A new study published in the Annals of Internal Medicine and summarized by Reuters Health says that spinal epidural injections of steroids may relieve low back pain from a ruptured disc, but only briefly. And the injections offer no significant relief for pain related to narrowing of the spaces around the spinal cord, the researchers say. Some earlier studies have reached similar conclusions, but others have shown some benefit. Meanwhile, the use of epidural steroid injections has been increasing in the face of contradictory guidelines for physicians.
To clarify this confusing situation, Dr. Roger Chou from Oregon Health and Science University in Portland and colleagues sorted through the evidence from 63 published reports about the use of epidural steroid injections for treating low back pain from ruptured discs or spinal narrowing. "I think the important thing is for patients and clinicians to be able to make informed decisions," Chou told Reuters Health by email. "Epidural corticosteroid injections are perceived as being more effective than they are."
Spinal steroid injections brought immediate relief of pain and improvement in function in patients with ruptured discs, but not in patients with spinal narrowing, or stenosis, the researchers reported in Annals of Internal Medicine. Injections also seemed to reduce the need for disc surgery in the short term. But in the long term, the effects of injecting steroids epidurally were no better than the effects of a placebo, the researchers say, and there was no reduction in the need for surgery. It didn’t seem to matter what specific injection technique or which particular steroid was used.
The new analysis seems unlikely to settle any controversies, however. Dr. Zack McCormick, who specializes in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago, told Reuters Health by email that because the studies available for analysis by Chou’s team were of low quality, the conclusions "cannot be applied to the realistic day-to-day practice of spine medicine. The goal of epidural steroid injection is not for long term ‘cure,’ but rather to (improve) symptoms in order to allow restoration of sleep, quality of life, and tolerance of physical therapy," McCormick said.
Dr. Laxmaiah Manchikanti from the University of Louisville, Kentucky, who is CEO and Chairman of the Board of American Society of Interventional Pain Physicians, was also skeptical, and he told Reuters Health by email that patients with lower back pain from a ruptured disk or spinal stenosis should talk to their physician rather than trust the new conclusions. "Over a million people receive epidural injections either with steroids or with local anesthetic alone per year and at least 60% of them receive significant relief," he said.
Dr. Steven P. Cohen, a pain specialist at Johns Hopkins School of Medicine in Baltimore, Maryland told Reuters Health by email, "I do not think we should categorically discontinue epidural steroid injections for either of these conditions, but we need to limit their use to those people who are most likely to benefit, and to only repeat them if patients obtain clearly defined improvements in function and quality of life. Otherwise, the costs and risks may outweigh the benefits." ...
To clarify this confusing situation, Dr. Roger Chou from Oregon Health and Science University in Portland and colleagues sorted through the evidence from 63 published reports about the use of epidural steroid injections for treating low back pain from ruptured discs or spinal narrowing. "I think the important thing is for patients and clinicians to be able to make informed decisions," Chou told Reuters Health by email. "Epidural corticosteroid injections are perceived as being more effective than they are."
Spinal steroid injections brought immediate relief of pain and improvement in function in patients with ruptured discs, but not in patients with spinal narrowing, or stenosis, the researchers reported in Annals of Internal Medicine. Injections also seemed to reduce the need for disc surgery in the short term. But in the long term, the effects of injecting steroids epidurally were no better than the effects of a placebo, the researchers say, and there was no reduction in the need for surgery. It didn’t seem to matter what specific injection technique or which particular steroid was used.
The new analysis seems unlikely to settle any controversies, however. Dr. Zack McCormick, who specializes in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago, told Reuters Health by email that because the studies available for analysis by Chou’s team were of low quality, the conclusions "cannot be applied to the realistic day-to-day practice of spine medicine. The goal of epidural steroid injection is not for long term ‘cure,’ but rather to (improve) symptoms in order to allow restoration of sleep, quality of life, and tolerance of physical therapy," McCormick said.
Dr. Laxmaiah Manchikanti from the University of Louisville, Kentucky, who is CEO and Chairman of the Board of American Society of Interventional Pain Physicians, was also skeptical, and he told Reuters Health by email that patients with lower back pain from a ruptured disk or spinal stenosis should talk to their physician rather than trust the new conclusions. "Over a million people receive epidural injections either with steroids or with local anesthetic alone per year and at least 60% of them receive significant relief," he said.
Dr. Steven P. Cohen, a pain specialist at Johns Hopkins School of Medicine in Baltimore, Maryland told Reuters Health by email, "I do not think we should categorically discontinue epidural steroid injections for either of these conditions, but we need to limit their use to those people who are most likely to benefit, and to only repeat them if patients obtain clearly defined improvements in function and quality of life. Otherwise, the costs and risks may outweigh the benefits." ...
A new CWCI update report takes an look at California workers’ compensation medical and indemnity loss trends,comparing paid losses on claims from 2002 through 2014.
The data shows that between 2002 and 2013, the average amount paid on indemnity claims at 12 months post injury for medical benefits, excluding medical management/medical cost containment (MCC), increased by 30.3 percent (from $5,859 to $7,631). In 2011, the average medical payments on indemnity claims at the 12-month valuation registered a brief decline, falling 4.1 percent to $6,988, before climbing back up again over the next two years,
Given the timing of the implementation of the various SB 863 reforms and the reductions in average medical payments at the 3- and 6-month benchmarks between 2013 and 2014, the recent results suggest that key provisions of the SB 863 medical reforms (i.e., the phase-in of the RBRVS fee schedule beginning in January 2014; the reinstatement of lien filing fees, the reductions in ambulatory surgery center fees, and the adoption of the IMR dispute resolution process) did have an immediate effect on the cost of medical services rendered during the initial period following the injury. The ultimate impact of the 2012 reforms on longer term treatment costs remains to be seen.
However the medical management/medical cost containment (MCC) expenses triggered by reforms skyrocketed over this same time period. Measured at 24-months post injury, average MCC payments rose from $685 in 2002 to $1,003 in 2005 (+46.5 percent), then increased over the next 7 years to a record $2,333 in 2012 -- a net increase of 240.7 percent from 2002.
There was an immediate decline in average TD payments that coincided with the implementation of the 104-week cap in April 2004. By 2005, however, average TD payments at 24 months had already started trending up again, and by 2006 average first-year payments were also up sharply. It was not until 2008 that the 24-month TD benefits surpassed the pre-reform 2004 level, and it was not until 2009 that average first-year payments exceeded the pre-SB 899 amount.
There was a net increase of 152 percent in the average amount paid for first-year med-legal reports between 2002 and 2013 ...
The data shows that between 2002 and 2013, the average amount paid on indemnity claims at 12 months post injury for medical benefits, excluding medical management/medical cost containment (MCC), increased by 30.3 percent (from $5,859 to $7,631). In 2011, the average medical payments on indemnity claims at the 12-month valuation registered a brief decline, falling 4.1 percent to $6,988, before climbing back up again over the next two years,
Given the timing of the implementation of the various SB 863 reforms and the reductions in average medical payments at the 3- and 6-month benchmarks between 2013 and 2014, the recent results suggest that key provisions of the SB 863 medical reforms (i.e., the phase-in of the RBRVS fee schedule beginning in January 2014; the reinstatement of lien filing fees, the reductions in ambulatory surgery center fees, and the adoption of the IMR dispute resolution process) did have an immediate effect on the cost of medical services rendered during the initial period following the injury. The ultimate impact of the 2012 reforms on longer term treatment costs remains to be seen.
However the medical management/medical cost containment (MCC) expenses triggered by reforms skyrocketed over this same time period. Measured at 24-months post injury, average MCC payments rose from $685 in 2002 to $1,003 in 2005 (+46.5 percent), then increased over the next 7 years to a record $2,333 in 2012 -- a net increase of 240.7 percent from 2002.
There was an immediate decline in average TD payments that coincided with the implementation of the 104-week cap in April 2004. By 2005, however, average TD payments at 24 months had already started trending up again, and by 2006 average first-year payments were also up sharply. It was not until 2008 that the 24-month TD benefits surpassed the pre-reform 2004 level, and it was not until 2009 that average first-year payments exceeded the pre-SB 899 amount.
There was a net increase of 152 percent in the average amount paid for first-year med-legal reports between 2002 and 2013 ...
The allegations in the Pacific Hospital of Long Beach criminal and civil litigation claims that fake hardware has been implanted in the spines of hundreds of victims. These allegations raise questions about surgeries in general. For example, it is now common to have hip or knee implants, or stents placed in an artery. Yet does anyone know who manufactured the surgical part, why that part was selected over any other part, what was the manufacturers warranty or if that was the best choice at the time it was made? Or, was it chosen because of kickbacks or other reasons? Consumers spend hours choosing the latest flat panel TV, but essentially zero time learning about a costly surgical part before it is implanted. Yet recent news continues to provoke questions about how surgeons select surgical products.
For example, the United States Attorney announced that Dr. Paul S. Singh, 55, of Tehachapi, pleaded guilty to mail fraud for a scheme to defraud his patients and their insurers by implanting and billing for unapproved intrauterine devices (IUDs). Singh had an office in Tehachapi. He provided obstetric and gynecological services to women. One form of birth control he provided were IUDs, which the Food and Drug Administration (FDA) regulates. The FDA has approved only one IUD that uses copper as its active ingredient, the ParaGard T-380A, which was sold only by its manufacturer and not available on third-party websites. The insertion of a non-FDA-approved copper IUD risks a patient’s safety. It can result in an increased risk of pelvic inflammatory disease, ectopic pregnancy, hysterectomy, and other serious complications.
According to court documents, Singh bought unapproved IUDs on the Internet but fraudulently billed his patients and their insurers as if he had inserted FDA-approved IUDs, all without the permission or consent of his patients, Singh was sent multiple bulletins and newsletters warning against the use of unapproved IUDs. He was also warned that products sold by online pharmacies were not identical to the ParaGard T-380A and had not been approved as safe and effective by the FDA. In spite of the warnings, Singh purchased unapproved IUDs from online retailers and implanted them in numerous patients without their consent.
In August 2010, agents from the FDA confronted Singh about his history of implanting unapproved IUDs. During the meeting, Singh agreed to stop implanting them in his patients. Agents later conducted a search warrant of Singh’s office in 2012 and learned that he had continued to implant unapproved IUDs in his patients.
Singh failed to advise his patients of the risks of unapproved IUDs or of the fact that one had been implanted in them. According to the plea agreement, many of Singh’s patients later complained to him and other doctors about medical complications they associated with Singh’s insertion of the IUD. In multiple instances, Singh responded to such complaints by re-inserting the IUD rather than removing it. Some patients ultimately had to switch doctors in order to have the IUD removed. Singh profited from the implanting unapproved IUDs by billing his patients and their insurers for the higher cost of approved IUDs, which was false and fraudulent.
Singh is scheduled to be sentenced by United States District Judge Anthony W. Ishii on November 23, 2015. Singh faces a maximum statutory penalty of 20 years in prison and a $250,000 fine ...
For example, the United States Attorney announced that Dr. Paul S. Singh, 55, of Tehachapi, pleaded guilty to mail fraud for a scheme to defraud his patients and their insurers by implanting and billing for unapproved intrauterine devices (IUDs). Singh had an office in Tehachapi. He provided obstetric and gynecological services to women. One form of birth control he provided were IUDs, which the Food and Drug Administration (FDA) regulates. The FDA has approved only one IUD that uses copper as its active ingredient, the ParaGard T-380A, which was sold only by its manufacturer and not available on third-party websites. The insertion of a non-FDA-approved copper IUD risks a patient’s safety. It can result in an increased risk of pelvic inflammatory disease, ectopic pregnancy, hysterectomy, and other serious complications.
According to court documents, Singh bought unapproved IUDs on the Internet but fraudulently billed his patients and their insurers as if he had inserted FDA-approved IUDs, all without the permission or consent of his patients, Singh was sent multiple bulletins and newsletters warning against the use of unapproved IUDs. He was also warned that products sold by online pharmacies were not identical to the ParaGard T-380A and had not been approved as safe and effective by the FDA. In spite of the warnings, Singh purchased unapproved IUDs from online retailers and implanted them in numerous patients without their consent.
In August 2010, agents from the FDA confronted Singh about his history of implanting unapproved IUDs. During the meeting, Singh agreed to stop implanting them in his patients. Agents later conducted a search warrant of Singh’s office in 2012 and learned that he had continued to implant unapproved IUDs in his patients.
Singh failed to advise his patients of the risks of unapproved IUDs or of the fact that one had been implanted in them. According to the plea agreement, many of Singh’s patients later complained to him and other doctors about medical complications they associated with Singh’s insertion of the IUD. In multiple instances, Singh responded to such complaints by re-inserting the IUD rather than removing it. Some patients ultimately had to switch doctors in order to have the IUD removed. Singh profited from the implanting unapproved IUDs by billing his patients and their insurers for the higher cost of approved IUDs, which was false and fraudulent.
Singh is scheduled to be sentenced by United States District Judge Anthony W. Ishii on November 23, 2015. Singh faces a maximum statutory penalty of 20 years in prison and a $250,000 fine ...
Geico, a large multi-line insurer licensed in California, has agreed to pay $6 million dollars and implement several changes to their business practices, as part of a settlement with the California Department of Insurance. The settlement stems from a petition in which Consumer Federation of California alleged Geico's online premium quoting system was discriminatory and misleading to consumers.
Based on information obtained through extensive testing of the Geico website, Consumer Federation of California discovered the insurer misrepresented a $100,000/$300,000 limit quote as being a lowest-limits quote, when in fact, it was not. Consumer Federation of California alleged in their petition that these higher policy limits were only quoted to certain consumers, based on their education level, occupation and gender.
Though insurers may also offer and sell policies with higher limits, California law requires insurers to offer a minimum limits policy of $15,000/$30,000. Geico's online premium quoting system was inaccurately describing quotes for higher limits as the lowest limits.
Insurance Commissioner Dave Jones issued an order approving the settlement agreement and requiring Geico to discontinue using consumers' education level or occupation to quote coverage limits, and to offer a quote for a $15,000/$30,000 policy to certain consumers for the next three years. The insurer has also agreed to submit to twice-yearly audits of their website for the next three years, to ensure they are complying with the law ...
Based on information obtained through extensive testing of the Geico website, Consumer Federation of California discovered the insurer misrepresented a $100,000/$300,000 limit quote as being a lowest-limits quote, when in fact, it was not. Consumer Federation of California alleged in their petition that these higher policy limits were only quoted to certain consumers, based on their education level, occupation and gender.
Though insurers may also offer and sell policies with higher limits, California law requires insurers to offer a minimum limits policy of $15,000/$30,000. Geico's online premium quoting system was inaccurately describing quotes for higher limits as the lowest limits.
Insurance Commissioner Dave Jones issued an order approving the settlement agreement and requiring Geico to discontinue using consumers' education level or occupation to quote coverage limits, and to offer a quote for a $15,000/$30,000 policy to certain consumers for the next three years. The insurer has also agreed to submit to twice-yearly audits of their website for the next three years, to ensure they are complying with the law ...
The owner and operator of three medical clinics located in Los Angeles pleaded guilty last week to submitting more than $4.5 million in fraudulent claims to Medicare.
Hovik Simitian, 48, of Los Angeles, pleaded guilty before U.S. District Court Judge Beverly Reid O’Connell of the Central District of California to one count of conspiracy to commit health care fraud. Sentencing has been scheduled for Nov. 16, 2015.
Simitian owned and operated three medical clinics that were located in the Los Angeles area: Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic, all in the same office buillding. In connection with his guilty plea, Simitian admitted that, from approximately February 2010 through June 2014, he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to the clinics. Simitian also admitted that he and his co-conspirators billed Medicare for lab tests and other services that either were not medically necessary or were not actually provided to the Medicare beneficiaries, and that, to support the bills to Medicare, he and others created false documentation reflecting that the services had been provided.
Simitian further admitted that, between February 2010 and June 2014, he and his co-conspirators submitted approximately $4,526,791 in false and fraudulent claims to Medicare.Medicare paid approximately $1,668,559 of those claims ...
Hovik Simitian, 48, of Los Angeles, pleaded guilty before U.S. District Court Judge Beverly Reid O’Connell of the Central District of California to one count of conspiracy to commit health care fraud. Sentencing has been scheduled for Nov. 16, 2015.
Simitian owned and operated three medical clinics that were located in the Los Angeles area: Columbia Medical Group Inc., Life Care Medical Clinic and Safe Health Medical Clinic, all in the same office buillding. In connection with his guilty plea, Simitian admitted that, from approximately February 2010 through June 2014, he and his co-conspirators paid cash kickbacks to patient recruiters who brought Medicare beneficiaries to the clinics. Simitian also admitted that he and his co-conspirators billed Medicare for lab tests and other services that either were not medically necessary or were not actually provided to the Medicare beneficiaries, and that, to support the bills to Medicare, he and others created false documentation reflecting that the services had been provided.
Simitian further admitted that, between February 2010 and June 2014, he and his co-conspirators submitted approximately $4,526,791 in false and fraudulent claims to Medicare.Medicare paid approximately $1,668,559 of those claims ...
Since the platform emerged in the 1990s, the popularity of online workers’ compensation programs has grown along with carrier appetites - for reasons beyond simple convenience. This growth demonstrates that quoting and binding entirely online has clear advantages for the insured, agent and underwriter, including quick turn-around times and capturing detailed data.
According to the report in PropertyCasualty360, online workers’ compensation programs may currently comprise a small percentage of the total workers’ compensation market, but they are excellent for addressing the insurance needs of certain types of businesses. Internet workers’ compensation best serves small to mid-sized employers as a stand-alone coverage. This typically means manufacturers, artisan contractors, service industry risks and others that can be easily pre-qualified through carrier-specific underwriting rules.
Agents and brokers, increasingly accustomed to always-available, online platforms, have developed high expectations for the speed of quoting and binding. Speed benefits everyone - faster quoting frees up underwriters to focus on servicing, while giving agents more time to focus on generating new business.
With online portals, agents don't need to submit paperwork and wait for a desk underwriter to approve it. Instead, they enter information and quickly get a quote - sometimes instantly. When they receive the quote, they also receive in real time the documents needed to present that quote, such as the rating worksheet details and the Accord application. They have the option to bind the account, giving them the ability to quickly move on to the next proposal. This is the closest agents can get to "one-stop shopping;" with everything handled through the Internet portal.
Carriers’ Internet workers’ compensation programs have pre-defined underwriting rules built-in. Once the agents understand those rules, they can significantly reduce the time they spend trying to pre-qualify accounts; they understand which accounts would not usually pre-qualify.
For underwriters, Internet workers’ compensation programs allow access to an enormous amount of data. That's because data can be captured through online submissions. This data allows underwriters to use analytics to confirm they are attracting the right risks while getting the underwriting results they expect. Using analytics to determine your specific underwriting appetite, is a critical part of the Internet process. There are large amounts of data stored within most Internet programs that can be used not only to determine missed opportunities but also to identify areas that need improvement ...
According to the report in PropertyCasualty360, online workers’ compensation programs may currently comprise a small percentage of the total workers’ compensation market, but they are excellent for addressing the insurance needs of certain types of businesses. Internet workers’ compensation best serves small to mid-sized employers as a stand-alone coverage. This typically means manufacturers, artisan contractors, service industry risks and others that can be easily pre-qualified through carrier-specific underwriting rules.
Agents and brokers, increasingly accustomed to always-available, online platforms, have developed high expectations for the speed of quoting and binding. Speed benefits everyone - faster quoting frees up underwriters to focus on servicing, while giving agents more time to focus on generating new business.
With online portals, agents don't need to submit paperwork and wait for a desk underwriter to approve it. Instead, they enter information and quickly get a quote - sometimes instantly. When they receive the quote, they also receive in real time the documents needed to present that quote, such as the rating worksheet details and the Accord application. They have the option to bind the account, giving them the ability to quickly move on to the next proposal. This is the closest agents can get to "one-stop shopping;" with everything handled through the Internet portal.
Carriers’ Internet workers’ compensation programs have pre-defined underwriting rules built-in. Once the agents understand those rules, they can significantly reduce the time they spend trying to pre-qualify accounts; they understand which accounts would not usually pre-qualify.
For underwriters, Internet workers’ compensation programs allow access to an enormous amount of data. That's because data can be captured through online submissions. This data allows underwriters to use analytics to confirm they are attracting the right risks while getting the underwriting results they expect. Using analytics to determine your specific underwriting appetite, is a critical part of the Internet process. There are large amounts of data stored within most Internet programs that can be used not only to determine missed opportunities but also to identify areas that need improvement ...
UR and IMR supports its decision on treatment guidelines derived from peer reviewed published medical journal articles. This sounds like a straight forward process. But, now there is a marked increase in the number of scientific and medical articles being retracted because of fraud, or suspected fraud. According to Retraction Watch, "[t]he number of papers retracted by all publishers for fake peer reviews since 2012 is now approximately 250, with another 32 flagged for peer review fraud . . . but not yet retracted." Retraction Watch estimates that approximately 1,500 papers have been retracted overall since 2012.
This week a major publisher of scientific and medical articles has confirmed that it is retracting 64 articles from 10 of its subscription journals based on concerns that the peer review process was "compromised." The publisher, Springer, issued this statement:
"Springer confirms that 64 articles are being retracted from 10 Springer subscription journals, after editorial checks spotted fake email addresses, and subsequent internal investigations uncovered fabricated peer review reports. After a thorough investigation we have strong reason to believe that the peer review process on these 64 articles was compromised. We reported this to the Committee on Publishing Ethics (COPE) immediately. Attempts to manipulate peer review have affected journals across a number of publishers as detailed by COPE in their December 2014 statement. Springer has made COPE aware of the findings of its own internal investigations and has followed COPE’s recommendations, as outlined in their statement, for dealing with this issue. Springer will continue to participate and do whatever we can to support COPE’s efforts in this matter."
The Springer journal collection includes more than 2.500 English-language and close to 200 German-language journals. Springer is also home to the largest portfolio of open access journals, including the journals from BioMed Central and the SpringerOpen portfolio. The announcement from Springer about the 64 retracted articles is brief - it does not say which papers were withdrawn or where they were published. Nor does it identify the source of the fake reviews The announcement comes nine months after 43 studies were retracted by BioMed Central (one of Springer’s imprints) for the same reason ...
This week a major publisher of scientific and medical articles has confirmed that it is retracting 64 articles from 10 of its subscription journals based on concerns that the peer review process was "compromised." The publisher, Springer, issued this statement:
"Springer confirms that 64 articles are being retracted from 10 Springer subscription journals, after editorial checks spotted fake email addresses, and subsequent internal investigations uncovered fabricated peer review reports. After a thorough investigation we have strong reason to believe that the peer review process on these 64 articles was compromised. We reported this to the Committee on Publishing Ethics (COPE) immediately. Attempts to manipulate peer review have affected journals across a number of publishers as detailed by COPE in their December 2014 statement. Springer has made COPE aware of the findings of its own internal investigations and has followed COPE’s recommendations, as outlined in their statement, for dealing with this issue. Springer will continue to participate and do whatever we can to support COPE’s efforts in this matter."
The Springer journal collection includes more than 2.500 English-language and close to 200 German-language journals. Springer is also home to the largest portfolio of open access journals, including the journals from BioMed Central and the SpringerOpen portfolio. The announcement from Springer about the 64 retracted articles is brief - it does not say which papers were withdrawn or where they were published. Nor does it identify the source of the fake reviews The announcement comes nine months after 43 studies were retracted by BioMed Central (one of Springer’s imprints) for the same reason ...
A federal jury in Los Angeles convicted the former owner, operator and managers of a Southern California ambulance company of health care fraud charges in connection with a Medicare fraud scheme of at least $2.4 million.
In health care fraud cases in the past, the prosecutions tended to be for "ghost billing," for illegal kickbacks or for services clearly not provided. These past years have brought on a large number of new cases where the services were provided but there are allegations of "no medical necessity." A recent example is the case filed against ProMed Medical Transportation in the Central District of California which was successfully prosecuted.
Yaroslav Proshak, aka Steven Proshak, 47, of Valley Village, California; Emilia Zverev, 58, of Van Nuys, California; and Sharetta Michelle Wallace, 37, of Inglewood, California, each were convicted this week of one count of conspiracy to commit health care fraud and five counts of health care fraud following a two-week trial. Proshak’s sentencing is scheduled for Nov. 24, 2015, and Zverev’s and Wallace’s sentencing is scheduled for Nov. 30, 2015, all before U.S. District Judge S. James Otero of the Central District of California, who presided over the trial.
Proshak owned and operated ProMed Medical Transportation, an ambulance transportation company in the greater Los Angeles area that provided non-emergency ambulance transportation services to Medicare beneficiaries, many of whom were dialysis patients. Zverev was the billing manager, and Wallace supervised ProMed’s emergency medical technicians (EMTs).
The evidence at trial demonstrated that, between May 2008, and October 2010, the defendants conspired to bill Medicare for ambulance transportation services for individuals whom the defendants knew did not need such services. In addition, the evidence showed that the defendants instructed EMTs who worked at ProMed to conceal the true medical conditions of patients they were transporting by altering requisite paperwork and creating fraudulent documents to justify the transportation services. According to the Indictment, the government contended that the owner and manager altered the "run sheets" completed during the ambulance transportation and instructed employees to alter the "run sheets" and to ensure that they did not write certain terms to indicate that they were ambulatory or able to walk ...
In health care fraud cases in the past, the prosecutions tended to be for "ghost billing," for illegal kickbacks or for services clearly not provided. These past years have brought on a large number of new cases where the services were provided but there are allegations of "no medical necessity." A recent example is the case filed against ProMed Medical Transportation in the Central District of California which was successfully prosecuted.
Yaroslav Proshak, aka Steven Proshak, 47, of Valley Village, California; Emilia Zverev, 58, of Van Nuys, California; and Sharetta Michelle Wallace, 37, of Inglewood, California, each were convicted this week of one count of conspiracy to commit health care fraud and five counts of health care fraud following a two-week trial. Proshak’s sentencing is scheduled for Nov. 24, 2015, and Zverev’s and Wallace’s sentencing is scheduled for Nov. 30, 2015, all before U.S. District Judge S. James Otero of the Central District of California, who presided over the trial.
Proshak owned and operated ProMed Medical Transportation, an ambulance transportation company in the greater Los Angeles area that provided non-emergency ambulance transportation services to Medicare beneficiaries, many of whom were dialysis patients. Zverev was the billing manager, and Wallace supervised ProMed’s emergency medical technicians (EMTs).
The evidence at trial demonstrated that, between May 2008, and October 2010, the defendants conspired to bill Medicare for ambulance transportation services for individuals whom the defendants knew did not need such services. In addition, the evidence showed that the defendants instructed EMTs who worked at ProMed to conceal the true medical conditions of patients they were transporting by altering requisite paperwork and creating fraudulent documents to justify the transportation services. According to the Indictment, the government contended that the owner and manager altered the "run sheets" completed during the ambulance transportation and instructed employees to alter the "run sheets" and to ensure that they did not write certain terms to indicate that they were ambulatory or able to walk ...
An LA-based Uber driver who says he was beaten up by a customer filed a class action accusing the ride-hailing upstart of refusing to buy workers' compensation insurance.
According to the report in Courthouse News Service, Uber driver and lead plaintiff Omar Zine on Friday sued Uber Technologies, Rasier LLC, Rasier-CA, Laju Choudhury, and a person identified only as Doe Assailant, in LA County Superior Court.
The California Labor Commission in June rejected Uber's arguments that it is a "neutral technological platform," finding that the company is "involved in every aspect of the operation." Given that involvement, the commission determined that drivers are properly classified as employees and ordered Uber to pay driver Barbara Berwick $4,152 in reimbursable business expenses.
Nevertheless, the plaintiff alleges that Uber still classifies drivers as independent contractors so it can avoid covering them under workers' compensation insurance. This lack of coverage meant he could not drive and earn income for weeks after a customer's friend beat him up, according to the complaint.
The plaintiff says he was driving Choudhury and Doe in December 2014 when he and Doe got into an argument: "A verbal dispute occurred and Doe assailant escalated this situation by repeatedly, and viciously, punching and hitting plaintiff in the face and head. Attorneys say that the assailant used a metal pipe or similar object during the assault. "He is driving again, but is not able to go back to full-time work," his attorney added. He is now allegedly permanently disabled and has struggled with depression, anxiety, sleeplessness, and humiliation after the "heinous beating" he suffered.
He also claims there are thousands of current and former drivers who are entitled to workers' compensation benefits they never received because Uber misclassified them as independent contractors. Zine wants a declaration that Uber must classify all drivers as employees, restitution for himself and all class members for all the profits Uber made by failing to protect them with workers' compensation coverage, and special, punitive and exemplary damages for unfair business practices, assault and battery.
Uber has been the target of several similar lawsuits since the 2013 suit brought by former drivers claiming they were misclassified as contractors. In June this year, Uber drivers Lori Kellett and David Cotoi of Los Angeles sued Uber for allegedly failing to pay overtime and regular wages and not providing them with meal and rest breaks. An administrative law judge in mid July recommended that Uber be fined $7.3 million for breaking several California laws, such as failing to report on disabled accessibility requirements and problems with drivers. Uber stated that it would appeal the ruling ...
According to the report in Courthouse News Service, Uber driver and lead plaintiff Omar Zine on Friday sued Uber Technologies, Rasier LLC, Rasier-CA, Laju Choudhury, and a person identified only as Doe Assailant, in LA County Superior Court.
The California Labor Commission in June rejected Uber's arguments that it is a "neutral technological platform," finding that the company is "involved in every aspect of the operation." Given that involvement, the commission determined that drivers are properly classified as employees and ordered Uber to pay driver Barbara Berwick $4,152 in reimbursable business expenses.
Nevertheless, the plaintiff alleges that Uber still classifies drivers as independent contractors so it can avoid covering them under workers' compensation insurance. This lack of coverage meant he could not drive and earn income for weeks after a customer's friend beat him up, according to the complaint.
The plaintiff says he was driving Choudhury and Doe in December 2014 when he and Doe got into an argument: "A verbal dispute occurred and Doe assailant escalated this situation by repeatedly, and viciously, punching and hitting plaintiff in the face and head. Attorneys say that the assailant used a metal pipe or similar object during the assault. "He is driving again, but is not able to go back to full-time work," his attorney added. He is now allegedly permanently disabled and has struggled with depression, anxiety, sleeplessness, and humiliation after the "heinous beating" he suffered.
He also claims there are thousands of current and former drivers who are entitled to workers' compensation benefits they never received because Uber misclassified them as independent contractors. Zine wants a declaration that Uber must classify all drivers as employees, restitution for himself and all class members for all the profits Uber made by failing to protect them with workers' compensation coverage, and special, punitive and exemplary damages for unfair business practices, assault and battery.
Uber has been the target of several similar lawsuits since the 2013 suit brought by former drivers claiming they were misclassified as contractors. In June this year, Uber drivers Lori Kellett and David Cotoi of Los Angeles sued Uber for allegedly failing to pay overtime and regular wages and not providing them with meal and rest breaks. An administrative law judge in mid July recommended that Uber be fined $7.3 million for breaking several California laws, such as failing to report on disabled accessibility requirements and problems with drivers. Uber stated that it would appeal the ruling ...
On Thursday August 27 the San Bernardino District Attorney’s Office in association with the Employers’ Fraud Task Force and Floyd, Skeren and Kelly is presenting an educational symposium on Medical and Provider Fraud in the Workers’ Compensation System. Only one week remains to register for this event.Learn from law enforcement officials and workers’ compensation professionals, who’s gaming the system and what you can do about it. Here is the agenda for the day.
8:00 a.m. - Registration/Continental Breakfast/Networking
9:00 a.m. - Welcome and Introductions: David Simon, Lead Deputy DA, SBDA's Office, Workers' Compensation Fraud Unit
9:15 a.m. - Why do Some Doctors Cheat and Become Crooks: David C. Hall, Ph.D., QME Clinical Psychologist
9:50 a.m. - Medical Fraud and Abuse: Trends and Solutions: Laura Clifford, Executive Director, Employers' Fraud Task Force
10:45 a.m. - Compounding Pharmacy Fraud: Suzanne Honor-Vangerov, Managing Attorney, Floyd, Skeren and Kelly; Tony Park, Attorney, California Pharmacy Law
11:45 a.m. - Suspected Fraudulent Claims Best Practices: David Simon, Lead Deputy DA, SBDA's Office; Laureen Pedroza, Bureau Chief, Ca. Dept. of Ins. Fraud Division
1:15 p.m. - Current Trends with Liens: Suzanne Honor-Vangerov, Managing Attorney- Lien Unit, Floyd, Skeren and Kelly
1:50 p.m. - Up coding: Gary Auer, SIU Director, Anthem Blue Cross
2:30 p.m. - Chiropractor Rules, Regulations, Enforcement, Complaints: Robert Puleo, Executive Officer, State of California Board of Chiropractic Examiners and Maria Martinez, Special Investigator
3:25 p.m. - Ethics: Terry Smith Managing Partner, Floyd, Skeren and Kelly,Troy Slaten, Managing Partner and Robert Dudley, Attorney, Floyd, Skeren and Kelly
The symposium will take place at the Ontario Police Department, 2500 S. Archibald Ave, in Ontario, CA. The $55 registration fee includes continental breakfast and all materials. Register using the online form, or you can pay by mailing a check by printing and filling out this registration form (PDF). For additional information contact Laura Clifford lauraclifford@sbcglobal.net ...
8:00 a.m. - Registration/Continental Breakfast/Networking
9:00 a.m. - Welcome and Introductions: David Simon, Lead Deputy DA, SBDA's Office, Workers' Compensation Fraud Unit
9:15 a.m. - Why do Some Doctors Cheat and Become Crooks: David C. Hall, Ph.D., QME Clinical Psychologist
9:50 a.m. - Medical Fraud and Abuse: Trends and Solutions: Laura Clifford, Executive Director, Employers' Fraud Task Force
10:45 a.m. - Compounding Pharmacy Fraud: Suzanne Honor-Vangerov, Managing Attorney, Floyd, Skeren and Kelly; Tony Park, Attorney, California Pharmacy Law
11:45 a.m. - Suspected Fraudulent Claims Best Practices: David Simon, Lead Deputy DA, SBDA's Office; Laureen Pedroza, Bureau Chief, Ca. Dept. of Ins. Fraud Division
1:15 p.m. - Current Trends with Liens: Suzanne Honor-Vangerov, Managing Attorney- Lien Unit, Floyd, Skeren and Kelly
1:50 p.m. - Up coding: Gary Auer, SIU Director, Anthem Blue Cross
2:30 p.m. - Chiropractor Rules, Regulations, Enforcement, Complaints: Robert Puleo, Executive Officer, State of California Board of Chiropractic Examiners and Maria Martinez, Special Investigator
3:25 p.m. - Ethics: Terry Smith Managing Partner, Floyd, Skeren and Kelly,Troy Slaten, Managing Partner and Robert Dudley, Attorney, Floyd, Skeren and Kelly
The symposium will take place at the Ontario Police Department, 2500 S. Archibald Ave, in Ontario, CA. The $55 registration fee includes continental breakfast and all materials. Register using the online form, or you can pay by mailing a check by printing and filling out this registration form (PDF). For additional information contact Laura Clifford lauraclifford@sbcglobal.net ...
The DWC will implement a new online panel process for represented initial panel requests on October 1, 2015. DWC will no longer accept or process paper submissions postmarked after September 3, 2015. The new process requires parties in a represented case to submit initial QME panel requests online and immediately receive a QME panel. The requesting party will then serve the panel request form, any required documentation and the QME panel on all parties with a proof of service.
The DWC has posted an online QME Form 106 Panel Request training video and FAQs on the Medical Unit website. The video demonstration details the way in which represented initial panel requests will be submitted using the new online system.
However, the question remains "what is the process for QME panel requests between September 3 and October 1?" We posed this question to the medical unit this week and received this response.
"The Medical Unit will not accept Form 106 panel requests between Sept. 3 and Oct. 1. All panel requests on paper Form 106 must be postmarked no later than Sept. 3, 2015. No panel requests will be processed for any represented initial panel requests postmarked after that date. This will give the Medical Unit an opportunity to process all of the paper requests. Pursuant to 8 CCR section 31.1(c), if the Medical Director is unable to issue a QME panel in a represented case within 30 calendar days from receipt of the request, parties may seek an order from a worker’s compensation administrative law judge. Although the Medical Unit will not process any represented initial panel requests submitted after Sept. 3, 2015, the parties will be able to generate a panel list automatically as of Oct. 1, 2015. Therefore, despite not processing any requests during that time period, the delay will be less than 30 calendar days for obtaining a panel list."
What this means is that the DWC will utilize the time between September 3, 2015 and October 1, 2015 to process all current paper requests. Although the Unit will not process any paper panel requests submitted after September 3, 2015, you will be able to generate a panel list automatically as of October 1, 2015. The timing should be carefully managed ...
The DWC has posted an online QME Form 106 Panel Request training video and FAQs on the Medical Unit website. The video demonstration details the way in which represented initial panel requests will be submitted using the new online system.
However, the question remains "what is the process for QME panel requests between September 3 and October 1?" We posed this question to the medical unit this week and received this response.
"The Medical Unit will not accept Form 106 panel requests between Sept. 3 and Oct. 1. All panel requests on paper Form 106 must be postmarked no later than Sept. 3, 2015. No panel requests will be processed for any represented initial panel requests postmarked after that date. This will give the Medical Unit an opportunity to process all of the paper requests. Pursuant to 8 CCR section 31.1(c), if the Medical Director is unable to issue a QME panel in a represented case within 30 calendar days from receipt of the request, parties may seek an order from a worker’s compensation administrative law judge. Although the Medical Unit will not process any represented initial panel requests submitted after Sept. 3, 2015, the parties will be able to generate a panel list automatically as of Oct. 1, 2015. Therefore, despite not processing any requests during that time period, the delay will be less than 30 calendar days for obtaining a panel list."
What this means is that the DWC will utilize the time between September 3, 2015 and October 1, 2015 to process all current paper requests. Although the Unit will not process any paper panel requests submitted after September 3, 2015, you will be able to generate a panel list automatically as of October 1, 2015. The timing should be carefully managed ...
Assembly Bill 553, authored by Assembly Member Tom Daly, was signed into law by Governor Brown. Sponsored by Insurance Commissioner Dave Jones, AB 553 establishes new oversight tools to reduce the number of insolvencies of insurance companies and bring U.S. standards for regulating insurance companies in compliance with established international standards.
"As the largest insurance market in the country, California is again leading the way in improving the regulation of insurance companies," said Commissioner Jones. "AB 553 includes an urgency clause so California can have these new consumer protection tools in place as soon as possible. I'd like to thank Assembly Member Daly for authoring this important bill."
Supported by insurance industry stakeholders, AB 553 improves oversight of the corporate governance of insurers by aligning state law with new and improved standards developed by the National Association of Insurance Commissioners (NAIC) in two key areas:
1) Improved oversight of the corporate governance policies and practices of insurance companies;including their board management structure, code of conduct, and risk-management processes. New disclosures and filings will assist the Commissioner in determining the overall financial and corporate capacity of companies to conduct business in California, and identify troubled companies quickly enough to avoid insurance company insolvencies that would jeopardize consumers.
2) Preserved national system of state-based insurance regulation by clarifying the role of state insurance departments as group-wide supervisors over multi-national insurance groups, as part of the Insurance Holding Company System Regulator Act.
The primary purpose of AB 553 is to make sure California insurance regulatory laws conform with national and international insurance regulatory laws and to provide the California Department of Insurance with additional resources for fulfilling its mission of overseeing the solvency of insurance companies.
The amendment to the Holding Company System Regulatory Act will clarify the roles of a group-wide supervisor between the states and the international insurance community.
AB 553 was approved by the Assembly and Senate unanimously. There was no opposition noted in the legislative record. As an "urgency statute" the bill takes effect immediately ...
"As the largest insurance market in the country, California is again leading the way in improving the regulation of insurance companies," said Commissioner Jones. "AB 553 includes an urgency clause so California can have these new consumer protection tools in place as soon as possible. I'd like to thank Assembly Member Daly for authoring this important bill."
Supported by insurance industry stakeholders, AB 553 improves oversight of the corporate governance of insurers by aligning state law with new and improved standards developed by the National Association of Insurance Commissioners (NAIC) in two key areas:
1) Improved oversight of the corporate governance policies and practices of insurance companies;including their board management structure, code of conduct, and risk-management processes. New disclosures and filings will assist the Commissioner in determining the overall financial and corporate capacity of companies to conduct business in California, and identify troubled companies quickly enough to avoid insurance company insolvencies that would jeopardize consumers.
2) Preserved national system of state-based insurance regulation by clarifying the role of state insurance departments as group-wide supervisors over multi-national insurance groups, as part of the Insurance Holding Company System Regulator Act.
The primary purpose of AB 553 is to make sure California insurance regulatory laws conform with national and international insurance regulatory laws and to provide the California Department of Insurance with additional resources for fulfilling its mission of overseeing the solvency of insurance companies.
The amendment to the Holding Company System Regulatory Act will clarify the roles of a group-wide supervisor between the states and the international insurance community.
AB 553 was approved by the Assembly and Senate unanimously. There was no opposition noted in the legislative record. As an "urgency statute" the bill takes effect immediately ...
Workers’ compensation benefits as a share of payroll for injured workers continue to decline even as employment grows and overall employer costs increase, according to a new report from the National Academy of Social Insurance.
Historically, cash benefits have been a larger share of workers’ compensation benefits than medical payments to injured workers. Due to rising health care costs during the last 30 years, medical benefits now account for an increasing share of total workers’ compensation benefits, from 29 percent in 1980 to more than 50 percent in 2013. About 33 states currently spend more than half of their workers’ compensation spending on medical care for injured workers. California pays 54.7% of costs as medical benefits.
Despite the growth in employment following the Great Recession - and the significant uptick in employees eligible to receive workers’ compensation - benefits per $100 of covered payroll dropped to $0.98 in 2013, a 5 percent decrease from 2009. At the same time, the growing workforce has translated into rising workers’ compensation costs for employers - now $1.37 per $100 of covered payroll, a 5 percent increase from 2009.
Workers’ compensation benefits as a share of payroll were lower in 2013 than during almost any period in the last three decades, according to the report Workers’ Compensation: Benefits, Coverage, and Costs, 2013. Total workers’ compensation benefits in 2013 were $63.6 billion, while employer costs were $88.5 billion.
Benefits as a percent of payroll declined in 39 states between 2009 and 2013, continuing a national trend in lower benefits relative to payroll that began in the 1990s. "The decline is due to a drop in workplace injuries as well as changes in many state laws that made it more difficult for workers' to qualify for benefits," said John F. Burton, Professor Emeritus, Rutgers and Cornell University. "These state laws include more stringent compensation rules, the reduction of coverage for certain medical diagnoses, and new legal requirements that make it more difficult for workers to succeed in their claims for benefits." ...
Historically, cash benefits have been a larger share of workers’ compensation benefits than medical payments to injured workers. Due to rising health care costs during the last 30 years, medical benefits now account for an increasing share of total workers’ compensation benefits, from 29 percent in 1980 to more than 50 percent in 2013. About 33 states currently spend more than half of their workers’ compensation spending on medical care for injured workers. California pays 54.7% of costs as medical benefits.
Despite the growth in employment following the Great Recession - and the significant uptick in employees eligible to receive workers’ compensation - benefits per $100 of covered payroll dropped to $0.98 in 2013, a 5 percent decrease from 2009. At the same time, the growing workforce has translated into rising workers’ compensation costs for employers - now $1.37 per $100 of covered payroll, a 5 percent increase from 2009.
Workers’ compensation benefits as a share of payroll were lower in 2013 than during almost any period in the last three decades, according to the report Workers’ Compensation: Benefits, Coverage, and Costs, 2013. Total workers’ compensation benefits in 2013 were $63.6 billion, while employer costs were $88.5 billion.
Benefits as a percent of payroll declined in 39 states between 2009 and 2013, continuing a national trend in lower benefits relative to payroll that began in the 1990s. "The decline is due to a drop in workplace injuries as well as changes in many state laws that made it more difficult for workers' to qualify for benefits," said John F. Burton, Professor Emeritus, Rutgers and Cornell University. "These state laws include more stringent compensation rules, the reduction of coverage for certain medical diagnoses, and new legal requirements that make it more difficult for workers to succeed in their claims for benefits." ...
The DWC has scheduled a public meeting to discuss issues related to developing an evidence-based drug formulary for use in the workers' compensation system. The meeting will be held on Monday, September 14, 2015 from 10 a.m. to noon at the Elihu Harris State Office Building Auditorium, 1515 Clay Street in Oakland.
This meeting is an opportunity for the public to provide input to the Division on developing and implementing a formulary. DWC will facilitate discussion on how to best achieve the intended goals of an evidence-based drug formulary in the workers’ compensation system, which include the following:
1) Improve appropriate care through the dispensing of evidenced-based medicine
2) Expedite pharmaceutical treatment for ill and injured workers
3) Reduce delays, including the reducing the need for elevated utilization review and independent medical review
4) Improve efficient delivery of medical benefits and reduce administrative costs.
At its most basic level, a formulary is a list of medicines. Traditionally, a formulary contained a collection of formulas for the compounding and testing of medication (a resource closer to what would be referred to as a pharmacopoeia today). Today, the main function of a prescription formulary is to specify particular medications that are approved to be prescribed under a particular public or private payment program. The development of prescription formularies is based on evaluations of efficacy, safety, and cost-effectiveness of drugs.
By the turn of the millennium, 156 countries had national or provincial essential medicines lists and 135 countries had national treatment guidelines and/or formulary manuals. In the US, where a system of private healthcare is in place, a formulary is a list of prescription drugs available to enrollees. When used appropriately, formularies can help manage drug costs. Most formularies cover at least one drug in each drug class, and encourage generic substitution (also known as a preferred drug list) ...
This meeting is an opportunity for the public to provide input to the Division on developing and implementing a formulary. DWC will facilitate discussion on how to best achieve the intended goals of an evidence-based drug formulary in the workers’ compensation system, which include the following:
1) Improve appropriate care through the dispensing of evidenced-based medicine
2) Expedite pharmaceutical treatment for ill and injured workers
3) Reduce delays, including the reducing the need for elevated utilization review and independent medical review
4) Improve efficient delivery of medical benefits and reduce administrative costs.
At its most basic level, a formulary is a list of medicines. Traditionally, a formulary contained a collection of formulas for the compounding and testing of medication (a resource closer to what would be referred to as a pharmacopoeia today). Today, the main function of a prescription formulary is to specify particular medications that are approved to be prescribed under a particular public or private payment program. The development of prescription formularies is based on evaluations of efficacy, safety, and cost-effectiveness of drugs.
By the turn of the millennium, 156 countries had national or provincial essential medicines lists and 135 countries had national treatment guidelines and/or formulary manuals. In the US, where a system of private healthcare is in place, a formulary is a list of prescription drugs available to enrollees. When used appropriately, formularies can help manage drug costs. Most formularies cover at least one drug in each drug class, and encourage generic substitution (also known as a preferred drug list) ...
Years of construction fraud and grand theft by scamming consumers out of thousands of dollars for asphalt driveway paving work will keep Alexander Pike Mitchell behind bars at least two additional years. Mitchell, who has a history of contracting without a license and abandoning jobs once he’s secured a down payment, pled guilty to three additional felony grand theft counts (Penal Code §487a) with a Harvey Waiver* on all dismissed accounts in Riverside Superior Court. Under a Harvey Waiver, the offender is required to pay restitution on all counts connected with the plea. Restitution orders are to be imposed based on the victim's losses and benefits paid by the Victim Compensation Program.
The Contractors State License Board (CSLB) added Mitchell to its Most Wanted List in April 2013 after the San Diego County District Attorney’s Office issued a warrant for his arrest that included five counts of grand theft, diversion of funds, and two counts of elder abuse. Mitchell was suspected of scamming consumers in Santa Clara, Santa Cruz, Riverside, and San Diego counties.
On June 17, 2013, Mitchell pled guilty to two counts of grand theft in San Diego County Superior Court and agreed to pay victim restitution. He received a four-year sentence with a 50/50 split of the time, meaning he must serve two years in San Diego County Jail and two years on mandatory supervision. He was ordered to pay $9,300 in victim restitution in that case.
Shortly after that ruling, an additional 40-month state prison sentence was added to the term he already was serving for theft by false pretenses, operating without a contractor license with prior convictions, and a workers’ compensation insurance violation. Overall, Mitchell has been sentenced to serve a total of nine years and four months for all of his convictions.
"CSLB investigators find unscrupulous people like Alex Pike Mitchell every day," said CSLB Registrar Cindi Christenson. "This is why we encourage everyone to check our website or call our toll-free line to make sure any contractor you’re considering is licensed and in good standing with CSLB."
CSLB’s Most Wanted List was created as an added measure to protect California consumers from dishonest operators ...
The Contractors State License Board (CSLB) added Mitchell to its Most Wanted List in April 2013 after the San Diego County District Attorney’s Office issued a warrant for his arrest that included five counts of grand theft, diversion of funds, and two counts of elder abuse. Mitchell was suspected of scamming consumers in Santa Clara, Santa Cruz, Riverside, and San Diego counties.
On June 17, 2013, Mitchell pled guilty to two counts of grand theft in San Diego County Superior Court and agreed to pay victim restitution. He received a four-year sentence with a 50/50 split of the time, meaning he must serve two years in San Diego County Jail and two years on mandatory supervision. He was ordered to pay $9,300 in victim restitution in that case.
Shortly after that ruling, an additional 40-month state prison sentence was added to the term he already was serving for theft by false pretenses, operating without a contractor license with prior convictions, and a workers’ compensation insurance violation. Overall, Mitchell has been sentenced to serve a total of nine years and four months for all of his convictions.
"CSLB investigators find unscrupulous people like Alex Pike Mitchell every day," said CSLB Registrar Cindi Christenson. "This is why we encourage everyone to check our website or call our toll-free line to make sure any contractor you’re considering is licensed and in good standing with CSLB."
CSLB’s Most Wanted List was created as an added measure to protect California consumers from dishonest operators ...
Bhagwant Singh, 45, of Hesperia, pleaded no contest to felony payroll tax evasion in Victorville Superior Court.
On Aug. 4, Singh entered a plea of “no contest” to the charge of Payroll Tax Evasion, a felony violation of Unemployment Insurance Code 2117.5.
According to Deputy District Attorney David W. Simon, who prosecuted the case, the plea was the culmination of an investigation and prosecution of Singh and his trucking and transportation companies "A and J Shipping" and "Los Angeles Express Trucking" of Fontana and Hesperia.
The investigation began after a number of complaints were received by the Labor Commissioner's office alleging underpayment of wages by Singh to his employees. When it was discovered that Singh's businesses did not have the proper Workers' Compensation Insurance coverage for their employees, the investigation was taken over by the Workers' Compensation Fraud Unit of the San Bernardino County District Attorney’s Office.
During the investigation, it was discovered that in addition to the allegations of underpaying workers and not having the required insurance coverage, Singh also failed to submit payroll records and deductions as required to the taxing authority--California's "Employment Development Department” (EDD).
As a result of this criminal conviction, Singh was placed on formal Probation for a period of three years, ordered to make restitution to the EDD in the amount of $178,000, and other terms and conditions of probation ...
On Aug. 4, Singh entered a plea of “no contest” to the charge of Payroll Tax Evasion, a felony violation of Unemployment Insurance Code 2117.5.
According to Deputy District Attorney David W. Simon, who prosecuted the case, the plea was the culmination of an investigation and prosecution of Singh and his trucking and transportation companies "A and J Shipping" and "Los Angeles Express Trucking" of Fontana and Hesperia.
The investigation began after a number of complaints were received by the Labor Commissioner's office alleging underpayment of wages by Singh to his employees. When it was discovered that Singh's businesses did not have the proper Workers' Compensation Insurance coverage for their employees, the investigation was taken over by the Workers' Compensation Fraud Unit of the San Bernardino County District Attorney’s Office.
During the investigation, it was discovered that in addition to the allegations of underpaying workers and not having the required insurance coverage, Singh also failed to submit payroll records and deductions as required to the taxing authority--California's "Employment Development Department” (EDD).
As a result of this criminal conviction, Singh was placed on formal Probation for a period of three years, ordered to make restitution to the EDD in the amount of $178,000, and other terms and conditions of probation ...
53 year old Marc Terbeek, an Oakland workers compensation attorney, is allegedly involved in a massive corruption case filed by the FBI's Public Corruption and Civil Rights Squad and unsealed this week. What is known are allegations only and are not considered to be true until proven in a court of law. The FBI and IRS raided Terbeek’s office in January 2015 and since then he has been cooperating with investigators.Tarbeek has been informed by the US Attorney that he is also a target of the investigation and is "likely to be prosecuted." The sworn Affidavit signed by FBI Special Agent Roahn Wynar attached to the criminal complaint against Daniel Rush, a cannabis union leader who faces serious federal charges involving bribery and other matters, claims the following scenario occurred.
Daniel Rush was an official with the United Food and Commercial Workers Union that had established a "Cannabis Division" to organize dispensary employees. He was also closely involved in Measure D, the process to regulate medical marijuana dispensaries in Los Angeles, and also connected to legalization's most prominent pitchman: Lt. Gov. Gavin Newsom.
Rush got in over his head in 2010 when he borrowed $600,000 from Martin Kaufman, a dispensary operator that he could not pay back. In 2014, Rush and workers' compensation attorney Tarbeek who represented some of the dispensary companies in the area "took steps" to provide "labor benefits" to Kaufman in exchange for forgiveness of the debt. Carl Anderson had an Oakland pot club until 2005, and wanted a new permit in 2010. Anderson tapped Rush and Terbeek for help with the application. Andersen is also cooperating with the FBI.
According to the allegations of paragraph 31 of the Affidavit , Tarbeek admitted to the FBI that he had been paying "kickbacks" to Rush for sending Terbeek legal work since 2004. Rush "encouraged" Terbeek to acquire a workers compensation law practice to litigate cases referred by the Insitutio Laboral de la Raza. In exchange Tarbeek gave Rush a credit card associated with Terbeek’s law firm and Terbeek paid it off routinely. Text messages confirmed this practice continued as late as February 2015. From 2010 to 2015, Rush spent $110,000 on Terbeek’s card, about $2,000 per month, for mostly personal expenses.
Also, Terbeek allegedly agreed to share legal fees with Rush derived from Terbeek’s clients seeking permits to operate dispensaries in California, Nevada, and beyond (Affidavit paragraph 34). After creation of this arrangement, Terbeek paid Rush $5000 as his "share" of the medical marijuana legal fees.
It is likely that this case will become more complex and involve higher level accomplices as it evolves. Only Rush has been charged so far, and others are "cooperating" with authorities, meaning providing information that will lead the FBI on with a complex investigation. The union claims it has fired Rush ...
Daniel Rush was an official with the United Food and Commercial Workers Union that had established a "Cannabis Division" to organize dispensary employees. He was also closely involved in Measure D, the process to regulate medical marijuana dispensaries in Los Angeles, and also connected to legalization's most prominent pitchman: Lt. Gov. Gavin Newsom.
Rush got in over his head in 2010 when he borrowed $600,000 from Martin Kaufman, a dispensary operator that he could not pay back. In 2014, Rush and workers' compensation attorney Tarbeek who represented some of the dispensary companies in the area "took steps" to provide "labor benefits" to Kaufman in exchange for forgiveness of the debt. Carl Anderson had an Oakland pot club until 2005, and wanted a new permit in 2010. Anderson tapped Rush and Terbeek for help with the application. Andersen is also cooperating with the FBI.
According to the allegations of paragraph 31 of the Affidavit , Tarbeek admitted to the FBI that he had been paying "kickbacks" to Rush for sending Terbeek legal work since 2004. Rush "encouraged" Terbeek to acquire a workers compensation law practice to litigate cases referred by the Insitutio Laboral de la Raza. In exchange Tarbeek gave Rush a credit card associated with Terbeek’s law firm and Terbeek paid it off routinely. Text messages confirmed this practice continued as late as February 2015. From 2010 to 2015, Rush spent $110,000 on Terbeek’s card, about $2,000 per month, for mostly personal expenses.
Also, Terbeek allegedly agreed to share legal fees with Rush derived from Terbeek’s clients seeking permits to operate dispensaries in California, Nevada, and beyond (Affidavit paragraph 34). After creation of this arrangement, Terbeek paid Rush $5000 as his "share" of the medical marijuana legal fees.
It is likely that this case will become more complex and involve higher level accomplices as it evolves. Only Rush has been charged so far, and others are "cooperating" with authorities, meaning providing information that will lead the FBI on with a complex investigation. The union claims it has fired Rush ...
Michael Drobot pleaded guilty more than a year ago to criminal charges related to paying more than $20 million in kickbacks and bribing California state Sen. Ron Calderon to preserve a loophole in state law that enabled him to charge insurers sky-high prices for spinal hardware used at the Pacific Hospital of Long Beach. He is scheduled to be sentenced next year.
The State Compensation Insurance Fund filed a Rico case against Drobot and others in federal court to recoup payments made to Defendants, who it alleges concealed the system of illegal kickbacks, fee-splitting, corporate practice of medicine, and other misconduct. The State Fund pleadings and documents filed in that case makes an interesting read if not a well documented tutorial on the dark side of the practice of medicine.
Michael Drobot last April filed a 15 page third-party complaint for equitable indemnity and declaratory relief against 22 doctors, health executives, chiropractors and a lawyer. Equitable indemnity says in theory that Drobot should not have to pay the State Fund, but if it ends up that he does, then he wants others to share the blame with him and pay the damages.
On August 10, Drobot filed his First Amended Third Party Complaint, in federal court again asking others who profited from the enterprise to step forward and pay the State Fund should they prevail in the case. The Amended Complaint adds details, substance, some dollar values to the terse information previously alleged by Drobot. More importantly, the alleged schemes for movement of money such as research fees, consulting agreements, and the like are more clearly alleged.
Just one illustrative example is the allegations against Philip A. Sobol MD, a physician and principal of Sobol Orthopedic Medical Group, Inc., Sobol allegedly referred patients, and performed surgeries at Pacific Hospital between 2005 and 2013. During that same timeframe there were option agreements between the parties to purchase his medical practice. Over $5 million was paid to Sobol under this option agreement, which the State Fund alleges the money "included disguised payments for unlawful patient referrals to PHLB, that were computed and based on patient referrals."
The new pleading goes on to specify how the allegations implicate other physicians, and medical operatives in the complex structure that Drobot now claims must come forward and take responsibility should the State Fund prevail. A careful study of these pleadings would indeed be the basis for a claim investigation framework involving any of these parties and a good learning experience on how kickbacks can be hidden and masked ...
The State Compensation Insurance Fund filed a Rico case against Drobot and others in federal court to recoup payments made to Defendants, who it alleges concealed the system of illegal kickbacks, fee-splitting, corporate practice of medicine, and other misconduct. The State Fund pleadings and documents filed in that case makes an interesting read if not a well documented tutorial on the dark side of the practice of medicine.
Michael Drobot last April filed a 15 page third-party complaint for equitable indemnity and declaratory relief against 22 doctors, health executives, chiropractors and a lawyer. Equitable indemnity says in theory that Drobot should not have to pay the State Fund, but if it ends up that he does, then he wants others to share the blame with him and pay the damages.
On August 10, Drobot filed his First Amended Third Party Complaint, in federal court again asking others who profited from the enterprise to step forward and pay the State Fund should they prevail in the case. The Amended Complaint adds details, substance, some dollar values to the terse information previously alleged by Drobot. More importantly, the alleged schemes for movement of money such as research fees, consulting agreements, and the like are more clearly alleged.
Just one illustrative example is the allegations against Philip A. Sobol MD, a physician and principal of Sobol Orthopedic Medical Group, Inc., Sobol allegedly referred patients, and performed surgeries at Pacific Hospital between 2005 and 2013. During that same timeframe there were option agreements between the parties to purchase his medical practice. Over $5 million was paid to Sobol under this option agreement, which the State Fund alleges the money "included disguised payments for unlawful patient referrals to PHLB, that were computed and based on patient referrals."
The new pleading goes on to specify how the allegations implicate other physicians, and medical operatives in the complex structure that Drobot now claims must come forward and take responsibility should the State Fund prevail. A careful study of these pleadings would indeed be the basis for a claim investigation framework involving any of these parties and a good learning experience on how kickbacks can be hidden and masked ...
NBC News reports that Bumble Bee Foods will pay $6 million for the 2012 death of an employee who was cooked in an industrial oven with tons of tuna - the biggest settlement ever in a California for workplace safety violations involving a single victim.
Jose Melena, 62, was loading a 35-foot-long oven at the company's Santa Fe Springs plant before dawn Oct. 11, 2012, when a co-worker, who mistakenly believed Melena was in the bathroom, filled the pressure cooker with 12,000 pounds of canned tuna and it was turned on. His body was found two hours later after the pressure cooker, which reached 270 degrees, was turned off and opened.
The state report, which was filed with the National Institute for Occupational Safety and Health, said the manned oven system was inherently dangerous, finding that the chain that pulls carts of tuna into the ovens would sometimes get snagged, requiring operators to enter the ovens to pull the carts through.
Los Angeles County District Attorney Jackie Lacey said Bumble Bee will pay $3 million to replace all of its outdated tuna ovens with automated ovens and will never require workers to set foot inside the super-heated, pressurized steam cookers. The company will also pay $1.5 million in restitution to Melena's family, and it will pay the district attorney's Environmental Enforcement Fund $750,000 for workplace safety programs and $750,000 in fines, penalties and court costs.
In addition, Saul Florez, Bumble Bee's former safety manager, pleaded guilty to a felony count of willfully violating lockout rules and indirectly causing Melena's death. He was sentenced to three years' probation, ordered to complete 30 days of community labor and assessed $19,000 in fines and penalties.
And another co-defendant, Angel Rodriguez, Bumble Bee's director of plant operations, will be allowed to plead guilty to a misdemeanor in 18 months if he completes 320 hours of community service, pays $11,400 in fines and takes classes on confined space rules ...
Jose Melena, 62, was loading a 35-foot-long oven at the company's Santa Fe Springs plant before dawn Oct. 11, 2012, when a co-worker, who mistakenly believed Melena was in the bathroom, filled the pressure cooker with 12,000 pounds of canned tuna and it was turned on. His body was found two hours later after the pressure cooker, which reached 270 degrees, was turned off and opened.
The state report, which was filed with the National Institute for Occupational Safety and Health, said the manned oven system was inherently dangerous, finding that the chain that pulls carts of tuna into the ovens would sometimes get snagged, requiring operators to enter the ovens to pull the carts through.
Los Angeles County District Attorney Jackie Lacey said Bumble Bee will pay $3 million to replace all of its outdated tuna ovens with automated ovens and will never require workers to set foot inside the super-heated, pressurized steam cookers. The company will also pay $1.5 million in restitution to Melena's family, and it will pay the district attorney's Environmental Enforcement Fund $750,000 for workplace safety programs and $750,000 in fines, penalties and court costs.
In addition, Saul Florez, Bumble Bee's former safety manager, pleaded guilty to a felony count of willfully violating lockout rules and indirectly causing Melena's death. He was sentenced to three years' probation, ordered to complete 30 days of community labor and assessed $19,000 in fines and penalties.
And another co-defendant, Angel Rodriguez, Bumble Bee's director of plant operations, will be allowed to plead guilty to a misdemeanor in 18 months if he completes 320 hours of community service, pays $11,400 in fines and takes classes on confined space rules ...
The County District Attorney’s office reports that a Marina man pleaded no contest to workers’ compensation fraud in Monterey County Superior Court .
Sven Hoffman, 56, was charged with one felony count of making a false statement for the purpose of obtaining workers’ compensation benefits and one felony count of knowingly failing to disclose an event that affected his right to an insurance benefit. He will be sentenced by Judge Carrie M. Panetta on Sept. 22.
Hoffman was a prep cook at a local corporation, and on June 13, 2013, he claimed that his right wrist was injured from kneading dough. He later added his left wrist to the injury report and received medical treatment as well as total temporary disability payments. He repeatedly indicated he could not return to work as he continued to receive medical treatment and financial benefits.
An investigation showed that during this time, Hoffman failed to disclose he had been working and engaged in various activities, including cooking for a private party, working as a consulting chef at a local restaurant, providing a homemade pizza demonstration and assembling office furniture. Surveillance showed he was also very active repairing a long section of a private fence and working out strenuously at a local gym.
Both of the felony charges carry a maximum penalty of five years in prison and a substantial fine. Also, in insurance fraud cases, state law allows restitution to be ordered and can include expenses like attorney’s fees and investigation costs. The employer has reported a loss of $36,256.83 ...
Sven Hoffman, 56, was charged with one felony count of making a false statement for the purpose of obtaining workers’ compensation benefits and one felony count of knowingly failing to disclose an event that affected his right to an insurance benefit. He will be sentenced by Judge Carrie M. Panetta on Sept. 22.
Hoffman was a prep cook at a local corporation, and on June 13, 2013, he claimed that his right wrist was injured from kneading dough. He later added his left wrist to the injury report and received medical treatment as well as total temporary disability payments. He repeatedly indicated he could not return to work as he continued to receive medical treatment and financial benefits.
An investigation showed that during this time, Hoffman failed to disclose he had been working and engaged in various activities, including cooking for a private party, working as a consulting chef at a local restaurant, providing a homemade pizza demonstration and assembling office furniture. Surveillance showed he was also very active repairing a long section of a private fence and working out strenuously at a local gym.
Both of the felony charges carry a maximum penalty of five years in prison and a substantial fine. Also, in insurance fraud cases, state law allows restitution to be ordered and can include expenses like attorney’s fees and investigation costs. The employer has reported a loss of $36,256.83 ...
