The owner and two officials of what officials call a "scofflaw" San Jose marijuana dispensary were indicted by a criminal grand jury this month on felony charges including illegal sales of marijuana, tax fraud, insurance fraud, worker’s compensation fraud, and money laundering.
The company, San Jose Organics, failed to pay over $2 million in taxes to the state and city. This, despite the fact that investigators found a paper trail showing the dispensary made approximately $10 million dollars in profit between April 2013 and July 2015. Also recovered from the San Francisco home of the owner Ben Kit Lew was $800,000 in cash. Another $400,000 was uncovered from other locations associated to the investigation.
Lew, 44, faces up to 46 years in prison on 46 felonies and one misdemeanor, if found guilty. Brian Wong, the 43-year-old manager, faces up to 23 years on 15 felonies and one misdemeanor. Ernest Ma, 28, the Secretary of the Corporation, faces a maximum of about 10 years on six felonies.
The dispensary was raided in July and the defendants were arrested. Evidence showed that the dispensary was bringing in $25,000 a day in sales.
San Jose Organics was featured in a May 2015 NBC Bay Area expose that called the club "one of the busiest medical marijuana collectives" in in the city and reported that it claims to have between 5,500 and 6,000 members. The report said city officials accused San Jose Organics of "breaking the law every day it's open for business" and had already served it with "multiple citations," and alleged the dispensary sold weed to buyers under age 21 in violation of city law. The TV report said the owners declined an interview through a consultant.
"People like these defendants are profiteers exploiting the medical marijuana laws," prosecutor Edward Liang said. "They do this, while at the same time ignoring laws that every other business in California is required to follow. We would not accept this conduct in any other industry. We will continue to hold medical marijuana dispensaries to the same standards."
...
The company, San Jose Organics, failed to pay over $2 million in taxes to the state and city. This, despite the fact that investigators found a paper trail showing the dispensary made approximately $10 million dollars in profit between April 2013 and July 2015. Also recovered from the San Francisco home of the owner Ben Kit Lew was $800,000 in cash. Another $400,000 was uncovered from other locations associated to the investigation.
Lew, 44, faces up to 46 years in prison on 46 felonies and one misdemeanor, if found guilty. Brian Wong, the 43-year-old manager, faces up to 23 years on 15 felonies and one misdemeanor. Ernest Ma, 28, the Secretary of the Corporation, faces a maximum of about 10 years on six felonies.
The dispensary was raided in July and the defendants were arrested. Evidence showed that the dispensary was bringing in $25,000 a day in sales.
San Jose Organics was featured in a May 2015 NBC Bay Area expose that called the club "one of the busiest medical marijuana collectives" in in the city and reported that it claims to have between 5,500 and 6,000 members. The report said city officials accused San Jose Organics of "breaking the law every day it's open for business" and had already served it with "multiple citations," and alleged the dispensary sold weed to buyers under age 21 in violation of city law. The TV report said the owners declined an interview through a consultant.
"People like these defendants are profiteers exploiting the medical marijuana laws," prosecutor Edward Liang said. "They do this, while at the same time ignoring laws that every other business in California is required to follow. We would not accept this conduct in any other industry. We will continue to hold medical marijuana dispensaries to the same standards."
...
A federal judge sentenced former California state senator Leland Yee on Wednesday to five years in prison after he acknowledged accepting thousands of dollars in bribes. Prosecutors had recommended an eight-year sentence, saying that would reflect the extent of Yee's crimes. Yee's attorneys had called for no more than five years and three months behind bars, saying Yee had a history of public service and his wife was ill.
"I take full responsibility for this. I accept my crimes, I am asking for lenience. I hope you look at my entire life and not just the crimes I committed," Yee said just before sentencing. District Court Judge Charles Breyer rejected his request. "The crimes you committed were an attack on our democratic institutions. Mr Yee, you abused that trust," he said. "These are very serious abuses. The most significant crime was that your vote was for sale."
Yee and his codefendants pleaded guilty in federal court in San Francisco last July. For his part, Yee, 66, acknowledged that he participated in two criminal enterprises, the Leland Yee for Mayor Campaign 2011 and the Leland Yee for Secretary of State campaign. In connection with these campaigns, Yee admitted he (1) accepted $10,000 in exchange for using his influence as a state senator to assist in the process of obtaining a grant from the California Department of Public Health, (2) conspired to extort money from individuals by suggesting he would cast favorable votes for specific legislation only if the money were paid, (3) accepted a $11,000 bribe in exchange for arranging a meeting with another state senator to discuss specific legislation, (4) conspired with others to purchase weapons in the Philippines and import them illegally into the United States, and (5) provided more than $6,000 in cash to a campaign aid knowing the aid would launder the money by arranging to convert the cash into checks made payable to Yee’s Secretary of State campaign.
The federal indictments included accusations that Yee took bribes in exchange for voting for bills that favored his contributors. One bill involved regulations for medical marijuana, a second extended the life of the California State Athletic Commission, and a third prevents pro football players on non-California teams from filing workers' compensation claims for their injuries.
The indictment said an undercover agent told one of his associates, Keith Jackson, a former San Francisco school board president who also worked as a consultant and fundraiser for Yee, that the owner of a National Football League team was prepared to contribute $60,000 to Yee if he would support the workers' compensation bill. Jackson accepted, after contacting Yee, who voted for the bill, the indictment said. It said the money was never paid.
The judge gave Yee 30 days to surrender to the U.S. Marshal's Service, which will turn him over to the federal prison system. James Lassart, Yee's lawyer, asked the judge to recommend the sentence be served at the federal prison in Taft in Kern County. Yee rushed out of the courthouse with his lawyer who said: "He's remorseful and he's tired of this humiliation to his family and he's tired of what I would call this circus." ...
"I take full responsibility for this. I accept my crimes, I am asking for lenience. I hope you look at my entire life and not just the crimes I committed," Yee said just before sentencing. District Court Judge Charles Breyer rejected his request. "The crimes you committed were an attack on our democratic institutions. Mr Yee, you abused that trust," he said. "These are very serious abuses. The most significant crime was that your vote was for sale."
Yee and his codefendants pleaded guilty in federal court in San Francisco last July. For his part, Yee, 66, acknowledged that he participated in two criminal enterprises, the Leland Yee for Mayor Campaign 2011 and the Leland Yee for Secretary of State campaign. In connection with these campaigns, Yee admitted he (1) accepted $10,000 in exchange for using his influence as a state senator to assist in the process of obtaining a grant from the California Department of Public Health, (2) conspired to extort money from individuals by suggesting he would cast favorable votes for specific legislation only if the money were paid, (3) accepted a $11,000 bribe in exchange for arranging a meeting with another state senator to discuss specific legislation, (4) conspired with others to purchase weapons in the Philippines and import them illegally into the United States, and (5) provided more than $6,000 in cash to a campaign aid knowing the aid would launder the money by arranging to convert the cash into checks made payable to Yee’s Secretary of State campaign.
The federal indictments included accusations that Yee took bribes in exchange for voting for bills that favored his contributors. One bill involved regulations for medical marijuana, a second extended the life of the California State Athletic Commission, and a third prevents pro football players on non-California teams from filing workers' compensation claims for their injuries.
The indictment said an undercover agent told one of his associates, Keith Jackson, a former San Francisco school board president who also worked as a consultant and fundraiser for Yee, that the owner of a National Football League team was prepared to contribute $60,000 to Yee if he would support the workers' compensation bill. Jackson accepted, after contacting Yee, who voted for the bill, the indictment said. It said the money was never paid.
The judge gave Yee 30 days to surrender to the U.S. Marshal's Service, which will turn him over to the federal prison system. James Lassart, Yee's lawyer, asked the judge to recommend the sentence be served at the federal prison in Taft in Kern County. Yee rushed out of the courthouse with his lawyer who said: "He's remorseful and he's tired of this humiliation to his family and he's tired of what I would call this circus." ...
A former Santa Clara County sheriff’s correctional deputy was sentenced this week for a false workers’ compensation claim filed last year.
Mark Samuel Navarrete, 40, of San Jose, was sentenced to 120 days in county jail, but can serve the time out of custody through electronic monitoring, his defense attorney Patrick Valencia said. Navarrete was also ordered to pay about $22,880 in restitution for the workers’ compensation he had received.
Navarrete originally pleaded not guilty to a felony count of making and presenting a false or fraudulent statement in support of a workers’ compensation claim. However last month, Navarrete changed his plea to no contest.
The former deputy was injured during a softball game on July 14 while off-duty at Twin Creeks Sports Complex in Sunnyvale and later took himself to an emergency room for pain to his left bicep, according to authorities. However Navarrete underwent surgery through the county and claimed he was injured while closing a filing cabinet at work..
Navarrete’s co-worker who knew the injury took place outside the workplace informed a supervisor, which led to an investigation into the claim. Investigators obtained hospital records, text messages and video from the sports complex that recorded the game.
His lawyer reported that Navarrete now understands the mistake he made, but it was "unfortunate" that he lost his job over the matter. Navarrete had worked with the sheriff’s office for 12 years and resigned soon after his arrest. His lawyer also called the sentence "lenient" and believed the judge would have even given a lighter punishment if there were not other issues surrounding violence at the county jail which has placed this case in the spotlight.
The Navarrete case predates the investigation into the deadly Aug. 26 beating of Michael Tyree at the Main Jail, which spurred murder charges against three other correctional deputies and prompted elected officials to promise a host of reforms of the county's jail facilities, with pointed attention at misconduct by jail staffers ...
Mark Samuel Navarrete, 40, of San Jose, was sentenced to 120 days in county jail, but can serve the time out of custody through electronic monitoring, his defense attorney Patrick Valencia said. Navarrete was also ordered to pay about $22,880 in restitution for the workers’ compensation he had received.
Navarrete originally pleaded not guilty to a felony count of making and presenting a false or fraudulent statement in support of a workers’ compensation claim. However last month, Navarrete changed his plea to no contest.
The former deputy was injured during a softball game on July 14 while off-duty at Twin Creeks Sports Complex in Sunnyvale and later took himself to an emergency room for pain to his left bicep, according to authorities. However Navarrete underwent surgery through the county and claimed he was injured while closing a filing cabinet at work..
Navarrete’s co-worker who knew the injury took place outside the workplace informed a supervisor, which led to an investigation into the claim. Investigators obtained hospital records, text messages and video from the sports complex that recorded the game.
His lawyer reported that Navarrete now understands the mistake he made, but it was "unfortunate" that he lost his job over the matter. Navarrete had worked with the sheriff’s office for 12 years and resigned soon after his arrest. His lawyer also called the sentence "lenient" and believed the judge would have even given a lighter punishment if there were not other issues surrounding violence at the county jail which has placed this case in the spotlight.
The Navarrete case predates the investigation into the deadly Aug. 26 beating of Michael Tyree at the Main Jail, which spurred murder charges against three other correctional deputies and prompted elected officials to promise a host of reforms of the county's jail facilities, with pointed attention at misconduct by jail staffers ...
An eight-week group program focused on mindfulness-based stress reduction may help with short-term function and long-term pain for people with chronic low back problems, according to a new study published in the JAMA Internal Medicine and reported in Reuters Health.
"Most people would think mindfulness meditation would help stress," said lead author Dr. Natalia Morone of the University of Pittsburgh. "They would not typically think it could actually lead to reduced pain or lead them to have less pain interference during their day to day activities."
The researchers studied 282 older adults, with an average age of 74, in the Pittsburgh area with functional limitations due to chronic low back pain between 2011 and 2014. The participants were randomly separated into two groups. Both groups entered into an eight-week program followed by monthly sessions for an additional six months.
In the mindfulness group, participants were taught four methods of meditation, using directed breathing and mindful awareness of thoughts and sensations in sitting, walking or lying down positions. They also learned mindful stretching during the initial eight weeks. During the six months of booster sessions, participants met to meditate and discuss themes of the mindfulness program.
Those in the comparison group met for the same amount of time in groups of the same size with the same amount of "homework" and time with a facilitator, but instead focused on education based on the 10 Keys to Healthy Aging, which does not address pain. They learned about managing high blood pressure and did the same chair stretches as the mindfulness group.
The participants had monthly 15-minute phone interviews about the back pain, function, mindfulness, and doctor or hospital visits. Based on disability questionnaires, the people in the mindfulness group had improved more after eight weeks than the control group, though disability scores were again similar by the six-month point.
The mindfulness group also had more improved current and most severe pain scores at the six-month point, as reported in JAMA Internal Medicine.
"In terms of mechanism for pain reduction, the study gives us a clue as patients in the mind-body program reported more self-efficacy toward pain - they were able to better cope with their pain," Morone told Reuters Health by email.
She and her coauthors did not compare the mindfulness program to other back pain treatments, but it should be seen as an option for some patients that does not involve medication or surgery, she said.
The authors did not report how consistently the treatments were delivered or how faithfully participants practiced outside of their sessions, which would be important information, Dr. M. Carrington Reid of Weill Cornell Medical Center in New York and coauthors wrote in a commentary alongside the paper.
But "chronic pain is one of the most common conditions encountered by health care professionals, particularly among patients 65 years and older," and barriers often prevent treating it with medication, so studies on non-medication options like mindfulness are important, they wrote.
The Mindfulness-Based Stress Reduction Program is offered in many medical centers, communities and online ...
"Most people would think mindfulness meditation would help stress," said lead author Dr. Natalia Morone of the University of Pittsburgh. "They would not typically think it could actually lead to reduced pain or lead them to have less pain interference during their day to day activities."
The researchers studied 282 older adults, with an average age of 74, in the Pittsburgh area with functional limitations due to chronic low back pain between 2011 and 2014. The participants were randomly separated into two groups. Both groups entered into an eight-week program followed by monthly sessions for an additional six months.
In the mindfulness group, participants were taught four methods of meditation, using directed breathing and mindful awareness of thoughts and sensations in sitting, walking or lying down positions. They also learned mindful stretching during the initial eight weeks. During the six months of booster sessions, participants met to meditate and discuss themes of the mindfulness program.
Those in the comparison group met for the same amount of time in groups of the same size with the same amount of "homework" and time with a facilitator, but instead focused on education based on the 10 Keys to Healthy Aging, which does not address pain. They learned about managing high blood pressure and did the same chair stretches as the mindfulness group.
The participants had monthly 15-minute phone interviews about the back pain, function, mindfulness, and doctor or hospital visits. Based on disability questionnaires, the people in the mindfulness group had improved more after eight weeks than the control group, though disability scores were again similar by the six-month point.
The mindfulness group also had more improved current and most severe pain scores at the six-month point, as reported in JAMA Internal Medicine.
"In terms of mechanism for pain reduction, the study gives us a clue as patients in the mind-body program reported more self-efficacy toward pain - they were able to better cope with their pain," Morone told Reuters Health by email.
She and her coauthors did not compare the mindfulness program to other back pain treatments, but it should be seen as an option for some patients that does not involve medication or surgery, she said.
The authors did not report how consistently the treatments were delivered or how faithfully participants practiced outside of their sessions, which would be important information, Dr. M. Carrington Reid of Weill Cornell Medical Center in New York and coauthors wrote in a commentary alongside the paper.
But "chronic pain is one of the most common conditions encountered by health care professionals, particularly among patients 65 years and older," and barriers often prevent treating it with medication, so studies on non-medication options like mindfulness are important, they wrote.
The Mindfulness-Based Stress Reduction Program is offered in many medical centers, communities and online ...
The Division of Workers’ Compensation encourages attorneys representing California injured workers to now submit independent medical review (IMR) applications and medical records online with MOVEit file transfer system.
MOVEit is a web-based portal that allows users to submit files securely and is the best and most reliable way to transmit medical records to MAXIMUS Federal Services, Inc., the independent medical review organization. The system also provides much better traceability than paper and fax submissions.
"We believe utilizing MOVEit for IMR applications will improve the efficiency and predictability of the IMR process," said DWC Acting Administrative Director George Parisotto. "Attorneys will know with certainty that their applications have been received."
Whether an applicant attorney chooses to submit a request for IMR via MOVEit or otherwise, it is very important do the following:
1) Include a copy of the complete utilization review (UR) determination with the IMR application form that was provided to you by your claims adjustor
2) Sign the IMR application form before submitting a request for IMR
3) Send the signed IMR application and the UR determination within 30 days of receiving the UR determination to the address on the form.
4) Remember to serve all parties
For further information on using MOVEit, contact IMRHelp@maximus.com ...
MOVEit is a web-based portal that allows users to submit files securely and is the best and most reliable way to transmit medical records to MAXIMUS Federal Services, Inc., the independent medical review organization. The system also provides much better traceability than paper and fax submissions.
"We believe utilizing MOVEit for IMR applications will improve the efficiency and predictability of the IMR process," said DWC Acting Administrative Director George Parisotto. "Attorneys will know with certainty that their applications have been received."
Whether an applicant attorney chooses to submit a request for IMR via MOVEit or otherwise, it is very important do the following:
1) Include a copy of the complete utilization review (UR) determination with the IMR application form that was provided to you by your claims adjustor
2) Sign the IMR application form before submitting a request for IMR
3) Send the signed IMR application and the UR determination within 30 days of receiving the UR determination to the address on the form.
4) Remember to serve all parties
For further information on using MOVEit, contact IMRHelp@maximus.com ...
The case of Saul Zuniga v. Interactive Trucking, Inc.; SCIF involves another challenge to the constitutionality of the IMR process, asserting that the anonymity of the IMR reviewers violates due process and the IMR statute violates the guarantee of right to appellate review.
After successfully appealing an IMR determination and obtaining an order remanding the matter back to IMR for review by a different physician reviewer, Zuniga filed a discovery motion seeking the disclosure of the IMR reviewers’ identities. While the discovery motion was pending, the second IMR decision was issued authorizing additional, but not all, of the prescribed medications. Thereafter, over defendant’s objections, a trial was set on the issue of the disclosure of the IMR physicians’ identities. The Workers’ Compensation Judge issued a decision finding that he could not release the names of the IMR physicians pursuant to Labor Code section 4610.6(f).
Zuniga filed a petition for reconsideration, which was denied. He then filed a petition for writ of review in October 2014 arguing that the anonymity of the IMR reviewers violates due process and that the IMR statutes violate the guaranteed right to appellate review. SCIF filed its answer arguing: (1) The petitioner lacks standing since he did not exhaust his administrative remedies by filing an appeal of the second determination and therefore the petition for review was premature; (2) the petition failed to name the DWC, which is an indispensable party; (3) the WCJ was correct in finding that he lacked the authority to order the disclosure of the reviewing doctors; and (4) not revealing the reviewers’ identities did not deprive the petitioner of his due process rights.
The briefing in this case was completed in December 2014 and the case remained idle for over a year.
In February 2016, the petition for writ of review was granted in case Saul Zuniga v. Interactive Trucking, Inc.; SCIF California Court of Appeal, First Appellate District, Div. 2, Case No. A143290. The Court issued the following order.
"Petitioner is directed on or before February 5, 2016 to serve a copy of his petition on the Administrative Director of the Division of Workers' Compensation, who has the option to file an informal opposition to the petition on or before February 23, 2016. The clerk of this court need not issue a formal writ in this proceeding. It appears to this court that the record provided by the parties is a complete record of the Board's proceedings on the issues raised in the petition. Accordingly, unless a party or the Administrative Director of the Division of Workers' Compensation serves and files an objection, in writing, within 20 days of the date of this order, the Board need not prepare a certified record in this matter. Absent further order of the court, no further briefing in this matter is contemplated. The justices will be familiar with the facts and issues, will have conferred among themselves, and will not require oral argument. If oral argument is requested, the request must be served and filed within 20 days of the date of this order. If no such request is received, the court will deem oral argument waived."
This important case has not received much attention from the Workers' Compensation community notwithstanding the significance of the outcome. Thus far the stakeholders have not appeared in this case as amicus ...
After successfully appealing an IMR determination and obtaining an order remanding the matter back to IMR for review by a different physician reviewer, Zuniga filed a discovery motion seeking the disclosure of the IMR reviewers’ identities. While the discovery motion was pending, the second IMR decision was issued authorizing additional, but not all, of the prescribed medications. Thereafter, over defendant’s objections, a trial was set on the issue of the disclosure of the IMR physicians’ identities. The Workers’ Compensation Judge issued a decision finding that he could not release the names of the IMR physicians pursuant to Labor Code section 4610.6(f).
Zuniga filed a petition for reconsideration, which was denied. He then filed a petition for writ of review in October 2014 arguing that the anonymity of the IMR reviewers violates due process and that the IMR statutes violate the guaranteed right to appellate review. SCIF filed its answer arguing: (1) The petitioner lacks standing since he did not exhaust his administrative remedies by filing an appeal of the second determination and therefore the petition for review was premature; (2) the petition failed to name the DWC, which is an indispensable party; (3) the WCJ was correct in finding that he lacked the authority to order the disclosure of the reviewing doctors; and (4) not revealing the reviewers’ identities did not deprive the petitioner of his due process rights.
The briefing in this case was completed in December 2014 and the case remained idle for over a year.
In February 2016, the petition for writ of review was granted in case Saul Zuniga v. Interactive Trucking, Inc.; SCIF California Court of Appeal, First Appellate District, Div. 2, Case No. A143290. The Court issued the following order.
"Petitioner is directed on or before February 5, 2016 to serve a copy of his petition on the Administrative Director of the Division of Workers' Compensation, who has the option to file an informal opposition to the petition on or before February 23, 2016. The clerk of this court need not issue a formal writ in this proceeding. It appears to this court that the record provided by the parties is a complete record of the Board's proceedings on the issues raised in the petition. Accordingly, unless a party or the Administrative Director of the Division of Workers' Compensation serves and files an objection, in writing, within 20 days of the date of this order, the Board need not prepare a certified record in this matter. Absent further order of the court, no further briefing in this matter is contemplated. The justices will be familiar with the facts and issues, will have conferred among themselves, and will not require oral argument. If oral argument is requested, the request must be served and filed within 20 days of the date of this order. If no such request is received, the court will deem oral argument waived."
This important case has not received much attention from the Workers' Compensation community notwithstanding the significance of the outcome. Thus far the stakeholders have not appeared in this case as amicus ...
EMPLOYERS® has named Samuel V. King as vice president, fraud investigations for EMPLOYERS. With 24 years of fraud investigations leadership experience and 10 years of law enforcement experience, King brings to EMPLOYERS his valuable expertise in the field of workers compensation fraud. This position will work under the senior vice president of claims, and will bring best-in-class thinking to fraud investigation function.
A recognized expert in the area of workers’ compensation fraud, King served as past chairman of the California Workers Compensation Institute’s (CWCI) Anti-Fraud Committee, founding member of California Department of Insurance Fraud Division Anti-Fraud Advisory Committee and former chairman of the California Department of Insurance committee on SIU training. King holds a Bachelor of Science degree in Business Management from Azusa Pacific University and is a licensed private investigator, which will add a valued contribution to the EMPLOYERS organization.
King will be based in Glendale, CA.
Earlier this month EMPLOYERS® reported operating income for the fourth quarter and full year 2015 of $34.3 million and $81.3 million, or $1.05 and $2.50 per diluted share, respectively, and announced a $50 million share repurchase program and a 50% increase in the first quarter 2016 cash dividend to $0.09 per share. Operating earnings benefited from favorable prior year reserve development of $8.5 million and $7.2 million for the quarter and full year, respectively. Combined ratio before the LPT of 93.0% and 97.1% for the quarter and full year, respectively, down 9.2 and 7.9 percentage points, respectively, year over year.
The Company commented: "We strengthened our performance throughout 2015 and we are pleased to report our best operating results in the fourth quarter and the full year since 2007. We achieved an annualized operating return on equity of 16.1% in the fourth quarter and 9.8% in the full year, representing a 9.4 and 5.1 percentage point increase in the quarter and full year, respectively, year-over-year. Our underwriting profitability, measured by the combined ratio before the LPT, improved 9.2 percentage points in the quarter and 7.9 points in the full year relative to 2014 and our adjusted book value per share increased 8% year-over-year." ...
A recognized expert in the area of workers’ compensation fraud, King served as past chairman of the California Workers Compensation Institute’s (CWCI) Anti-Fraud Committee, founding member of California Department of Insurance Fraud Division Anti-Fraud Advisory Committee and former chairman of the California Department of Insurance committee on SIU training. King holds a Bachelor of Science degree in Business Management from Azusa Pacific University and is a licensed private investigator, which will add a valued contribution to the EMPLOYERS organization.
King will be based in Glendale, CA.
Earlier this month EMPLOYERS® reported operating income for the fourth quarter and full year 2015 of $34.3 million and $81.3 million, or $1.05 and $2.50 per diluted share, respectively, and announced a $50 million share repurchase program and a 50% increase in the first quarter 2016 cash dividend to $0.09 per share. Operating earnings benefited from favorable prior year reserve development of $8.5 million and $7.2 million for the quarter and full year, respectively. Combined ratio before the LPT of 93.0% and 97.1% for the quarter and full year, respectively, down 9.2 and 7.9 percentage points, respectively, year over year.
The Company commented: "We strengthened our performance throughout 2015 and we are pleased to report our best operating results in the fourth quarter and the full year since 2007. We achieved an annualized operating return on equity of 16.1% in the fourth quarter and 9.8% in the full year, representing a 9.4 and 5.1 percentage point increase in the quarter and full year, respectively, year-over-year. Our underwriting profitability, measured by the combined ratio before the LPT, improved 9.2 percentage points in the quarter and 7.9 points in the full year relative to 2014 and our adjusted book value per share increased 8% year-over-year." ...
Last December, the WCAB sitting en banc issued a Notice of Intention to suspend the privilege of Javier Jimenez to appear in any proceeding as a representative of any party before the Appeals Board, or any of its workers’ compensation administrative law judges (WCJs) for one hundred eighty (180) days. Notice was also given in the Notice of Intention that the Appeals Board intended to further order that any suspension continue until there is full compliance with the sanction orders described in the Notice of Intention.
The Notice claimed that over the last three years Mr. Javier Jimenez has been sanctioned numerous times for engaging in bad-faith actions or tactics that are frivolous or solely intended to cause unnecessary delay while acting for lien claimants as their Labor Code section 5700 agent before the WCAB. "His misconduct has resulted in the repeated imposition of sanctions against him and his clients and has injured other parties and wasted judicial resources."
Sanctions have been imposed for knowingly proceeding to trial without necessary evidence, repeatedly presenting meritless arguments, making a false statement of material facts in a petition presented to the Appeals Board, impugning the integrity of the WCAB and WCJs, and other willful failures to comply with statutory and regulatory obligations.
Several examples were provided in the Notice. In one case he appeared as a hearing representative on behalf of lien claimant Universal Psychiatric Medical Center (UPMC). Hearing were scheduled in that case and the lien claimant failed to offer evidence in support of its lien claim. The WCJ jointly and severally ordered IMM and UPMC to pay a $2,500.00 sanction and to pay defendant’s reasonable attorney’s fees of $3,500.00.
In another illustrative case, Mr. Jimenez represented lien claimant Joyce Altman Interpreters. The WCJ jointly and severally sanctioned Mr. Jimenez and Altman $2,500.00 for failing to present evidence showing that the lien claims were not barred by the statute of limitations, and because they "failed to provide relevant and probative evidence to support the reasonableness and necessity of the services rendered and reasonableness of the charges," that they "knew or should have known that their insistence on trial without relevant and probative evidence is frivolous," and that their activities and those of their hearing representatives "were egregious and frivolous."
Other examples were provided of a similar nature. However response to the Notice Of Intention and no request for further hearing was received from Mr. Jimenez. Therefore it was ordered that the privilege of Javier Jimenez to appear in any proceeding as a representative of any party before the Appeals Board or any of its workers’ compensation administrative law judges is hereby suspended for one hundred eighty (180) days ...
The Notice claimed that over the last three years Mr. Javier Jimenez has been sanctioned numerous times for engaging in bad-faith actions or tactics that are frivolous or solely intended to cause unnecessary delay while acting for lien claimants as their Labor Code section 5700 agent before the WCAB. "His misconduct has resulted in the repeated imposition of sanctions against him and his clients and has injured other parties and wasted judicial resources."
Sanctions have been imposed for knowingly proceeding to trial without necessary evidence, repeatedly presenting meritless arguments, making a false statement of material facts in a petition presented to the Appeals Board, impugning the integrity of the WCAB and WCJs, and other willful failures to comply with statutory and regulatory obligations.
Several examples were provided in the Notice. In one case he appeared as a hearing representative on behalf of lien claimant Universal Psychiatric Medical Center (UPMC). Hearing were scheduled in that case and the lien claimant failed to offer evidence in support of its lien claim. The WCJ jointly and severally ordered IMM and UPMC to pay a $2,500.00 sanction and to pay defendant’s reasonable attorney’s fees of $3,500.00.
In another illustrative case, Mr. Jimenez represented lien claimant Joyce Altman Interpreters. The WCJ jointly and severally sanctioned Mr. Jimenez and Altman $2,500.00 for failing to present evidence showing that the lien claims were not barred by the statute of limitations, and because they "failed to provide relevant and probative evidence to support the reasonableness and necessity of the services rendered and reasonableness of the charges," that they "knew or should have known that their insistence on trial without relevant and probative evidence is frivolous," and that their activities and those of their hearing representatives "were egregious and frivolous."
Other examples were provided of a similar nature. However response to the Notice Of Intention and no request for further hearing was received from Mr. Jimenez. Therefore it was ordered that the privilege of Javier Jimenez to appear in any proceeding as a representative of any party before the Appeals Board or any of its workers’ compensation administrative law judges is hereby suspended for one hundred eighty (180) days ...
Plumas News reports that measures taken to improve employee safety have resulted in workers compensation cost savings for Plumas County. "We have good news that we’re saving money," Pat Bonnett told the supervisors during their Feb. 9 meeting. "We’ve probably saved over $1.8 million in workers compensation claims."
In 2009-10, the county paid $1.85 million in workers compensation, and by 2014-15 that number had dropped to $117,504.
Bonnett, who is the county’s safety officer, presented the information to the board with Roberta Allen, the county’s treasurer and risk management officer. Bonnett said the savings reflected the emphasis placed on employee safety.
Supervisor Lori Simpson said the numbers show that the "active safety program instilled in the county" is working.
Bonnett attributed the program’s success to the department heads’ commitment to making the workplace safe for their employees.
This report is confirmatory of longstanding industry findings. On August 29, 2001, Liberty Mutual Insurance Company released a report titled: A Majority of U.S. Businesses Report Workplace Safety Delivers a Return on Investment. The Liberty Mutual survey shows 61 percent of executives say $3 or more is saved for each $1 invested in workplace safety.
OSHA's Office of Regulatory Analysis has stated: "our evidence suggests that companies that implement effective safety and health cans expect reductions of 20% or greater in their injury and illness rates and a return of $4 to $6 for every $1 invested..."
In its 2012 Workplace Safety Index, Liberty Mutual estimated that employers paid almost $1 billion per week for direct workers' compensation costs for the most disabling workplace injuries and illnesses in 2010. Employers that implement effective safety and health management systems may expect to significantly reduce injuries and illnesses and reduce the costs associated with these injuries and illnesses, including workers' compensation payments, medical expenses, and lost productivity. In addition, employers often find that process and other changes made to improve workplace safety and health may result in significant improvements to their organization's productivity and profitability ...
In 2009-10, the county paid $1.85 million in workers compensation, and by 2014-15 that number had dropped to $117,504.
Bonnett, who is the county’s safety officer, presented the information to the board with Roberta Allen, the county’s treasurer and risk management officer. Bonnett said the savings reflected the emphasis placed on employee safety.
Supervisor Lori Simpson said the numbers show that the "active safety program instilled in the county" is working.
Bonnett attributed the program’s success to the department heads’ commitment to making the workplace safe for their employees.
This report is confirmatory of longstanding industry findings. On August 29, 2001, Liberty Mutual Insurance Company released a report titled: A Majority of U.S. Businesses Report Workplace Safety Delivers a Return on Investment. The Liberty Mutual survey shows 61 percent of executives say $3 or more is saved for each $1 invested in workplace safety.
OSHA's Office of Regulatory Analysis has stated: "our evidence suggests that companies that implement effective safety and health cans expect reductions of 20% or greater in their injury and illness rates and a return of $4 to $6 for every $1 invested..."
In its 2012 Workplace Safety Index, Liberty Mutual estimated that employers paid almost $1 billion per week for direct workers' compensation costs for the most disabling workplace injuries and illnesses in 2010. Employers that implement effective safety and health management systems may expect to significantly reduce injuries and illnesses and reduce the costs associated with these injuries and illnesses, including workers' compensation payments, medical expenses, and lost productivity. In addition, employers often find that process and other changes made to improve workplace safety and health may result in significant improvements to their organization's productivity and profitability ...
A new CWCI study provides an updated look at California workers’ compensation independent medical review (IMR) decisions rendered in 2015 and finds that even though IMR physicians continue to uphold the vast majority of utilization review (UR) physicians’ denials or modifications of treatment, total IMR volume rose 19% last year.
The Institute’s latest analysis uses data from all 163,826 IMR determination letters issued in 2015 in response to applications submitted to the state after a utilization review (UR) physician modified or denied a requested medical service. Although state lawmakers who enacted IMR expected that the number of disputed treatment requests would decline as doctors, attorneys and others involved in the process became familiar with the types of services that would meet the evidence-based medicine standards and be approved through UR and IMR, the latest data show that after 2 years, IMR volume remains high, with 26,065 more cases in 2015 than in 2014.
CWCI’s review of the 2015 IMR decisions reveals the IMR physicians upheld the UR doctor’s modification or denial of the service 88.6% of the time, just shy of the 91% uphold rate for 2014. The mix of services reviewed by IMR physicians was also similar, with prescription drug requests accounting for half of last year’s IMR decisions, versus 48% in 2014, and the UR determination was upheld in nearly 90% of those pharmaceutical IMRs. Disputes over prescription drugs, physical therapy, durable medical equipment, injections and MRI/CT/PET scans accounted for 75% of all services that went through IMR in 2015, while surgery requests accounted for 4.2%, which was down from 4.7% in 2014. Uphold rates ranged from 80% to 90% for most services, with the exception being Evaluation and Management services - primarily requested referrals for consultations - where nearly 1/3 of the UR modifications or denials were overturned by the IMR physician.
The analysis also linked most of the disputed medical services that went through IMR to a small number of requesting physicians. The top 10% of physicians named in 2015 IMR decision letters (1,276 physicians) accounted for 85% of the disputed service requests, while the top 1% (128 providers) accounted for 46%. As in 2014, the new results also show significant geographic variation, with 34% of the IMR decision letters addressed to Los Angeles County recipients even though only 22% of all claims came from that region. On the flip side, the percentage of IMR decisions was disproportionately low in rural areas of the state, as well as in the Inland Empire, Orange County and San Diego.
CWCI has published its complete analysis of 2015 IMR outcomes in a Spotlight Report, "Independent Medical Review Decisions: January Through December 2015." CWCI members and subscribers can download the report and a summary Bulletin, while others can purchase a copy. at the CWCI store ...
The Institute’s latest analysis uses data from all 163,826 IMR determination letters issued in 2015 in response to applications submitted to the state after a utilization review (UR) physician modified or denied a requested medical service. Although state lawmakers who enacted IMR expected that the number of disputed treatment requests would decline as doctors, attorneys and others involved in the process became familiar with the types of services that would meet the evidence-based medicine standards and be approved through UR and IMR, the latest data show that after 2 years, IMR volume remains high, with 26,065 more cases in 2015 than in 2014.
CWCI’s review of the 2015 IMR decisions reveals the IMR physicians upheld the UR doctor’s modification or denial of the service 88.6% of the time, just shy of the 91% uphold rate for 2014. The mix of services reviewed by IMR physicians was also similar, with prescription drug requests accounting for half of last year’s IMR decisions, versus 48% in 2014, and the UR determination was upheld in nearly 90% of those pharmaceutical IMRs. Disputes over prescription drugs, physical therapy, durable medical equipment, injections and MRI/CT/PET scans accounted for 75% of all services that went through IMR in 2015, while surgery requests accounted for 4.2%, which was down from 4.7% in 2014. Uphold rates ranged from 80% to 90% for most services, with the exception being Evaluation and Management services - primarily requested referrals for consultations - where nearly 1/3 of the UR modifications or denials were overturned by the IMR physician.
The analysis also linked most of the disputed medical services that went through IMR to a small number of requesting physicians. The top 10% of physicians named in 2015 IMR decision letters (1,276 physicians) accounted for 85% of the disputed service requests, while the top 1% (128 providers) accounted for 46%. As in 2014, the new results also show significant geographic variation, with 34% of the IMR decision letters addressed to Los Angeles County recipients even though only 22% of all claims came from that region. On the flip side, the percentage of IMR decisions was disproportionately low in rural areas of the state, as well as in the Inland Empire, Orange County and San Diego.
CWCI has published its complete analysis of 2015 IMR outcomes in a Spotlight Report, "Independent Medical Review Decisions: January Through December 2015." CWCI members and subscribers can download the report and a summary Bulletin, while others can purchase a copy. at the CWCI store ...
A Fontana man was arrested on insurance fraud charges earlier this month following an investigation conducted by the San Bernardino County District Attorney's Workers' Compensation Insurance Fraud Unit.
Jamie Gallardo, 45, is charged with a violation of Insurance Code § 1871.4, Workers’ Compensation Insurance Fraud.
It is alleged that on or about April 21, 2010 through April 19, 2014, Gallardo was employed at California Coach and Body located in the City of Walnut. During this time, Gallardo filed a workers' compensation claim alleging he sustained injuries to his chest and back while performing his job duties.
According to Senior District Attorney Investigator Rodney Tamparong, an investigation into possible fraud resulted in the current allegation that Gallardo presented a knowingly false or fraudulent statement in order to obtain Workers' Compensation benefits.
After obtaining an arrest warrant, investigators--with assistance from officers from the Fontana Police Department--arrested Gallardo at his place of residence Feb. 2. Gallardo was transported and booked into the West Valley Detention Center.
This case will be prosecuted by Deputy District Attorney Scott Byrd. If convicted, Gallardo faces five years County prison. Arraignment is scheduled March 24 at the Rancho Cucamonga Superior Court ...
Jamie Gallardo, 45, is charged with a violation of Insurance Code § 1871.4, Workers’ Compensation Insurance Fraud.
It is alleged that on or about April 21, 2010 through April 19, 2014, Gallardo was employed at California Coach and Body located in the City of Walnut. During this time, Gallardo filed a workers' compensation claim alleging he sustained injuries to his chest and back while performing his job duties.
According to Senior District Attorney Investigator Rodney Tamparong, an investigation into possible fraud resulted in the current allegation that Gallardo presented a knowingly false or fraudulent statement in order to obtain Workers' Compensation benefits.
After obtaining an arrest warrant, investigators--with assistance from officers from the Fontana Police Department--arrested Gallardo at his place of residence Feb. 2. Gallardo was transported and booked into the West Valley Detention Center.
This case will be prosecuted by Deputy District Attorney Scott Byrd. If convicted, Gallardo faces five years County prison. Arraignment is scheduled March 24 at the Rancho Cucamonga Superior Court ...
California got a $3.1-million piece of the settlement pie when drugmaker Warner Chilcott agreed to pay the federal government $125 million in October over allegations it defrauded Medicare and Medicaid. But the state did much better in a second, lesser known settlement with the drugmaker just two months later. It got $11.8 million. That heftier payout stemmed from a separate but similar case brought under a California law that allows whistle-blowers to file lawsuits alleging fraud against private insurers.
ModernHealthcare.com reports that California and Illinois are the only states with such laws, and until now, not many healthcare lawsuits have been filed under those statutes. That, however, may change, as awareness of the laws -- and recognition of the potential rewards for those who use them -- grows. Fraudsters face triple damages under the laws, and whistle-blowers are often entitled to larger shares of recovered money than what they can get under the federal False Claims Act.
"We have found that health insurance fraud is one of the biggest problems we have," said Nancy Kincaid, a spokesperson with the California Department of Insurance. "It's a multi-billion dollar problem. Everybody is paying for these losses." Kincaid also expects to see more such cases in California.
The idea behind the laws, which have been on the books for years, is that it's in a state's interest to pursue fraud against private insurers because such misdeeds raise healthcare costs for everyone.
An even larger healthcare-related case preceded the Warner Chilcott one in California. In 2013, Sutter Health, which has hospitals throughout northern California, settled a case brought under the statute for $46 million. The whistle-blower in that case alleged that Sutter included extra, false charges for anesthesia on bills sent to patients and insurers. Sutter did not admit to any wrongdoing as part of the settlement.
There are rich rewards for whistle-blowers who file successful cases under the two laws. Whistle-blowers are entitled to 30% to 50% of the money that is recovered. In the Warner Chilcott case, the whistle-blowers got 49% of the recoveries, amounting to about $11.4 million. In the Sutter case, the whistle-blower received about $13.2 million, according to the California Department of Insurance.
There's no way to track exactly how many cases are now being brought under these laws in California and Illinois. The cases typically remain private - or under seal - at first. In some cases, the cases can stay under seal for years.
But R. Scott Oswald, managing principal of The Employment Law Group in Illinois, which represents whistle-blowers, said he and his colleagues are seeing more whistle-blowers taking action under the Illinois statute. His firm has several cases that have been under seal for years, he said.
Justin Berger, a principal at Cotchett Pitre and McCarthy who represents whistle-blowers in such cases in California, said his firm also seems to be filing more of the cases lately. Berger said he's also hearing from U.S. attorneys that they're seeing more of the lawsuits filed in conjunction with Medicare fraud cases. "It's becoming more common because there's a little more visibility," Berger said.
Historically, the California and Illinois laws haven't grabbed much attention. Over the years, not too many healthcare related lawsuits had been filed under the California law and even fewer had been filed in Illinois, Simmer said.
Insurance companies may not have traditionally been very interested in the laws because they can simply raise rates to absorb the costs of fraud, said Patrick Burns, a co-executive director of the Taxpayers Against Fraud Education Fund, a not-for-profit supporting whistle-blower incentive programs. It's also possible not as much fraud slips under the noses of private insurers as it does in Medicare and Medicaid because private insurers have their own robust fraud detection programs, Oswald said. A lack of awareness about the laws is also likely to blame for the slow drip of cases filed under them over the years, Oswald said.
Recent cases, however, are raising the profile of the laws, he said.
The California Department of Insurance is now using $4 million set aside from that Sutter settlement to fund a special health insurance enforcement team that investigates complaints and claims of wrongdoing, Kincaid said. "The commissioner is concerned that there have been a number of these that have been brought forward, typically by whistle-blowers or insiders," Kincaid said of cases brought under the California law.
In recent years, the number of False Claims Act cases involving healthcare has exploded. Two-thirds of federal whistle-blower lawsuits last year were healthcare-related ...
ModernHealthcare.com reports that California and Illinois are the only states with such laws, and until now, not many healthcare lawsuits have been filed under those statutes. That, however, may change, as awareness of the laws -- and recognition of the potential rewards for those who use them -- grows. Fraudsters face triple damages under the laws, and whistle-blowers are often entitled to larger shares of recovered money than what they can get under the federal False Claims Act.
"We have found that health insurance fraud is one of the biggest problems we have," said Nancy Kincaid, a spokesperson with the California Department of Insurance. "It's a multi-billion dollar problem. Everybody is paying for these losses." Kincaid also expects to see more such cases in California.
The idea behind the laws, which have been on the books for years, is that it's in a state's interest to pursue fraud against private insurers because such misdeeds raise healthcare costs for everyone.
An even larger healthcare-related case preceded the Warner Chilcott one in California. In 2013, Sutter Health, which has hospitals throughout northern California, settled a case brought under the statute for $46 million. The whistle-blower in that case alleged that Sutter included extra, false charges for anesthesia on bills sent to patients and insurers. Sutter did not admit to any wrongdoing as part of the settlement.
There are rich rewards for whistle-blowers who file successful cases under the two laws. Whistle-blowers are entitled to 30% to 50% of the money that is recovered. In the Warner Chilcott case, the whistle-blowers got 49% of the recoveries, amounting to about $11.4 million. In the Sutter case, the whistle-blower received about $13.2 million, according to the California Department of Insurance.
There's no way to track exactly how many cases are now being brought under these laws in California and Illinois. The cases typically remain private - or under seal - at first. In some cases, the cases can stay under seal for years.
But R. Scott Oswald, managing principal of The Employment Law Group in Illinois, which represents whistle-blowers, said he and his colleagues are seeing more whistle-blowers taking action under the Illinois statute. His firm has several cases that have been under seal for years, he said.
Justin Berger, a principal at Cotchett Pitre and McCarthy who represents whistle-blowers in such cases in California, said his firm also seems to be filing more of the cases lately. Berger said he's also hearing from U.S. attorneys that they're seeing more of the lawsuits filed in conjunction with Medicare fraud cases. "It's becoming more common because there's a little more visibility," Berger said.
Historically, the California and Illinois laws haven't grabbed much attention. Over the years, not too many healthcare related lawsuits had been filed under the California law and even fewer had been filed in Illinois, Simmer said.
Insurance companies may not have traditionally been very interested in the laws because they can simply raise rates to absorb the costs of fraud, said Patrick Burns, a co-executive director of the Taxpayers Against Fraud Education Fund, a not-for-profit supporting whistle-blower incentive programs. It's also possible not as much fraud slips under the noses of private insurers as it does in Medicare and Medicaid because private insurers have their own robust fraud detection programs, Oswald said. A lack of awareness about the laws is also likely to blame for the slow drip of cases filed under them over the years, Oswald said.
Recent cases, however, are raising the profile of the laws, he said.
The California Department of Insurance is now using $4 million set aside from that Sutter settlement to fund a special health insurance enforcement team that investigates complaints and claims of wrongdoing, Kincaid said. "The commissioner is concerned that there have been a number of these that have been brought forward, typically by whistle-blowers or insiders," Kincaid said of cases brought under the California law.
In recent years, the number of False Claims Act cases involving healthcare has exploded. Two-thirds of federal whistle-blower lawsuits last year were healthcare-related ...
The federal government saw a spike in utilization in the prescription compounding industry that led investigators to an estimated $2 billion in fraud in claims to Tricare nationally beginning in 2013 and running into last year. There have been civil settlements and federal investigators said criminal charges are likely early this year.
Across the country compounding pharmacies were charging as much as $10,000 to $20,000 each for prescriptions and some hired marketers who used Facebook and other social media to target military families, enticing them with inclusion in research studies and telling them of creams and salves that were pain relievers, migraine headache medicines and scar reducers, said Jason Mehta, a Jacksonville-based assistant U.S. attorney for the Middle District of Florida.
The cost to actually compound these creams was often only about 5 percent of the submitted cost, according to the Department of Justice. Compounding pharmacies were making in the range of 90 percent profit on each prescription.
According to the Defense Health Agency that oversees Tricare, costs for compound drugs skyrocketed from $5 million in 2004 to $514 million in 2014. Costs topped $1 billion in the first six months of 2015. Tricare went to Congress for help so the agency could make the payments, and rules were changed to make approvals of compound prescriptions more stringent. The agency was on track to lose $2 billion in 2015 alone until the controls were put in place in May, said George Jones, chief of pharmacy operations at the agency.
The safeguards have resulted in a 98 percent reduction in cost, he said.
Of the $2 billion in estimated fraud, about $500 million is believed to have occurred in Florida, Mehta said. One-quarter to a third of that was in the Jacksonville region. Since March the U.S. Attorney’s Office that covers Florida from Jacksonville to Fort Myers has collected at least $50 million in civil settlements related to compounding pharmacies.
Investigations are taking place in other states, Mehta said. In Mississippi recently about 1,000 federal agents conducted a mass seizure of about $15 million, as well as boats, cars and airplanes all related to compounding cases, Mehta said. So far Florida is the only state to have settlements ...
Across the country compounding pharmacies were charging as much as $10,000 to $20,000 each for prescriptions and some hired marketers who used Facebook and other social media to target military families, enticing them with inclusion in research studies and telling them of creams and salves that were pain relievers, migraine headache medicines and scar reducers, said Jason Mehta, a Jacksonville-based assistant U.S. attorney for the Middle District of Florida.
The cost to actually compound these creams was often only about 5 percent of the submitted cost, according to the Department of Justice. Compounding pharmacies were making in the range of 90 percent profit on each prescription.
According to the Defense Health Agency that oversees Tricare, costs for compound drugs skyrocketed from $5 million in 2004 to $514 million in 2014. Costs topped $1 billion in the first six months of 2015. Tricare went to Congress for help so the agency could make the payments, and rules were changed to make approvals of compound prescriptions more stringent. The agency was on track to lose $2 billion in 2015 alone until the controls were put in place in May, said George Jones, chief of pharmacy operations at the agency.
The safeguards have resulted in a 98 percent reduction in cost, he said.
Of the $2 billion in estimated fraud, about $500 million is believed to have occurred in Florida, Mehta said. One-quarter to a third of that was in the Jacksonville region. Since March the U.S. Attorney’s Office that covers Florida from Jacksonville to Fort Myers has collected at least $50 million in civil settlements related to compounding pharmacies.
Investigations are taking place in other states, Mehta said. In Mississippi recently about 1,000 federal agents conducted a mass seizure of about $15 million, as well as boats, cars and airplanes all related to compounding cases, Mehta said. So far Florida is the only state to have settlements ...
A state correctional officer accused of playing baseball while collecting disability leave benefits for a foot injury has pleaded guilty to workers' compensation fraud.
Todd Phillips, a correctional officer with the California Department of Corrections and Rehabilitation, was charged with intentionally making false statements regarding his physical abilities and failing to disclose participation in certain events and activities. Had his participation in those activities been known, it would have affected his workers’ compensation benefits, according to a Sacramento County District Attorney’s Office news release.
On Nov. 10, 2010, Phillips injured his right foot while working for the Department of Corrections and Rehabilitation. He continued to work after the injury until he was taken off work by his doctors on Dec. 27, 2011, pending surgery on his foot on Feb. 15, 2012. Phillips continued to tell his doctors that he was unable to return to work because of pain in his foot, prosecutors said.
While off work due to the foot injury and while receiving industrial disability leave benefits, Phillips was filmed by Department of Corrections and Rehabilitation investigators playing in nine police softball games in September 2012. He was filmed running the bases, aggressively running to catch balls in the outfield, hitting his right foot with the bat and pivoting on the right foot while swinging and hitting the ball, authorities said.
Investigators also determined through interviews with other peace officers that Phillips was an active and aggressive participant in softball games during tournaments in July and August 2012.
Sacramento Superior Court Judge Marjorie Koller ordered Phillips to serve 60 days in county jail with the sheriff’s release program recommended. He also was ordered to serve three years probation and to pay $12,823.77 in restitution to the Department of Corrections and Rehabilitation ...
Todd Phillips, a correctional officer with the California Department of Corrections and Rehabilitation, was charged with intentionally making false statements regarding his physical abilities and failing to disclose participation in certain events and activities. Had his participation in those activities been known, it would have affected his workers’ compensation benefits, according to a Sacramento County District Attorney’s Office news release.
On Nov. 10, 2010, Phillips injured his right foot while working for the Department of Corrections and Rehabilitation. He continued to work after the injury until he was taken off work by his doctors on Dec. 27, 2011, pending surgery on his foot on Feb. 15, 2012. Phillips continued to tell his doctors that he was unable to return to work because of pain in his foot, prosecutors said.
While off work due to the foot injury and while receiving industrial disability leave benefits, Phillips was filmed by Department of Corrections and Rehabilitation investigators playing in nine police softball games in September 2012. He was filmed running the bases, aggressively running to catch balls in the outfield, hitting his right foot with the bat and pivoting on the right foot while swinging and hitting the ball, authorities said.
Investigators also determined through interviews with other peace officers that Phillips was an active and aggressive participant in softball games during tournaments in July and August 2012.
Sacramento Superior Court Judge Marjorie Koller ordered Phillips to serve 60 days in county jail with the sheriff’s release program recommended. He also was ordered to serve three years probation and to pay $12,823.77 in restitution to the Department of Corrections and Rehabilitation ...
Partial meniscectomy - a form of arthroscopic surgery for patients with a torn meniscus, a rupture of the fibrocartilage strips in the knee - is ineffective for individuals with mechanical symptoms of degenerative knee. This is a conclusion of a new study recently published in The Annals of Internal Medicine.
A torn meniscus is one of the most common symptoms of degenerative knee - the deterioration of the knee joint with age. It occurs when one of the two menisci in the knee - the C-shaped pieces of cartilage that protect and cushion the thighbone and shinbone - become damaged. Many people with knee degeneration may experience mechanical symptoms such as joint locking or catching, which are often attributed to a section of the knee joint becoming lodged between the joint surfaces as a result of friction caused by a torn meniscus.
According to the story in Medical News Today, partial meniscectomy - the surgical removal of the damaged part of a torn meniscus - has become standard practice for patients with mechanical symptoms, despite there being insufficient evidence that it is beneficial. "Orthopedists are largely unanimous on the benefits of arthroscopic surgery on patients suffering from mechanical symptoms. However, scientific proof of the benefits is scarce, and before our study, entirely based on uncontrolled follow-up studies," says coauthor Dr. Raine Sihvonen, a specialist in orthopedics at the Hatanpää Hospital in Tampere, Finland.
For their study, the researchers set out to gain a better understanding of the effectiveness of partial meniscectomy for such patients. The team analyzed the data of 146 patients aged 35-65 who were part of the Finnish Degenerative Meniscal Lesion Study (FIDELITY). All patients had experienced pain in the inner side of their knee for at least 3 months, which clinical examination and MRI suggested was down to a torn meniscus.
The patients were free of knee osteoarthritis - a condition commonly associated with degenerative knee - and meniscus damage had not been caused by an isolated trauma. Each patient's torn meniscus was confirmed through diagnostic keyhole surgery. The patients were then randomized to receive either a partial meniscectomy or a sham treatment.
Based on their findings, Prof. Järvinen concludes that "the partial removal of a degenerative torn meniscus does not reduce or alleviate mechanical symptoms when compared with sham surgery." Additionally, the researchers say their findings suggest that trauma-related meniscal tearing and degenerative meniscal tearing are two separate conditions and should be treated as such ...
A torn meniscus is one of the most common symptoms of degenerative knee - the deterioration of the knee joint with age. It occurs when one of the two menisci in the knee - the C-shaped pieces of cartilage that protect and cushion the thighbone and shinbone - become damaged. Many people with knee degeneration may experience mechanical symptoms such as joint locking or catching, which are often attributed to a section of the knee joint becoming lodged between the joint surfaces as a result of friction caused by a torn meniscus.
According to the story in Medical News Today, partial meniscectomy - the surgical removal of the damaged part of a torn meniscus - has become standard practice for patients with mechanical symptoms, despite there being insufficient evidence that it is beneficial. "Orthopedists are largely unanimous on the benefits of arthroscopic surgery on patients suffering from mechanical symptoms. However, scientific proof of the benefits is scarce, and before our study, entirely based on uncontrolled follow-up studies," says coauthor Dr. Raine Sihvonen, a specialist in orthopedics at the Hatanpää Hospital in Tampere, Finland.
For their study, the researchers set out to gain a better understanding of the effectiveness of partial meniscectomy for such patients. The team analyzed the data of 146 patients aged 35-65 who were part of the Finnish Degenerative Meniscal Lesion Study (FIDELITY). All patients had experienced pain in the inner side of their knee for at least 3 months, which clinical examination and MRI suggested was down to a torn meniscus.
The patients were free of knee osteoarthritis - a condition commonly associated with degenerative knee - and meniscus damage had not been caused by an isolated trauma. Each patient's torn meniscus was confirmed through diagnostic keyhole surgery. The patients were then randomized to receive either a partial meniscectomy or a sham treatment.
Based on their findings, Prof. Järvinen concludes that "the partial removal of a degenerative torn meniscus does not reduce or alleviate mechanical symptoms when compared with sham surgery." Additionally, the researchers say their findings suggest that trauma-related meniscal tearing and degenerative meniscal tearing are two separate conditions and should be treated as such ...
Ellen Sims Langille has been named to succeed Michael McClain as general counsel of the California Workers’ Compensation Institute according to Alex Swedlow, president of the Oakland-based research group.
Ms. Langille received her undergraduate degree from UC Santa Cruz and her law degree from the University of California, Hastings College of the Law. Certified as a specialist in workers’ compensation by the State Bar of California, Ms. Langille is currently a partner at the defense firm of Finnegan, Marks, Theofel & Desmond in San Francisco. She brings nearly 25 years of industry experience to the Institute, having specialized in appellate level workers’ compensation cases throughout her career, as well as having served as amicus counsel for the Institute and other organizations in a number of important cases, including Angelotti Chiropractic v. Baker; Dubon v. World Restoration; Brodie v. WCAB; Lockheed Martin v. WCAB; Stuart v. WCAB; and Avalon Bay Foods v. WCAB (Moore). In addition, she has extensive experience in client training, was the editor of "Workers’ Compensation" - California Labor Law Digest, 2014-2016, published by the California Chamber of Commerce, and has been a frequent speaker at industry seminars and conferences.
In her new capacity, Ms. Langille will manage the Institute’s internal and external legal affairs; serve as staff liaison to the Legal Committee, which directs CWCI’s amicus activities; analyze regulatory and legal issues affecting California workers’ compensation; and help develop and present research and legal programs for Institute members and other members of the workers’ compensation community.
In announcing her appointment, Mr. Swedlow said, "The Institute is fortunate to have found someone of Ellen’s caliber for this key position. Her knowledge and expertise, her reputation throughout the California workers’ compensation community, and her familiarity with CWCI’s goals, operations and staff made her an ideal choice. She will begin working at the Institute in early April which should make for a seamless transition as Mike McClain moves toward his retirement in late May." ...
Ms. Langille received her undergraduate degree from UC Santa Cruz and her law degree from the University of California, Hastings College of the Law. Certified as a specialist in workers’ compensation by the State Bar of California, Ms. Langille is currently a partner at the defense firm of Finnegan, Marks, Theofel & Desmond in San Francisco. She brings nearly 25 years of industry experience to the Institute, having specialized in appellate level workers’ compensation cases throughout her career, as well as having served as amicus counsel for the Institute and other organizations in a number of important cases, including Angelotti Chiropractic v. Baker; Dubon v. World Restoration; Brodie v. WCAB; Lockheed Martin v. WCAB; Stuart v. WCAB; and Avalon Bay Foods v. WCAB (Moore). In addition, she has extensive experience in client training, was the editor of "Workers’ Compensation" - California Labor Law Digest, 2014-2016, published by the California Chamber of Commerce, and has been a frequent speaker at industry seminars and conferences.
In her new capacity, Ms. Langille will manage the Institute’s internal and external legal affairs; serve as staff liaison to the Legal Committee, which directs CWCI’s amicus activities; analyze regulatory and legal issues affecting California workers’ compensation; and help develop and present research and legal programs for Institute members and other members of the workers’ compensation community.
In announcing her appointment, Mr. Swedlow said, "The Institute is fortunate to have found someone of Ellen’s caliber for this key position. Her knowledge and expertise, her reputation throughout the California workers’ compensation community, and her familiarity with CWCI’s goals, operations and staff made her an ideal choice. She will begin working at the Institute in early April which should make for a seamless transition as Mike McClain moves toward his retirement in late May." ...
The Division of Workers’ Compensation posted proposed regulations revising its Workers’ Compensation Information System (WCIS) regulations and Electronic Data Interchange (EDI) Implementation Guides. A public hearing has been scheduled for 10:00 a.m., Monday, March 28, 2016, in the Auditorium of the Elihu Harris State Office Building, 1515 Clay Street, Oakland, CA 94612. Members of the public may also submit written comments on the regulations until 5 p.m. that day.
The regulations contain proposed revisions to the WCIS Regulations and the two California EDI Implementation Guides published by the DWC:
1) The Guide for First and Subsequent Reports of Injury. This guide has not been updated since 2011. It is being revised to correct minor reporting inefficiencies, improve file transfer security through the use of secure file transfer protocol and a new file naming convention, as well as an enhanced claim validation process.
2) The EDI Implementation Guide for Medical Bill Payment Records, Version 2.0. This guide, though updated in 2015, requires additional revisions to comply with reporting standards set forth in the International Association of Industrial Accident Boards and Commissions (IAIABC) Workers’ Compensation Medical Bill Reporting Implementation Guide, Release 2.0, February 1, 2015 Publication. Compliance with this newer standard is essential in order for WCIS to be able to collect data regarding compound and repackaged drugs.
These materials can be found on the proposed regulations page ...
The regulations contain proposed revisions to the WCIS Regulations and the two California EDI Implementation Guides published by the DWC:
1) The Guide for First and Subsequent Reports of Injury. This guide has not been updated since 2011. It is being revised to correct minor reporting inefficiencies, improve file transfer security through the use of secure file transfer protocol and a new file naming convention, as well as an enhanced claim validation process.
2) The EDI Implementation Guide for Medical Bill Payment Records, Version 2.0. This guide, though updated in 2015, requires additional revisions to comply with reporting standards set forth in the International Association of Industrial Accident Boards and Commissions (IAIABC) Workers’ Compensation Medical Bill Reporting Implementation Guide, Release 2.0, February 1, 2015 Publication. Compliance with this newer standard is essential in order for WCIS to be able to collect data regarding compound and repackaged drugs.
These materials can be found on the proposed regulations page ...
The Division of Workers’ Compensation has posted the Agenda and background materials for the February 17th Drug Formulary Public Meeting. The meeting is being held to solicit public input on issues relating to implementation of Assembly Bill 1124, which requires the adoption of a workers’ compensation drug formulary by July 1, 2017.
The meeting is scheduled from 10 a.m. until noon on Wednesday, February 17, 2016 in the auditorium of the Elihu Harris State Office Building, 1515 Clay Street, Oakland, CA 94612.
The Agenda and background materials may be accessed on the DWC Forum. The Agenda includes a presentation by Barbara Wynn, Senior Health Policy Analyst with RAND and a public discussion of formulary issues identified by RAND.
The DWC contracted with RAND to provide assistance in the design and implementation of the formulary and related policies and in estimating the economic impact of the formulary. Key questions that RAND researchers will address include:
1) How should the drug formulary be structured? What are the advantages and disadvantages of existing formularies that might be considered by the California WC program?
2) What implementation policies should be considered to address the AB 1124 requirements and promote the provision of appropriate pharmaceuticals expeditiously while minimizing administrative burden?
3) What are the likely impacts of implementing the formulary on drug utilization patterns and spending? What are the costs and benefits of implementing an evidence-based formulary consistent with the AB 1124 requirements for injured workers, providers,employers, and society?
4) What are the key indicators and measures that should be used to monitor implementation of the formulary?
The DWC will also gather and analyze information on potential formularies that DWC might consider and the ancillary policies that other state WC programs have adopted in implementing drug formularies, including how the formulary is integrated with medical treatment guidelines. It will consider the feasibility of DWC constructing a formulary tailored to its medical treatment utilization guidelines and review the evidence-based formularies from American College of Occupational and Environmental Medicine (ACOEM), the Official Disability Guidelines (ODG), the Washington Department of Labor and Industries, and the California Department of Health Care Services (MediCal).
The review of the regulatory policies that other WC programs have adopted in implementing a WC formulary will include the states of Ohio, Oklahoma, Texas, Tennessee and Washington ...
The meeting is scheduled from 10 a.m. until noon on Wednesday, February 17, 2016 in the auditorium of the Elihu Harris State Office Building, 1515 Clay Street, Oakland, CA 94612.
The Agenda and background materials may be accessed on the DWC Forum. The Agenda includes a presentation by Barbara Wynn, Senior Health Policy Analyst with RAND and a public discussion of formulary issues identified by RAND.
The DWC contracted with RAND to provide assistance in the design and implementation of the formulary and related policies and in estimating the economic impact of the formulary. Key questions that RAND researchers will address include:
1) How should the drug formulary be structured? What are the advantages and disadvantages of existing formularies that might be considered by the California WC program?
2) What implementation policies should be considered to address the AB 1124 requirements and promote the provision of appropriate pharmaceuticals expeditiously while minimizing administrative burden?
3) What are the likely impacts of implementing the formulary on drug utilization patterns and spending? What are the costs and benefits of implementing an evidence-based formulary consistent with the AB 1124 requirements for injured workers, providers,employers, and society?
4) What are the key indicators and measures that should be used to monitor implementation of the formulary?
The DWC will also gather and analyze information on potential formularies that DWC might consider and the ancillary policies that other state WC programs have adopted in implementing drug formularies, including how the formulary is integrated with medical treatment guidelines. It will consider the feasibility of DWC constructing a formulary tailored to its medical treatment utilization guidelines and review the evidence-based formularies from American College of Occupational and Environmental Medicine (ACOEM), the Official Disability Guidelines (ODG), the Washington Department of Labor and Industries, and the California Department of Health Care Services (MediCal).
The review of the regulatory policies that other WC programs have adopted in implementing a WC formulary will include the states of Ohio, Oklahoma, Texas, Tennessee and Washington ...
Former Workers' Compensation Judge Frank Lynn Kleeman passed away peacefully on February 5, 2016 at UCLA Ronald Reagan Medical Center of Cardiac Arrest with his wife, Charlotte, and daughter, Shari, by his side. He was 82.
Judge Kleeman led an incredibly diverse life, serving in the US Navy, Air Force Reserve, and as a Los Angeles County Sheriff's Deputy. He went on to be an attorney in 1977, Workers Compensation Judge in the 1980s, and later an Arbitrator.
After moving to the Santa Clarita Valley, Judge Kleeman became actively involved in the community, supporting many organizations including the Boys and Girls Club of Santa Clarita Valley, the College of the Canyons Foundation, the SCV Repertory Theater, and the Newhall Redevelopment Committee. He was Board Emeritus of The Pasadena Playhouse. He was named Santa Clarita Valley Man of the Year in 2002, and he was also named Philanthropist of the Year for the Network of California Community Colleges in 2002..
Judge Kleeman leaves behind his wife Charlotte, son Jeff, daughters Shari, Robin, and Suzette, grandchildren Elijah, Maxwell and Destiny, brother Dr. Charles Kleeman and wife, Annette, many nieces and nephews and, his beloved dogs, Cookie and Oreo. Frank was preceded in death by his brother Stanley Kleeman, and sister Ruth Pelter.
"He was so very well-liked in this community," said Cheryl Jones, vice president of the Child and Family Center Foundation. "He volunteered with us and his efforts were substantial," she said. He served on the foundation’s Board of Directors for more than 20 years.
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Judge Kleeman led an incredibly diverse life, serving in the US Navy, Air Force Reserve, and as a Los Angeles County Sheriff's Deputy. He went on to be an attorney in 1977, Workers Compensation Judge in the 1980s, and later an Arbitrator.
After moving to the Santa Clarita Valley, Judge Kleeman became actively involved in the community, supporting many organizations including the Boys and Girls Club of Santa Clarita Valley, the College of the Canyons Foundation, the SCV Repertory Theater, and the Newhall Redevelopment Committee. He was Board Emeritus of The Pasadena Playhouse. He was named Santa Clarita Valley Man of the Year in 2002, and he was also named Philanthropist of the Year for the Network of California Community Colleges in 2002..
Judge Kleeman leaves behind his wife Charlotte, son Jeff, daughters Shari, Robin, and Suzette, grandchildren Elijah, Maxwell and Destiny, brother Dr. Charles Kleeman and wife, Annette, many nieces and nephews and, his beloved dogs, Cookie and Oreo. Frank was preceded in death by his brother Stanley Kleeman, and sister Ruth Pelter.
"He was so very well-liked in this community," said Cheryl Jones, vice president of the Child and Family Center Foundation. "He volunteered with us and his efforts were substantial," she said. He served on the foundation’s Board of Directors for more than 20 years.
...
The second-degree murder convictions last October of a Los Angeles-area physician were the first against a U.S. doctor for prescribing massive quantities of addictive and dangerous drugs to patients with no legitimate need, three of whom died of overdoses. A jury of 10 women and two men found Hsiu Ying "Lisa" Tseng, 45, guilty of 23 counts, including 19 counts of unlawful controlled substance prescription and one count of obtaining a controlled substance by fraud. The guilty verdict marks the first time in the United States where a doctor was convicted of murder for overprescribing drugs.
Tseng was convicted of second-degree murder for the deaths of Vu Nguyen, 28, of Lake Forest; Steven Ogle, 24, of Palm Desert; and Joseph Rovero, 21, an Arizona State University student from San Ramon. Nguyen died March 2, 2009. Ogle died a month later on April 9, 2009. Rovero died Dec. 18, 2009. All were patients of Tseng, who prescribed a myriad of drugs for the three young men.
Tseng, licensed to practice in 1997, opened a storefront medical office in Rowland Heights in 2005. During the timeframe when nine of her patients died in less than three years, Tseng took in $5 million from her clinic and continued dispensing potent and addictive drugs unabated.
Tseng surrendered her license to practice medicine in February 2012 and has been behind bars in lieu of $3 million bail since her March 2012 arrest.
This month she was sentenced to 30 years to life in prison for the overdose deaths, in a case that could change how doctors prescribe medication.
The 46-year-old mother of two, wearing blue jail scrubs, apologized to the families of her victims, but the judge sentenced her based on Tseng refusing to take responsibility for her actions during the trial and blaming her patients or pharmacists or even other doctors instead. "[She']) a person who seemingly did not care about the lives of her patients in this case but rather appeared more concerned about distributing dangerous controlled substances in an assembly line fashion so as to collect payments which amounted to her amassing several million dollars," Los Angeles County Superior Court Judge George Lomeli said.
But April Rovero, the mother of one of the victims, was mostly unmoved by Tseng's apologies. Her son, Joey, died after mixing Xanax and oxycodone -- which he had both been prescribed by Tseng -- with alcohol. "It feels too late," Rovero said outside the courtroom. "But it was better to hear something than nothing. But Rovero, who, founded the National Coalition Against Prescription Drug Abuse after her son's death, praised the sentence. "Justice has been served," she said.
Outside the courtroom, Peter Osinoff, who represented Tseng before the state medical board said Tseng's prosecution has had a negative impact on physicians and patients. "The doctors are scared out of their minds," he said. "The pendulum has swung so far. The people who need [pain medication] can't get it now."
Other medical experts have echoed his concerns since Tseng was charged in 2012. "When you use the word 'murder,'" said Dr. Peter Staats, president of the American Society of Interventional Pain Physicians, "of course it’s going to have a chilling effect." Staats said he believes an aggressive medical board -- not prosecutors -- should go after reckless doctors. But, he added, any doctor who is prescribing pills knowing that they are being abused or diverted shouldn’t be called a doctor ...
Tseng was convicted of second-degree murder for the deaths of Vu Nguyen, 28, of Lake Forest; Steven Ogle, 24, of Palm Desert; and Joseph Rovero, 21, an Arizona State University student from San Ramon. Nguyen died March 2, 2009. Ogle died a month later on April 9, 2009. Rovero died Dec. 18, 2009. All were patients of Tseng, who prescribed a myriad of drugs for the three young men.
Tseng, licensed to practice in 1997, opened a storefront medical office in Rowland Heights in 2005. During the timeframe when nine of her patients died in less than three years, Tseng took in $5 million from her clinic and continued dispensing potent and addictive drugs unabated.
Tseng surrendered her license to practice medicine in February 2012 and has been behind bars in lieu of $3 million bail since her March 2012 arrest.
This month she was sentenced to 30 years to life in prison for the overdose deaths, in a case that could change how doctors prescribe medication.
The 46-year-old mother of two, wearing blue jail scrubs, apologized to the families of her victims, but the judge sentenced her based on Tseng refusing to take responsibility for her actions during the trial and blaming her patients or pharmacists or even other doctors instead. "[She']) a person who seemingly did not care about the lives of her patients in this case but rather appeared more concerned about distributing dangerous controlled substances in an assembly line fashion so as to collect payments which amounted to her amassing several million dollars," Los Angeles County Superior Court Judge George Lomeli said.
But April Rovero, the mother of one of the victims, was mostly unmoved by Tseng's apologies. Her son, Joey, died after mixing Xanax and oxycodone -- which he had both been prescribed by Tseng -- with alcohol. "It feels too late," Rovero said outside the courtroom. "But it was better to hear something than nothing. But Rovero, who, founded the National Coalition Against Prescription Drug Abuse after her son's death, praised the sentence. "Justice has been served," she said.
Outside the courtroom, Peter Osinoff, who represented Tseng before the state medical board said Tseng's prosecution has had a negative impact on physicians and patients. "The doctors are scared out of their minds," he said. "The pendulum has swung so far. The people who need [pain medication] can't get it now."
Other medical experts have echoed his concerns since Tseng was charged in 2012. "When you use the word 'murder,'" said Dr. Peter Staats, president of the American Society of Interventional Pain Physicians, "of course it’s going to have a chilling effect." Staats said he believes an aggressive medical board -- not prosecutors -- should go after reckless doctors. But, he added, any doctor who is prescribing pills knowing that they are being abused or diverted shouldn’t be called a doctor ...
