - an option that was never exercised. PSPM paid some doctors inflated prices for the right to operate their practices and collect on their insurance claims. In still other cases, Pacific Hospital entered into contracts with doctors under which the doctors were to help the hospital collect on its surgery bills to insurance companies, but the hospital’s own collection staff, rather than the doctors, actually performed the collections work. Several doctors entered into lease agreements under which PSPM or Pacific Hospital paid rent for the use of office space, but rarely used the space. And other doctors ...
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/ 2015 News, Daily News
In 2002, Heather Reese sustained industrial injury while employed by All Saints Healthcare to her lumbar spine, psychological system, central nervous system (in the form of a sleep disorder) and cardiovascular system (in the form of deep vein thrombophlebitis). Stipulations with Request for Award for 100% permanent disability were approved including an award for future medical care.

In 2013, her PTP, Philip A. Sobol, M.D., requested authorization for home care assistance at four hours per day, five days per week for one year on an indefinite basis to aid in food preparation, cooking and cleaning, laundry, sweeping, mopping, vacuuming, household chores and grocery shopping due to the patient's permanent disability. The State Fund adjuster sent a letter to Sobol denying the request for home care assistance (and other requests) but did not send the letter to Reese's attorney.

On March 19, 2014 the parties proceeded to an expedited hearing on the need for home health care services. The WCJ found that despite the fact that UR was untimely Reese was not entitled to further medical treatment in the form of home health care services. In his Opinion, he noted that applicant had the burden to show that the requested treatment was reasonable and necessary. He found that the request for assistance for food preparation, cooking and cleaning, laundry, sweeping, mopping, vacuuming, household chores and grocery shopping was not considered medical treatment based on Bishop v. Workers' Comp. Appeals Bd. (2011) 76 Cal.Comp.Cases 1192 (writ den.) (Bishop). With respect to the request for assistance with dressing and bathing, he found that Dr. Sobol had not provided a sufficient rationale.

The WCAB reversed in the panel decision of Reese v All Saints Healthcare. It rejected the view in Bishop and relied instead on Smyers v. Workers' Comp. Appeals Bd (1984) 157 Cal.App.3d 36 [49 Cal. Comp. Cases 454] (Smyers). The Court of Appeal stated that "Our holding in the instant case extends coverage to recipients of housekeeping services when there is a demonstrated medical need. .... We hold that the proper approach by the Board is to treat the question of reimbursement under section 4600 for housekeeping services as a factual question to be resolved in each case by lay and expert evidence. The test then is whether household services in the particular case before the Board are medically necessary and reasonable." Thus, under Smyers, applicant's request for housekeeping services was not precluded.

Further, on June 12, 2014, the WCAB issued Neri Hernandez v. Geneva Staffing, Inc. dba Workforce Outsourcing, Inc. (2014) 79 Cal.Comp.Cases 682 (Appeals Board en banc) concerning home health care services. In Hernandez, the WCAB summarized the impact of section 4600(h): "Section 4600(h) makes clear that home health care services are included in the definition of 'medical treatment,' but it also limits an employer's duty to provide that treatment by imposing two additional conditions which are part of an injured worker's burden of proof. The first condition requires that home health care services be prescribed by a physician, and an employer may become liable for home health care services provided 14 days prior to receipt of a prescription. The second condition requires that an employer's liability for home health care services is subject to either section 5307.1 or section 5307.8. (Id. at pp. 688-689.) ...
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/ 2015 News, Daily News
San Diego became the destination for information about anti-health-care fraud efforts, courtesy of the National Healthcare Anti-Fraud Association’s annual training conference. According to the recap published in Bloomberg BNA attendees were treated to an inside look at how law enforcement is fighting the scourge of health-care fraud.

First up on the docket was a presentation from Timothy Delaney, deputy assistant director of the Federal Bureau of Investigation’s criminal investigative division. According to Delaney, health-care fraud prison sentences have gotten increasingly longer, which has served as an effective deterrent. In addition, Delaney said the number of qui tam settlements and judgments has grown dramatically, from 43 in 1985, totaling around $2 billion, to 753 in 2014, totaling around $3 trillion.

Delaney said the major health-care fraud areas include mental health, durable medical equipment, labs and pharmaceuticals, and said there’s no lack of creativity behind some of the fraud schemes. For instance, Delaney said one doctor billed for wave therapy, which turned out to involve the doctor walking through a room full of patients and waving to them.

A presentation from the OIG that laid out the scope of existing pharmaceutical drug fraud. Shimon Richmond, the OIG’s special agent in charge of Miami, said that while the agency continues to have trouble with opiate drug fraud, non-controlled drug fraud is rising rapidly. Richmond said Medicare Part D spending has increased from $51 billion in 2006 to $121 billion in 2014, and out of the $121 billion, $113 billion was spent on non-controlled drugs.

Richmond was joined by the OIG’s Michael Cohen, who said the agency is concerned by the rise of high-dollar specialty drugs being approved by the FDA. Cohen said the high-priced drugs are too much of a temptation for fraudsters. For example, Cohen said the agency is keeping a close eye on the new Hepatitis C drugs that have recently hit the market, such as Solvadi and Harvoni ...
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/ 2015 News, Daily News
It what might be considered bad news for health insurers and consumers, pharmaceutical giants Pfizer Inc. and Allergan just announced a $160-billion merger that would create the world’s largest drugmaker with high-profile products such as Botox, Lipitor and Viagra, while increasing pressure on Washington policymakers to address corporate tax policy because the deal would shelter the new firm's global earnings. Although New York-based Pfizer is the larger company, the deal is structured so that Allergan technically is the purchaser.

The Los Angeles Times reports that the move allows the new firm - which would take Pfizer’s name and be headed by its current chief executive, Ian Read - to be headquartered for tax purposes in Dublin, Ireland, where Allergan already is located, to take advantage of that nation’s lower corporate tax rate. The tactic, known as an inversion, would lead to an effective tax rate for the new company of about 17% to 18%, Pfizer and Allergan said Monday. Pfizer’s effective tax rate last year was about 27%. The new firm would have its global headquarters in New York, but its principal executive offices would be in Ireland, which has a 12.5% corporate tax rate. The U.S. has a 35% corporate tax rate, the highest of any developed economy.

Corporate mergers and acquisitions this year are on pace to break the record of $4.6 trillion set in 2007, according to Dealogic, which tracks the market. Healthcare, in particular, has seen a spree of takeovers as providers, insurers, pharmaceutical makers and drugstores reposition themselves for industry changes spawned by the federal Affordable Care Act.

But critics have raised concerns about the increased number of takeovers. In the case of healthcare, some have said that as the number of players in each sector shrinks, consumers will have fewer choices and prices will rise. The Pfizer-Allergan deal drew such criticism amid the ongoing debate about higher drug prices ...
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/ 2015 News, Daily News
Dr. Robert Califf, President Obama’s recent nominee to head the Food and Drug Administration, has been the target of serious criticism in recent weeks over his close ties to the pharmaceutical industry. He has received hundreds of thousands of dollars from Big Pharma.

The New York Times reports that Dr. Califf, a cardiologist, is a renowned clinical researcher who has deep respect for the system in which he works, and no one who knows him thinks he wants to weaken the regulatory agency he has been chosen to lead. But he has deeper ties to the pharmaceutical industry than any F.D.A. commissioner in recent memory, and some public health advocates question whether his background could tilt him in the direction of an industry he would be in charge of supervising.

While the previous commissioner, Dr. Margaret A. Hamburg, a former top health official in New York City, came from the field of public health, Dr. Califf ran a multimillion-dollar clinical research center at Duke University that received more than 60 percent of its funding from industry.

His financial disclosure form last year listed seven drug companies and a device maker that paid him for consulting and six others that partly supported his university salary, including Merck, Novartis and Eli Lilly. A conflict-of-interest section at the end of an article he wrote in the European Heart Journal last year declared financial support from more than 20 companies.

"In a sense, he’s the ultimate industry insider," said Daniel Carpenter, a Harvard political science professor who has written extensively about the F.D.A.

But , Dr. Califf’s supporters note that a résumé studded with industry funding is not unusual in academic medicine. Doctors are paid consulting fees all the time, and universities routinely conduct clinical trials on behalf of companies. Those contracts help support university researchers’ salaries, a standard practice. Many emphasize that it does not imply an inherent conflict. His supporters contend that Dr. Califf’s vast experience in the clinical science world could be a major asset in his new post ...
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/ 2015 News, Daily News
The Department of Industrial Relations (DIR) has posted California’s 2014 occupational injury and illness data with detailed information on employer-reported injuries involving days away from work. The data shows that the incidence of occupational injuries remains at its lowest level in 13 years.

"As a whole, the lower work-related injury and illness rates reflect California’s commitment to on-the-job health and safety," said DIR Director Christine Baker. "However, employers in industry sectors that have a disproportionate share of work-related injuries must focus on prevention to further protect the health and safety of employees."

The Survey of Occupational Injuries and Illnesses (SOII) data reflect a total of 460,000 reportable injury and illness cases in 2014, of which 265,000 cases involve lost work-time, job transfer, or restriction-from-duty cases (referred to as lost work-time cases), with over 140,000 of those cases involving days away from work. The incidence of nonfatal occupational injuries and illnesses in California remain at their lowest level in the past decade in all three categories.

For cases involving days away from work, Latino workers continue to experience the highest incidence of occupational injuries, comprising 59 percent of all reported days away from work cases. In construction, manufacturing, mining and natural resources, 3 out of 4 workers injured on the job and losing work days are Latino.

In private industry, new hires and young workers have higher rates of injury. One of every four workers whose injury or illness at work involved days away from work in private industry had been on the job less than a year. Teenagers from 16 to 19 years of age suffered the highest incidence of days away from work compared to all other age groups.

Sprains, strains and tears are the largest injury category involving days away from work. Among private sector workers, the greatest number of injuries or illnesses requiring days away from work were caused by overexertion and bodily reaction, by contact with an object or piece of equipment, and by falls, trips and slips.

Tables and charts reflecting nonfatal occupational injuries and illnesses data for 2014 (and prior years’ data) for California are posted online ...
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/ 2015 News, Daily News
Valentino H. Douglas, 45, of Rialto, was arrested and booked into the West Valley Detention Center on multiple counts of felony insurance fraud after receiving more than $112,000 in workers' compensation benefits for an alleged work injury that actually occurred a month earlier while playing softball.

While employed as a security officer at Rialto High School, Douglas filed a workers' compensation claim in July 2013, two months after an altercation with a student claiming that he injured his shoulder during the incident. An investigation by Department of Insurance detectives revealed Douglas sought treatment a month earlier for the same shoulder injury stating that it occurred while playing softball.

"Workers' compensation fraud is a costly crime that we all pay for," said Insurance Commissioner Dave Jones. "Insurers pass along the cost of their losses to businesses through higher insurance premiums and those costs are passed onto to consumers through higher prices for goods and services. Ultimately, there is a ripple effect on our economy."

Videotape evidence also showed Douglas exercising with a boot camp group with no apparent physical limitations. When questioned about his statements to physicians and his exercise activity, Douglas continued to misrepresent the facts of his alleged injury. The case is being prosecuted by the San Bernardino District Attorney's office ...
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/ 2015 News, Daily News
Glaus Pyle Schomer Burns and Dehaven, Inc. is in the telecommunications business. Part of Glaus Pyle’s operations includes doing work for major cell companies by providing site audits on cell phone transmission equipment. Glaus Pyle subcontracted with ITC Service Group, which provided workers to conduct the site audits. Under this contract, employees of ITC Service Group traveled to the locations of the cell phone transmission sites being audited to conduct the site inspections. ITC Service Group assigned Chris Anderson to the job of inspecting the sites.

In June 2009, Anderson was injured when conducting a field inspection of cell phone transmission equipment. Anderson’s injury stemmed from exposure to radio frequency radiation emitted from the cell tower. Anderson filed a workers’ compensation claim against ITC Service Group, and he settled that claim. In June 2011, Anderson sued Glaus Pyle, alleging negligence and gross negligence in connection with his injuries. The theory of his case was that Glaus Pyle negligently maintained the site and was grossly negligent in failing to protect him from excess radiation.

Glaus Pyle filed a motion for summary judgment, contending it did not owe Anderson a duty of care because employees of an independent contractor cannot sue the third party that hired the contractor to do the work. The trial court agreed with Glaus Pyle, granting summary judgment. The Court of Appeal affirmed in the unpublished case of Anderson v Glaus Pyle Schomer Burns and Dehaven, Inc.

In affirming the dismissal, the Court of Appeal relied on the "Privette" doctrine. "Generally, when employees of independent contractors are injured in the workplace, they cannot sue the party that hired the contractor to do the work. . . . [¶] By hiring an independent contractor, the hirer implicitly delegates to the contractor any tort law duty it owes to the contractor’s employees to ensure the safety of the specific workplace that is the subject of the contract.” (SeaBright Ins. Co. v. US Airways, Inc. (2011) 52 Cal.4th 590, 594; see Privette v. Superior Court (1993) 5 Cal.4th 689, 696; Toland v. Sunland Housing Group, Inc. (1998) 18 Cal.4th 253, 257 [the hiring person “has no obligation to specify the precautions an independent hired contractor should take for the safety of the contractor’s employees" and "[a]bsent an obligation, there can be no liability in tort"].) ...
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/ 2015 News, Daily News
The U.S. Food and Drug Administration approved the first-ever nasal spray emergency treatment for opioid overdose on Wednesday. The reformulated drug, sold as Narcan, comes as a nasal spray and should help first responders, police and others deliver the antidote in emergency situations. Known generically as naloxone, it reverses the effects of opioids - drugs that include legal painkillers such as oxycodone and illegal narcotics such as heroin.

Data from the Centers for Disease Control and Prevention indicates opioid overdose led to about 23,500 deaths in the United States in 2013, a four-fold jump from 1999. A majority of these deaths occur in non-medical settings, stressing the need for user-friendly treatments that can be administered without the help of a medical practitioner, Adapt Chief Executive Seamus Mulligan told Reuters.

The treatment, Narcan, which Adapt plans to launch by January, is expected to have wide coverage under health insurance with affordable co-pays, Mulligan added. Ireland-based Adapt bought the development and commercialization rights to Narcan from London-based Lightlake Therapeutics Inc in December 2014. The company says the nasal spray is cheaper and easier to use than injections.

Group purchasers, such as law enforcement, fire fighters, departments of health, local school districts, colleges and universities, and community-based organizations will be able to purchase the spray at a discounted price of $37.50 per 4 mg device. Some first responders already convert naloxone injections into a nasal spray using nozzles and other equipment ...
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/ 2015 News, Daily News
The WCIRB has released its Senate Bill No. 863 WCIRB Cost Monitoring Report - 2015 Retrospective Evaluation which is part of a multi-year cost monitoring plan developed by the WCIRB following the signing of SB 863 by the California Governor on September 18, 2012.

This Report includes an updated retrospective evaluation of the cost impact of a number of SB 863 provisions based on data emerging through the third quarter of 2015. Based on the most current information, the WCIRB estimates the impact of SB 863 is an annual net savings of $770 million, or 4.1%, of total system costs.

The measure sought to change the long-standing practice in workers’ compensation cases of charging unregulated medical fees for care by tying fees to other publicly financed health care programs. The medical care portions of the bill appear to be having the desired effect. SB 863’s elimination of the duplicate payment for spinal surgical implants was estimated to save approximately $20,000 per procedure, while WCIRB Medical Data Call (MDC) data shows an over $25,000, or 28%, reduction in the average cost of these procedures since 2013.

The changes to PD related to FEC were estimated to eliminate any increases to PD for the Ogilvie decision and included significant savings to frictional costs resulting from the elimination of Ogilvie. However, since the implementation of SB 863, average allocated loss adjustment expense (ALAE) costs per claim have not declined and, in fact, have increased significantly, suggesting no savings to ALAE from the elimination of Ogilvie are emerging.

Expedited hearings related to medical treatment disputes were expected to be substantially eliminated by the new IMR process, while approximately 5,500 more expedited hearings have been held per year since the implementation of SB 863.

The number of lien filings was projected to decrease by approximately 41% as a result of the SB 863 lien filing fee and statute of limitations. Although filings in 2013 and 2014 decreased by approximately 60% annually when compared to 2011 levels, the number of liens filed increased significantly in 2015 and are projected to be only 20% lower than 2011 levels. However, some of this increase may be a result of temporary increases in lien filings due to the transition of the statute of limitations on filing liens from three years to eighteen months for dates of service on or after July 1, 2013. As a result, at this time it is not clear whether the SB 863 lien provisions will produce saving more or less than originally projected ...
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/ 2015 News, Daily News
Antibiotic resistance, which can turn common ailments into killers, has reached dangerous levels globally, the World Health Organization warned Monday, saying widespread misunderstandings about the problem was fuelling the risk.

Antibiotic resistance happens when bugs become immune to existing drugs, allowing minor injuries and common infections to become deadly. This happens naturally, but overuse and misuse of the drugs dramatically speeds up resistance, WHO said, voicing alarm at the results of a worldwide study showing that misconceptions about the threat are widespread, prompting dangerous behaviors.

"The rise of antibiotic resistance is a global health crisis. More and more governments recognize (it is) one of the greatest threats to health today," WHO chief Margaret Chan told reporters, stressing that worldwide, resistance was "reaching dangerously high levels." Chan pointed out that "super bugs haunt hospitals and intensive care units all around the world," warning that the world is heading into "a post-antibiotic era, in which common infections will once again kill."

WHO's 12-country survey published Monday found that nearly two thirds of all those questioned (64 percent) believe wrongly that antibiotics can be used to treat colds and flu, despite the fact that the drugs have no impact on viruses.The survey, conducted in Barbados, China, Egypt, India, Indonesia, Mexico, Nigeria, Russia, Serbia, South Africa, Sudan and Vietnam, also showed that 66 percent believe there is no risk of antibiotic resistance for people who take their antibiotics as prescribed. And nearly half thought antibiotic resistance was only a problem for people who take the drugs regularly, when in fact, anyone, of any age and anywhere, can get an antibiotic-resistant infection. Around a third meanwhile believed it was best to stop an antibiotic treatment as soon as they felt better, rather than completing the prescribed course of treatment, the survey showed.

The survey results indicate that "one of the biggest health challenges of the 21st century will require global behavior change by individuals and societies," said Keiji Fukuda, the UN chief's special representative on antimicrobial resistance. "Antibiotics are really one of the miracles of the time that we live in. They are a global good ... that we cannot take for granted," he said.

In a bid to correct misconceptions about the problem, WHO launched a campaign Monday called "Antibiotics: Handle with care". It aims to help alter a range of dangerous behaviors brought to light in the survey, including the ease of acquiring antibiotics without a prescription in some countries.

The survey showed for instance that five percent of Chinese respondents who had taken antibiotics in the past six months had purchased them on the Internet, while the same percentage in Nigeria had bought them from a stall or hawker. In Russia, only 56 percent of those who had taken antibiotics in the past year had them prescribed by a doctor or nurse ...
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/ 2015 News, Daily News
Department of Insurance detectives arrested Ramon Humerto Otero, 37, of Adelanto, and Efrain Heredia Ojeda, 43, of Corona, last week on multiple felony counts of insurance fraud and grand theft. The duo allegedly conspired to steal an $18,946 settlement check intended for a client whose workers' compensation case Otero was presiding over and who passed away before the settlement with the insurer was achieved.

The Department of Insurance alleges that Otero, a hearing representative for the law offices of Ramon Otero Jr., negotiated a workers' compensation settlement agreement for his client. During the course of the negotiation, his client passed away. Otero still proceeded with negotiations despite the passing of his client and reported to the insurer that his client's address changed. Suspecting fraud, the State Compensation Insurance Fund referred the claim to the Department of Insurance for investigation. Detectives found evidence that Otero instructed the insurer to mail the settlement check to the residence of Ojeda, an interpreter and close associate of Otero. Ojeda allegedly forged the deceased's signature to endorse the settlement check and deposited it into his personal bank account.

A search for the law office of Ramon Otero Jr. shows an office located at 522 W Holt Ave. in Pomona. Yet a search of California State Bar records for an attorney with the name of Ramon Otero Jr. shows only one individual with that name in Pomona, and he is reported to be "deceased."

Otero was booked into the Inmate Reception Center in Los Angeles. Ojeda was booked into the Robert Presley Detention Center in Riverside. Both face a maximum five-year prison sentence if convicted on all counts. This case is being prosecuted by the Los Angeles County District Attorney's Office ...
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/ 2015 News, Daily News
An Orange County couple was sentenced last week for owing nearly $2 million from a tax evasion and insurance fraud scheme. Rand Paul Gordon 61, Laguna Hills, and Michele Louise Gordon, 62, Laguna Hills owned and operated moving service companies under the business names Gordon Moving Services Inc., Gordon Moving and Storage Inc., GMS Solutions, and various other names.

in 2006, Rand Gordon obtained an insurance policy for his company with SCIF which was subsequently canceled in 2009 for failure to pay premiums. When he renewed his insurance policy with SCIF he knowingly made false and fraudulent statements by underreporting his payroll to SCIF and failed to pay taxes to the Employment Development Department (EDD).

He also instructed his workers to lie about claims, On Jan. 9, 2008, Rand Gordon told one of his workers to lie about how an injury occurred during a work assignment, while the defendant was driving the victim to a hospital. On Sept. 3, 2009, Rand Gordon dissuaded another worker from filing a workers compensation claim for an injury sustained at work with the intent of keeping his loss history at a minimum to keep the premium on his insurance low. John Doe 2 filed a workers compensation claim.

Rand Robert Gordon pleaded guilty last February to five felony counts of misrepresenting facts to the State Compensation Insurance Fund (SCIF), one felony count of filing a false tax return, 10 felony counts of willful failure to file or make fraudulent tax return, two felony counts of making false statements, two felony counts of making false statements to discourage injured worker from claiming benefits, 20 felony counts of failing to file a return with intent to evade tax, 20 felony counts of willful failure to pay tax, and a sentencing enhancement for aggravated white collar crime over $500,000. He was sentenced to one year and four months in state prison. Rand Gordon paid $385,000 in restitution and was ordered to the remaining $2 million dollars by civil judgment.

Michele Louise Gordon, 62, Laguna Hills, pleaded guilty to four felony counts of willful failure to file or make fraudulent tax returns and one felony count of filing a false tax return. She was sentenced to three years formal probation, pay a $5,000 fine, and $464,560 restitution. The defendants paid the Franchise Tax Board (FTB) $123,189.12 toward the restitution and ordered to pay the remaining restitution of $341,370.88 by civil judgment.

Deputy District Attorney Debbie Jackson of the Insurance Fraud Unit prosecuted this case ...
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/ 2015 News, Daily News
Catastrophic thinking, perceived injustice, entrenched beliefs and fear avoidance. You can call these combined psychosocial risk factors the elephant in the room when it comes to their negative impact on claims outcomes.

At a presentation Thursday at the National Workers’ Compensation and Disability Conference® and Expo in Las Vegas, Darrell Bruga, the founder and CEO of LifeTEAM Health, laid out a game plan for mitigating these factors.

Known as a progressive goal attainment program, Bruga outlined the ways that injured workers, who might have a defeatist mind-set, can be re-engaged and brought back to a more fulfilling life, one that includes a working income.

LifeTEAM is conducting a pilot program with Southern California Permanente Medical Group. Dr. John Harbaugh, an occupational medicine physician director at Permanente was Bruga’s co-presenter.

That path back involves activity coaching, so that someone who has been off work for months can be aided in finding activities to create more structure in their life and build confidence. Such a "disability intervention" Bruga said, can be started in a matter of weeks.

"Ideally, you are engaging this person early on," Bruga said.

The obstacles to a healthy mind-set in an injured worker can be formidable and deep-rooted however, Dr. Harbaugh said.

Abuse in childhood, whether it be physical violence, sexual abuse, or the psychic chaos created by an alcoholic or drug-addicted parent, greatly increase the possibility of work performance problems and a delayed recovery after an injury, Harbaugh said.

A permanent disability settlement, Harbaugh said, is nothing more than a veiled "pathway to poverty." ...
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/ 2015 News, Daily News
Nurse case managers can vastly improve outcomes for injured workers and save a bundle for payers. The trick is to understand which claims will benefit from intervention and to use nurses with the right skill set. "If an injury occurs from lifting equipment or falling from a height, the claim needs a nurse," said Stephanie Perilli, senior director of medical and health management for The Home Depot, during a session at the National Workers’ Compensation and Disability Conference® and Expo on Thursday.

For non-catastrophic cases, the company uses a model to determine whether to involve a nurse. "Our results have significantly improved over the last three years," she said.

In a comparison of claims more than 24 months old, the company saw a 12 percent savings on paid medical dollars and a 28 percent reduction on paid loss dollars for claims with nurse involvement.

But not every claim is appropriate for nurse intervention. A recent study determined that 25 variables, especially when some are in combination, can serve as triggers.

"If you’ve got an injured worker who is over 35, has no college degree, has injured a certain body part and undergone certain medical treatment, get a nurse as soon as possible," said Mary O’Donoghue, VP of medical services for Helmsman Management Services.

In addition to the complexity of a claim, the nurse’s skill set can determine the value of involvement. Those nurses who are trustworthy can make the most difference.

"They can identify problems, educate folks, and redirect where needed," O’Donoghue said.

Helmsman has found the most effective soft skills needed to move claims forward are communication with all parties involved, including family members; empathy, to establish trust with the injured worker; and collaboration, to make sure there is a plan in place and everyone involved is on the same page ...
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/ 2015 News, Daily News
Gene therapy - a risky approach aimed at fixing the malfunctioning genes at the root of some diseases - is finally emerging from its own darkness after weathering high-profile tragedies, including the death of a teenage patient. And, according to the story in the Washington Post, as it evolves from experimental to applied medicine, gene therapy might soon find itself steeped in a new controversy: soaring drug prices. No therapy is approved yet in the United States. But industry leaders are already talking about massive one-time price tags that could make insurers and patients balk. A gene therapy approved in Europe in 2012 costs close to $1 million, and prices are expected to follow suit in the United States. And the industry anticipates the potential backlash against a seven-figure price tag.

As basic research moved forward, excitement about gene therapy soared. But, that initial exuberance would die down as the powerful idea of replacing broken genes collided with the inherent complexity of human biology. In 1999, an Arizona teenager named Jesse Gelsinger died after he experienced an unexpected, severe immune reaction while participating in a clinical trial of gene therapy led by researcher James M. Wilson at the University of Pennsylvania.

Wilson became the subject of legal action and scathing media coverage. The government restricted his work on human subjects. Lawmakers on Capitol Hill held hearings to probe the lack of oversight and the ethical lapses that had marked some gene-therapy trials. Also in the early 2000s, a few patients in a French gene-therapy trial developed leukemia. Along with the Gelsinger case, it proved a tipping point. Private investment in the field rapidly dried up, and a "nuclear winter" followed. Regulators halted dozens of trials.

Gene therapy’s comeback started with a trickle. In 2008, researchers reported that a small number of patients with an inherited form of blindness gained modest improvements in vision with gene therapy. Not long after, gene therapy restored immune function in eight of 10 children with typically lethal "bubble boy" disease. Katherine High, a researcher at the Children’s Hospital of Philadelphia who worked on one of the early blindness trials, started getting cold calls from investors and from pharmaceutical companies, asking if they could partner with her. Then the team of experts she had assembled in Philadelphia began to get job offers.

Today, many companies have treatments in the pipeline. UniQure’s drug, Glybera, in 2012 became the first gene therapy approved in Europe, for a rare metabolic disease. Bluebird Bio, a biotechnology company that went public in 2013, is developing a variety of gene therapies, including a treatment for a genetic blood disease. Regenxbio, where Wilson serves as chief scientific adviser, went public in September.

But the potential sticker shock from a million-dollar drug - even if it’s for a previously incurable disease - is sure to raise some of the same questions from politicians and the public. Spark Therapeutics’ gene therapy is estimated to cost $500,000 per eye. Spending on hemophilia B a gene therapy could conceivably be priced as a one-time payment of $4 million to $6 million. Spark Therapeutics chief executive Jeffrey Marrazzo is reluctant to talk about a dollar figure ...
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/ 2015 News, Daily News
A new study reported in Reuters Health says that customized physical therapy may provide more relief for lower back pain than general advice on the best ways to remain active. Researchers offered 300 patients with lower back pain two advice sessions explaining the source of their discomfort and providing instruction on proper lifting techniques. Roughly half of them also got 10 treatment sessions of personalized physical therapy over 10 weeks.

The physical therapy group had significantly greater reductions in activity limitations at 10, 26 and 52 weeks than the advice group and they also had less back pain at 5, 10 and 26 weeks.
"Our findings suggest that advice works for many people but that individualized physical therapy achieves more rapid reduction in pain and in the long term superior improvements in function/disability," lead study author Jon Ford of La Trobe University in Bundoora, Australia said by email. The study was published in the British Journal of Sports Medicine.

To be included in the study, patients needed to have experienced pain for six weeks to six months and have one of five specific types of back pain: disc herniation, reducible disc pain, non-reducible disc pain, joint pain or multifactorial persistent pain.

Patients assigned to customized physical therapy in the study using specific exercise techniques tailored to the type of injury and individual barriers to recovery. Some, for example, focused on posture and lifting to ease disc pain, while others with disc herniation worked on motor control targeting specific muscle groups.

Participants in both the advice and the physical therapy groups improved over time, but the people who received the customized exercise sessions generally did better.

"There was an 8-session difference in treatment groups, so there was a notable difference in provider attention that could account for some of these group differences," Steven George, a physical therapy researcher at the University of Florida who wasn’t involved in the study, said by email.

In addition, the differences in outcomes between the two groups aren’t that large, as is often the case in studies of back pain, noted Julie Fritz, associate dean for research at the College of Health at the University of Utah in Salt Lake City.

"Back pain is very common and many patients are advised to attend physical therapy at some point," Fritz said by email. "The challenge for researchers is to continue to examine which particular physical therapy interventions work for specific types of patients with low back pain and determine the optimal timing for physical therapy intervention." ...
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/ 2015 News, Daily News
Eight medical professionals and associates are charged in federal grand jury indictments with buying and selling patients in a bribery scheme involving $25 million in improper claims for medical services and devices which were then billed to California Workers’ Compensation insurance companies.

FBI agents along with investigators from the California Department of Insurance and the San Diego County District Attorney’s Office served five search warrants and three seizure warrants at locations in San Diego, Chula Vista, National City, Murietta and Los Angeles. Five people plus six corporations, are charged in three federal grand jury indictments with conspiracy and honest services mail fraud. The indictments allege that these players either paid or received tens of thousands of dollars to buy or sell hundreds of patients, without the patients’ knowledge - therefore depriving those patients of their right to their doctors’ honest services.

"Today’s indictments are only the first wave of charges in what we believe is rampant corruption on the part of some physicians and chiropractors in their dealings with the health care system in general, and California’s Workers’ Compensation System in particular," said U.S. Attorney Laura Duffy. "This criminal network bought and sold patients like cattle," said District Attorney Bonnie Dumanis.

One of the indictments alleges that Los Angeles radiologist Ronald Grusd paid bribes to a San Diego chiropractor in exchange for patient referrals. The bribes were funneled to the chiropractor via Grusd’s corporation, Willows Consulting, a shell company. The checks were labeled "professional services," but this was a sham. In order to further hide the illegal kickbacks, checks were allegedly issued to intermediaries - defendants Alexander Martinez and his father, Ruben - through their front companies, "Line of Sight" and "Desert Blue Moon." The Martinezes allegedly took their "cut" and then, in turn, paid off the chiropractor.

Grusd’s practice, California Imaging Network Medical Group, has clinics in San Diego, Los Angeles, Beverly Hills, Fresno, Rialto, Santa Ana, Studio City, Bakersfield, Calexico, East Los Angeles, Lancaster, Victorville and Visalia.

In another indictment, allegations say a second San Diego chiropractor, Dr. George Reese, with offices on El Cajon Boulevard, referred patients to a Los Angeles area medical service provider (controlled by attorney Lee Mathis, 70, of San Clemente, and Fernando Valdes, 50, of Westminster, president of Foremost Shockwave Solutions ) in return for bribes. The bribes were set by the conspirators at $100 per patient and paid through an intermediary. After taking a cut amounting to $25 per patient, the intermediary would pay the remaining $75 per patient to Reese. Mathis and Valdes were not arrested, but were ordered to appear in court.

Although disguised as "office rent" payments, the illegal bribes were paid in cash during clandestine exchanges in restaurants and parking lots. For example, $6,000 in cash was allegedly delivered to Reese in the parking lot of the Jolly Roger in Oceanside, hidden in a gift bag. Other times, it was passed in envelopes or stashed inside newspapers. According to the indictment, Reese and his codefendants generated and submitted bills to insurers totaling in the tens of millions of dollars. Most of these treatments involved the providing of "Shockwave therapy," which uses low energy sound waves to initiate tissue repair. Proceeds from the insurance claims generated through this scheme were allegedly paid to Mathis and Valdes.

In the final indictment, a San Diego chiropractor referred patients to a licensed provider of durable medical equipment, Julian Garcia. In return Garcia paid the chiropractor $50 for each patient - in cash, to disguise the kickbacks. Garcia then improperly billed Workers Comp insurers millions for hot and cold packs for patients who had been secured by bribes ...
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/ 2015 News, Daily News
A longtime counselor with the California Department of Corrections and Rehabilitation was sentenced Tuesday to six months in jail for workers’ compensation fraud and related criminal charges.

Hosea Morgan, 55, of Vacaville, worked at San Quentin State Prison. He told doctors starting in 2009 of pain in several parts of his body that kept him from walking, sitting and sleeping. Morgan told doctors that 24 years of altercations and fights with inmates had left him disabled. He received more than $50,000 for his workers’ compensation and medical claims, according to testimony during his September jury trial.

Jurors in the trial watched hours of video surveillance footage of Morgan playing basketball, moving appliances, working out at a local health club and coaching basketball. Morgan was also shown performing in the play "Misery Loves Company" at the Fairfield Center for Creative Arts.

Morgan is set to be back in court in January to determine how much he will be ordered to repay the state during his five years of formal probation that follow his jail time ...
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/ 2015 News, Daily News