In a small trial of 10 patients with damaged knee joints, doctors harvested cells from their noses to engineer new cartilage tissue and transplant it into their damaged knees. In a paper published in The Lancet, the Swiss team describes how 2 years after transplant, most of the patients had developed new tissue similar to normal cartilage and reported improvements in knee function, pain, and quality of life.

However, the authors point out that while the results of their phase I study are promising and show the approach is feasible and safe, there is still a long way to go before such a procedure can be approved for routine use with patients. There now needs to be randomized trials - with longer follow-up - that compare the promising treatment with conventional alternatives.

About 2 million people in Europe and the United States are diagnosed with damage to knee joint cartilage every year, caused by injury or accident. Joint or articular cartilage is the layer of smooth tissue at the ends of bones that eases movement, and protects and cushions the surfaces of the joint where the bones meet.

As this tissue has no blood supply, if it gets damaged it cannot regenerate. Eventually, as the cartilage wears away, the bones become exposed and inflamed from rubbing against each other, leading to painful joint conditions like osteoarthritis.

There are medical techniques - such as microfracture surgery - that can prevent or delay the onset of cartilage degeneration following injury or accident, but they do not regenerate healthy cartilage to protect the joints.

There have also been attempts to use cartilage cells or chondrocytes from the patients' own joints to make new cartilage in the joint, but these have not been very successful at creating the right structure and function of the cushioning tissue.

One of the unique features of the new study is that Prof. Martin and colleagues used chondrocytes harvested from a site far away from the damaged joint - from the patients' nasal septum. These cells have a unique ability to grow new cartilage tissue.

For the study, the team enrolled 10 patients (age 18-55) with full-thickness cartilage damage to the knee and took a biopsy from their nasal septum under local anesthetic. They grew chondrocytes harvested from the biopsy tissue by stimulating them with growth factor for 2 weeks.

The team then took the cultured new cells and seeded them onto "scaffolding" made of collagen and grew them for another 2 weeks. The result was a 2-millimeter thick graft of new cartilage measuring about 30-40 millimeters.

Each patient then underwent surgery where the damaged knee cartilage was removed and replaced with their own cultured graft cut into the appropriate shape. After 2 years, scans showed new tissue of similar composition to cartilage had grown at the affected sites.

Nine of the 10 patients - one was excluded because of sports injuries not related to the trial - also reported significant improvements in the use and function of their knee and reduction in pain, compared with pre-surgery.

The authors note there were no reports of adverse reactions to the surgery, although there were two reports of injuries not related to the procedure. Patient age does not appear to affect success They also mention the promising result that patient age does not appear to affect the success of the procedure ...

There is currently no blood test for early-stage osteoarthritis, a degenerative joint disease where the cartilage that eases and cushions movement breaks down, causing pain, swelling, and problems moving the joint.

Now, researchers at Warwick University in the United Kingdom have developed a blood test that can provide an early diagnosis of osteoarthritis and distinguish it from rheumatoid arthritis and other inflammatory joint diseases.

The researchers, led by Dr. Naila Rabbani of Warwick Medical School, report how they developed the new blood test in the journal Arthritis Research & Therapy.

The test could be available within 2 years, say the researchers. The earlier that arthritis is diagnosed - before physical and irreversible symptoms set in - the better the chances that treatment can focus on how to prevent the problem, for instance with lifestyle changes.

The new blood test looks for chemical signatures in fragments of joint proteins (amino acids) that have been damaged, as Dr. Rabbani explains: "The combination of changes in oxidized, nitrated and sugar-modified amino acids in blood enabled early stage detection and classification of arthritis - osteoarthritis, rheumatoid arthritis or other self-resolving inflammatory joint disease."

Dr. Rabbani notes that scientists have known for a while that proteins in the arthritic joint get damaged, but this is the first time they have looked at them from the point of view of early disease diagnosis. "For the first time we measured small fragments from damaged proteins that leak from the joint into blood," she adds.

For the study, the team recruited 225 participants. These included patients with knee joint early-stage and advanced osteoarthritis and rheumatoid arthritis or other inflammatory joint disease, and healthy volunteers with no joint problems.

Using mass spectrometry, the researchers analyzed samples of blood and synovial fluid (from the affected knee joints) for oxidized, nitrated, and sugar-modified proteins and amino acids.

They found some patterns of damaged amino acids in samples from patients with early and advanced osteoarthritis and rheumatoid arthritis that were markedly lower in samples from the healthy volunteers.

Using sophisticated bioinformatic computer methods, they developed algorithms - based on 10 damaged amino acids - that can diagnose early-stage osteoarthritis, rheumatoid arthritis, and non-rheumatoid arthritis. The researchers note the new blood test has a "relatively high sensitivity and specificity for early-stage diagnosis and typing of arthritic disease." Sensitivity is the extent to which a negative result is able to rule the disease out, and specificity is the extent to which a positive result can rule the disease in. In the case of early-stage osteoarthritis, the study found the blood test had a sensitivity of 92 percent and a specificity of 90 percent.

These compare favorably with current techniques. For instance, in their background information, the researchers note that current magnetic resonance imaging techniques for evaluating cartilage damage in early-stage osteoarthritis have sensitivities around 70 percent and specificities around 90 percent ...

The Santa Barbara Independent reports that Freddy Pachon, a former vice president of risk management for Select Staffing, was sentenced Monday to eight years and eight months in prison for embezzling more than $700,000 from the Santa Barbara-based temp agency.

Between January 2008 and December 2012, Pachon funneled money from reimbursement checks related to workers’ compensation claims into a personal account he created under the fictitious business entity "Select Consulting Services." At a previous court hearing, it was revealed that Pachon had placed his sister-in-law, Paula Orozco, in a job at AG Employment Services, the company contracted by Select Staffing to handle medical claims. Orozco testified she altered the checks then mailed them to an address provided by Pachon, on some occasions even hand-delivering them to him in the Select Staffing parking lot or at his house. Orozco was later fired from her job but avoided criminal charges.

According to prosecutors, Pachon spent the stolen funds on a lavish home and backyard renovations. At the time of his arrest, he was earning approximately $250,000 a year from Select Staffing, where he’d been working since 2001.

At the Monday hearing, Pachon’s attorney Steven Andrade admitted his client "made a horrible exercise in judgment" but deserved leniency and probation, not the 20-year prison sentence prosecutor Brian Cota had asked the judge to impose. Andrade said as soon as Select Staffing discovered Pachon’s theft, he immediately sold his home and transferred the funds to the company. He had hoped to make full restitution and not involve law enforcement, Andrade said. "Mr. Pachon was like the most cooperative suspect in the world," he stated. Since his arrest, Pachon has been volunteering and cleaning offices part-time, and still works in risk management. "He’s really fighting for his family," Andrade said of Pachon’s wife and young children.

Pachon’s wife, Julia Orozco, also pleaded with Judge Michael Carrozzo to show her husband compassion. "I know he did something wrong," she said, "but he’s not a bad guy. He’s a good father." Attorney and real estate broker John J. Thyne III, who helped Pachon sell his home, said he found him honest and well-meaning.

In arguing for a lengthy prison term, Cota stressed the depth and repetition of Pachon’s deception. "And using a family member is way beyond a typical embezzlement case," he said. Cota said Pachon meticulously planned his scheme and deserved no credit for selling his home, as it was going to be foreclosed upon anyway. "He was just trying to save his own skin," Cota said, noting that since his arrest Pachon has still not paid Select Staffing any of the the $250,000 or so he still owes. Instead, that money has been used to pay four different private attorneys. In addition, Cota went on, all the embezzled funds previously went toward "vanity projects" so Pachon, who has multiple ex-wives and as many as 10 children, would "look like the big guy in the office." None of it went to his family.

More than a dozen of Pachon’s family members were present in the courtroom Monday. During a short break in the proceedings, a woman who identified herself as one of Pachon’s cousins offered to pay Independent staff photographer Paul Wellman to not publish photographs of Pachon. Wellman declined. The cousin persisted, offering to double his hourly rate and insisting he could take the money without the Independent finding out. Wellman again declined.

In handing down his sentence, Judge Carrozzo said while Pachon’s case certainly didn’t warrant probation, he also didn’t deserve 20 years behind bars. "I think the defendant is a good person who made a mistake," Carrozzo said. He noted multiple letters of support from friends and family influenced his decision. He said he hoped Pachon, from Colombia on a work visa, would get his life back on track after prison. "I hope Mr. Pachon is still able to become an American success story," he said.

Though Pachon was technically sentenced to eight years and eight months in prison, the credit he receives for good behavior - along with new incarceration rules guided by current and pending legislation aimed at reducing prison overcrowding - may make him eligible for parole in as little as eight months ...

The Department of Industrial Relations, Division of Labor Standards Enforcement (DLSE) imposed a $179,329.60 penalty, pursuant to Labor Code section 3722, subdivision (b) against Aron's Automotive for failure to maintain workers’ compensation insurance as required by section 3700. The employer unsuccessfully pursued an administrative appeal and later court appeals of this penalty.

Aaron’s Automotive has been in operation since 2007. On January 22, 2015, DLSE inspected and discovered the business had employees but had never acquired workers’ compensation insurance coverage. On February 9, 2015, Taylor obtained coverage through the State Compensation Insurance Fund, which was effective as of January 29, 2015.

At the administrative hearing, Taylor argued: (1) the term calendar year, as used in section 3722(b), means January 1 to December 31; (2) section 3722(b) violates the equal protection clause of the Fourteenth Amendment; (3) the penalty violates substantive due process; and (4) the penalty is an excessive fine imposed in violation of the Eighth Amendment.

On April 8, 2015, the hearing officer issued written findings and affirmed the penalty assessment. The hearing officer found: "[Taylor] did not have workers’ compensation insurance for the period of February 27, 2012 through January 29, 2015 and had 11 employees during that time period." The hearing officer concluded Taylor’s constitutional arguments provided no basis for defense in an administrative hearing and also determined the term calendar year, as used in section 3722(b), means "one year back from the date that the director determines an employer has been uninsured on the date the citation is issued."

Taylor filed a petition for writ of administrative mandamus. A demurrer to the petition was granted without leave to amend. The Court of Appeal affirmed the dismissal in the partially published case of Aaron Taylor v Department of Industrial Relations.

The parties frame this case as primarily a dispute regarding the meaning of "calendar year" in section 3722(b).

It is undisputed that the date of "the determination" is the date the penalty assessment citation issued - in this case, February 27, 2015. Taylor maintains the term calendar year necessarily means January 1, 2014, through December 31, 2014, and that "this is the required statutory interpretation of this term no matter how absurd the result of that interpretation . . . ."

DLSE, on the other hand, insists calendar year means "the one-year period immediately before the date that the director determines that an employer is uninsured" - or, in this case, February 27, 2014, to February 27, 2015. DLSE analogize section 3722(b) to "a one year statute of limitations on issuing a citation." (See Code. Civ. Proc., §340, subds. (a), (b).) In other words, section 3722(b) allows a citation to be issued "if the DLSE determines that an employer was uninsured [in excess of one week] during the past year, whether or not the employer subsequently obtains insurance."

The interpretation of section 3722(b) is a question of first impression. The Court of Appeal concluded that "calendar year", as used in section 3722(b), means the 12-month period immediately preceding the determination. In this case, a triggering event of uninsurance did occur between February 27, 2014, and February 27, 2015. Therefore, this construction of the statute does not in any way invalidate the penalty imposed ...

A licensed occupational therapist pleaded guilty in Los Angeles for his role in a $2.6 million Medicare fraud scheme that involved billing for occupational therapy services that were not provided.

Keith Canlapan, 38, of West Covina, California, pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge George H. Wu of the Central District of California.

Sentencing is scheduled for Feb. 16, 2017, before Judge Wu.

As part of his guilty plea, Canlapan admitted that he was a licensed occupational therapist employed with JH Physical Therapy, an occupational therapy clinic located in Walnut, California. Canlapan further admitted that through JH Physical Therapy, he billed Medicare for occupational therapy services when no such services were provided to the Medicare beneficiaries. Instead, the Medicare beneficiaries received massage and acupuncture services, which are not reimbursable under Medicare rules, he admitted. In fact, on dates that Canlapan purportedly provided occupational services to Medicare beneficiaries at JH Physical Therapy, Canlapan was admittedly not present at JH Physical and instead was either out of the country or at his other places of employment on some of those dates.

Between approximately October 2009 and approximately December 2012, Canlapan, through JH Physical Therapy, billed Medicare $2,669,618 in false and fraudulent claims, of which Medicare paid $1,860,786, he admitted.

Canlapan was charged in an indictment returned on June 16, 2016, along with co-defendants Simon Hong, 54, and Grace Hong, 50, husband and wife, both of Brea, California. Simon Hong is the owner and Grace Hong is the co-operator of JH Physical Therapy, and they are charged with one count of conspiracy to commit health care fraud and three counts of health care fraud. Both are pending trial, which is scheduled for Jan. 17, 2017. An indictment is merely an allegation and all defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.

Co-conspirator Roderick Belmonte Concepcion, a licensed occupational therapist, was also previously indicted in a separate related case and pleaded guilty in April 2016. His sentencing is scheduled for Jan. 23, 2017.

The case was investigated by the Los Angeles Region of HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. The case is being prosecuted by Trial Attorney Blanca Quintero of the Fraud Section.
...

Life Care Centers of America Inc. and its owner, Forrest L. Preston, have agreed to pay $145 million to resolve a lawsuit alleging that Life Care violated the False Claims Act by knowingly causing skilled nursing facilities (SNFs) to submit false claims to Medicare and TRICARE for rehabilitation therapy services that were not reasonable, necessary or skilled;

Life Care, based in Cleveland, Tennessee, owns and operates more than 220 skilled nursing facilities across the country including ten in California. The California facilities include Bel Tooren Villa Convalescent Hospital in Bellflower, Life Care Center of Escondido, La Habra Convalescent Hospital, Lake Forest Nursing Center, Life Care Center of Menifee, Mirada Hills Rehabilitation and Convalescent Hospital, North Walk Villa Convalescent Hospital in Norwalk, Orangegrove Rehabilitation Hospital, Rimrock Villa Convalescent Hospital in Barstow, and Life Care Center of Vista.

"This resolution is the largest settlement with a skilled nursing facility chain in the department’s history," said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. "It is critically important that we protect the integrity of government health care programs by ensuring that services are provided based on clinical rather than financial considerations."

This settlement resolves allegations that between Jan. 1, 2006 and Feb. 28, 2013, Life Care submitted false claims for rehabilitation therapy by engaging in a systematic effort to increase its Medicare and TRICARE billings. Medicare reimburses skilled nursing facilities at a daily rate that reflects the skilled therapy and nursing needs of their qualifying patients. The greater the skilled therapy and nursing needs of the patient, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for skilled nursing facilities is for "Ultra High" patients who require a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, speech), one of which has to be provided five days a week.

The United States alleged in its complaint that Life Care instituted corporate-wide policies and practices designed to place as many beneficiaries in the Ultra High reimbursement level irrespective of the clinical needs of the patients, resulting in the provision of unreasonable and unnecessary therapy to many beneficiaries. Life Care also sought to keep patients longer than was necessary in order to continue billing for rehabilitation therapy, even after the treating therapists felt that therapy should be discontinued. Life Care carefully tracked the minutes of therapy provided to each patient and number of days in therapy to ensure that as many patients as possible were at the highest level of reimbursement for the longest possible period. The settlement also resolves allegations brought in a separate lawsuit by the United States that Forrest L. Preston, as the sole shareholder of Life Care, was unjustly enriched by Life Care’s fraudulent scheme.

As part of this settlement, Life Care has also entered into a five-year chain-wide Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires an independent review organization to annually assess the medical necessity and appropriateness of therapy services billed to Medicare.

The settlement, which was based on the company’s ability to pay, resolves allegations originally brought in lawsuits filed under the qui tam, or whistleblower, provisions of the False Claims Act by Tammie Taylor and Glenda Martin, former Life Care employees. The act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery. The government may intervene and file its own complaint in such a lawsuit, as it has done in this case. The whistleblower reward in this case will be $29 million.

This matter was handled by the Civil Division’s Commercial Litigation Branch, the U.S. Attorneys’ Offices for the Eastern District of Tennessee and the Southern District of Florida, and the HHS-OIG, with assistance from the U.S. Attorneys’ Offices for the District of Colorado, the Middle District of Florida, the Northern District of Georgia, the District of Massachusetts and the District of South Carolina and NCI/AdvanceMed, a Medicare Zone Program Integrity Contractor ...

Helmerich & Payne International Drilling operates oil drilling rigs located in south Kern County on an Occidental Petroleum leasehold.

One of the drilling rigs operated by H&P was called Oil Rig 261. The night shift crew for Oil Rig 261 included defendant Luis Mooney, a floorhand, and Mark Stewart, a motorman. Ruben Ibarra was the crew’s driller and, therefore, the supervisor of Mooney, Stewart and other members of the crew. Ibarra and Stewart did not live in the area and stayed at the Best Western Hotel.

Mooney lived in Bakersfield and provided Ibarra and Stewart with rides to and from the drill site in his personal vehicle, a Ford F250 pickup. Mooney testified that he had given Ibarra a ride at least 50 times. Ibarra testified that he believed he had ridden with Mooney a few dozen times before the accident. Mooney’s route from his home to the jobsite took him by the hotel. As pointed out by plaintiff, Mooney’s route changed when he gave rides because he would have to turn off of Stockdale Highway and into the parking lot of the hotel to pick up or drop off his passengers. This slight change in route is not relevant in this case. Mooney would have traveled by the accident site on his way to and from work regardless of whether he was providing crew members with a ride to or from the hotel.

On December 12, 2011, after the end of their shift, Mooney was returning home and giving Ibarra and Stewart a ride to the hotel. Mooney also had driven Ibarra and Stewart to work the previous afternoon. At approximately 6:30 a.m., about 13 miles from Oil Rig 261, Mooney’s pickup collided with a Chevrolet 2500 pickup driven by plaintiff Brent Pierson. Mooney crossed the double yellow line and into the lane of oncoming traffic.

Pierson and his wife filed a personal injury action against Mooney, and later added H&P as a defendant. Travelers Property Casualty Company of America, the worker’s compensation insurer for Pierson’s employer, intervened in this lawsuit.

H&P filed a motion for summary judgment against Pierson and Travelers. The motion asserted that the incident occurred when Mooney was driving home from work and did not occur while he was in the course or scope of his employment with H&P. Pierson opposed this motion and filed his own motion for summary adjudication on the scope of employment issue. The trial court granted summary judgment for H&P, concluding as a matter of law that the going and coming rule applied and, therefore, Mooney’s operation of his vehicle at the time of the accident was not within the scope of his employment. Subsequently, a judgment was entered and Pierson filed an appeal. The Court of Appeal affirmed the dismissal of H&P in the published case of Pierson v Helmerich & Payne International Drilling.

The doctrine of respondeat superior holds an employer liable for torts of its employees committed within the scope of their employment. Thus, a plaintiff suing an employer under the doctrine must prove that the tort was committed within the scope of employment.

A corollary of the doctrine of respondeat superior is the "going and coming rule," which states that employees do not act within the scope of employment while going to or coming from the workplace. The rationale for the rule is that the employment relationship is suspended from the time the employee leaves work until he or she returns because an employee ordinarily renders no service to the employer while traveling.

The going and coming rule is used in tort law to determine the scope of employment for purposes of respondeat superior liability and also is used in workers’ compensation law to determine whether an employee injured while traveling to or from work sustained an injury arising out of and in the course of the employment for purposes of Labor Code section 3600.

However the Court of Appeal noted that the coming and going rule applied in tort law to determine the scope of employment is not identical to the rule applied in workers’ compensation law to determine the course of employment. The differences exist because the policy considerations underlying each field of law are different. This view of the going and coming rule is nothing new and has been confirmed by most recent published decisions addressing the going and coming rule.

Secondly, the workers’ compensation cases awarding coverage under an exception to the going and coming rule cannot be categorically excluded as having persuasive force in tort cases involving the same exception and similar facts. The two versions of the rule and its exception are closely related and, as a result of this overlap, courts often cite tort and workers’ compensation cases interchangeably.

Third, workers’ compensation cases awarding coverage do not necessarily provide reliable precedent for tort cases because the version of the rule applied in tort cases is more restrictive ...

The WCIRB expands its research on regional differences in California workers’ compensation claim costs and frequency with the release of its second report, the 2016 Study of Geographic Differences in California Workers' Compensation Claim Costs. The Study, which controls for wage level differences and industrial mix, includes nine new maps illustrating regional differences.

Earlier this month the Oregon Department of Consumer and Business Services (DCBS) announced the results of its bi-annual nationwide study of the costs of workers' compensation programs for 2016. According to that study, California once again is the worst state in the union in terms of costs. It ranks at 176% of the study median. It is a good distance away from the second highest state, New Jersey, which ranks 158% of the study median. Rounding off the worst five, third worst is New York at 154%, Connecticut is the fourth worst at at 149%, and fifth is Alaska also at 149%.

To sum it up, California ranks as the most costly workers' compensation program in the nation, and Los Angeles is the most costly region in the most costly state. You might call that ground zero.

Key findings of the new WCIRB Regional Study include:

1) The Los Angeles/Long Beach area continues to show higher indemnity claim frequencies than the rest of California, while the Silicon Valley region continues to show lower indemnity claim frequencies.
2) The median permanent disability rating is higher in northern regions of California than in the central and southern regions.
3) The Los Angeles/Long Beach Area is the most litigious region in California. Medical legal costs are over 2.8% of total incurred costs on indemnity claims in the Los Angeles/Long Beach area compared with 2.0% statewide.
Pharmaceutical spending as a percentage of total medical costs also varies by region.

The complete Study and a mapping of nine-digit zip codes to the regions included in the Study are available on the WCIRB website in the Research and Analysis section ...

Former California State Senator Ronald S. Calderon was sentenced to 3½ years in federal prison after pleading guilty to a federal corruption charge and admitting that he accepted tens of thousands of dollars in bribes in exchange for performing official acts as a legislator.

Ron Calderon pleaded guilty in June to one count of mail fraud through the deprivation of honest services. In a plea agreement filed in this case, Ron Calderon admitted accepting bribe payments from the owner of a Long Beach hospital who wanted a law to remain in effect so he could continue to reap tens of millions of dollars in illicit profits from a health care fraud scheme. Ron Calderon also admitted taking bribes from undercover FBI agents who were posing as independent filmmakers who wanted changes to California’s Film Tax Credit program.

Ron Calderon’s brother, Thomas M. Calderon, 62, also of Montebello, a former member of the California State Assembly who became a political consultant, was sentenced last month to 10 months in custody for his conviction on a money laundering charge for allowing bribe money earmarked for his brother to be funneled through his company.

The Calderon family was a political dynasty for decades in California. A third brother, former Assemblyman Charles Calderon, was not implicated in the corruption scandal. Ronald Calderon’s nephew Ian Calderon is a state assemblyman and the last family member in state elected office. He was not alleged to have any part in the scheme.

Ron Calderon admitted participating in a bribery scheme involving two areas of legislation and the hiring of a staffer who was also an undercover FBI agent.

In the first part of the bribery scheme, Ron Calderon took bribes from Michael Drobot, the former owner of Pacific Hospital in Long Beach, which was a major provider of spinal surgeries that were often paid by workers’ compensation programs. The spinal surgeries are at the center of a massive healthcare fraud scheme that Drobot orchestrated and to which he previously pleaded guilty. Ron Calderon was not charged in the healthcare fraud scheme that led to well over $500 million in fraudulent billings. Drobot, who was described in court papers filed by prosecutors as "a greedy fraudster robbing taxpayer-funded federal programs," was a client of Tom Calderon’s political consulting firm.

California law known as the "spinal pass-through" legislation allowed a hospital to pass on to insurance companies the full cost it had paid for medical hardware it used during spinal surgeries. As Drobot admitted in court, his hospital exploited this law, typically by using hardware that had been purchased at highly-inflated prices from companies that Drobot controlled and passing this cost along to insurance providers.

Drobot bribed Ron Calderon so that he would use his public office to preserve this law that helped Drobot maintain a long-running and lucrative healthcare fraud scheme, which included Ron Calderon asking a fellow senator to introduce legislation favorable to Drobot and attempting to recruit other senators to support Drobot. The payments from Drobot came in the form of summer employment for Ron Calderon’s son, who was hired as a summer file clerk at Pacific Hospital and received a total of $30,000 over the course of three years, despite the son doing little actual work at the hospital.

In a sentencing memorandum filed with the court, prosecutors write that Ron Calderon "sold his vote not just to help pay for the expenses of living beyond his means, but for the more banal and predictable aims of corruption - fancy luxuries, fancy parties, and fancy people."

The memorandum further argues that a significant term of imprisonment was necessary to send a message to other political officials and the electorate because, without such a sentence, "the trust already eroded by individual detections of corrupt politicians will spread like cancer and threaten the fundamentals of a trusted democracy. It is not hyperbole to insist that nothing less is at stake in defendant’s sentencing."

His attorney Mark Geragos suggested during the court hearing that his client should serve no time in prison. He alleged that the government had entrapped Calderon and raised the former lawmaker's poor health. The former state senator’s legacy has been ruined by his guilty plea in the case, he added. "This is going to be the opening paragraph of his obituary, unfortunately," Geragos told Judge Snyder.

When Snyder rebuffed Geragos’ appeal and said Calderon needed to spend some amount of time behind bars, Geragos switched tactics, asking her to consider a two-year sentence.

Striking a defiant tone throughout, Calderon, 59, refused to admit any wrongdoing or to apologize."My goal was always to do the right thing for California," he said. "At no point did I intend to break the law."

Calderon added that he was unemployed and tens of thousands of dollars in debt. He said he was not only banned from running for public office again but had been stripped of his real estate license and had been unable to get a job. His wife, he said, would likely have to declare bankruptcy and sell their house.

Judge Snyder was unmoved. "I did not really hear Sen. Calderon accept responsibility or apologize," she said. "It was really about himself."
...

The U.S. Food and Drug Administration is seeking to improve hospital reporting of injuries and deaths associated with medical devices after inspections at 17 hospitals revealed widespread under-reporting of such events. And of course an injury or death of an injured worker while being treated at a hospital would be a compensable consequence additional injury.

Reuters Health reports that the FDA initiated the inspections following high-profile safety scandals involving power morcellators and contaminated duodenoscopes.

Morcellators are used to remove uterine fibroids but can spread unsuspected cancerous tissue beyond the uterus. Duodenoscopes are threaded through the mouth and throat to treat problems in the pancreas and bile ducts. Contaminated scopes can carry infections from one patient to another.

In a blog posted on the FDA's website, Dr. Jeffrey Shuren, head of the agency's device division, said many events uncovered at the 17 hospitals should have been reported and were not, in violation of the agency's reporting requirements. The FDA believes such under-reporting is a nationwide problem.

"We believe that these hospitals are not unique in that there is limited to no reporting to FDA or to the manufacturers," he said.

In some cases, hospital staff were neither aware of, nor trained to comply with, the agency's medical device reporting requirements.

Shuren said the agency wanted to "work with all hospitals to address these issues."

On Dec. 5, the FDA will hold a public workshop seeking input on improving hospital surveillance systems and how hospitals can better evaluate how well devices work in the clinical setting.

Last year, the FDA sent warning letters to manufacturers of duodenoscopes, saying they skirted a host of testing, manufacturing and reporting requirements. The biggest makers of the products are Olympus Corp, Pentax Medical and Fujifilm Holdings Corp.

The FDA first warned of their potential to transmit antibiotic-resistant germs in 2009. Since then they have been implicated in superbug outbreaks at multiple U.S. hospitals.

In 2014, the FDA warned that morcellators could inadvertently spread uterine cancer. It recommended that the use of these instruments be restricted and that the label includes a boxed warning, the most severe possible.

Morcellators are used to slice fibroid and uterine tissue into small pieces inside the body, allowing it to be removed through a small opening.

The FDA estimates that 1 in 350 women who have fibroid surgery have an unsuspected uterine cancer ...

An Orange County Sheriff’s Department (OCSD) deputy was arrested on charges for committing insurance fraud by failing to disclose his true physical abilities and activities to his health care providers and lying under oath.

Nicholas Zappas, 36, who lives in Laguna Niguel, is charged with 11 felony counts of insurance fraud and seven felony counts of perjury under oath. If convicted, Zappas faces a maximum sentence of 16 years in state prison. The defendant was arrested by Orange County District Attorney (OCDA) Investigators, and his arraignment date and time is yet to be determined.

At the time of the alleged crimes, Zappas was employed as an Orange County Sheriffs Department deputy for approximately 14 years.

On April 2, 2015, while working Harbor Patrol and engaged in a boat rescue, Zappas claimed he tripped over a fire hose falling on his back. He filed a workers’ compensation insurance claim for injuries to his left shoulder, left side of his neck, and lower back. He was placed on work restrictions of no lifting, pushing or pulling of greater than 10 pounds by a medical doctor due to his complaint of pain. The OCSD accommodated the work restrictions and Zappas was assigned to dispatch.

However, between May 2015 and November 2015,Zappas is accused of engaging in CrossFit, which is a high-impact exercise with varied functional movements. He allegedly lifted substantial weights in excess of 200 pounds, doing box jumps, burpees, squats, and other activities that were contrary to the limitations imposed by the doctor based on his description of his pain, symptoms and limitations. Zappas appeared on video while engaging in CrossFit. Thus he is accused of failing to disclose that he was participating in CrossFit to his medical physicians.

In May 2015, the County discovered that Zappas was engaging in CrossFit, and it was reported to OCDA Bureau of Investigations, who investigated this case.

On Dec. 1, 2015, while under oath during his deposition, Zappas allegedly denied lifting anything over 20 pounds since the date of his injury and claimed that he could not lift anything heavy, could not do squats, and could not run.

Between January 2016 and May 2016, Zappas is accused of continuing to engage in CrossFit and not disclosing his abilities to his medical physicians.

Deputy District Attorney Pamela Leitao of the Insurance Fraud Unit is prosecuting this case ...

Berskhire Hathawy has recently been under scrutiny by the California Insurance Commissioner for selling workers' compensation insurance policies that have not been administratively approved for sale in California. It now seems that another major national carrier has resolved a claim filed by three Southern California district attorneys for nearly $1 million also for violating California law while advertising insurance policies.

Los Angeles County District Attorney Jackie Lacey announced a $925,000 settlement with Liberty Mutual Group, Inc., for advertising an accident forgiveness program that was not available in California.

The civil complaint was jointly filed in Riverside County Superior Court by district attorneys in Los Angeles, Riverside and San Diego counties and alleges unfair competition by Liberty Mutual. The settlement was signed by Riverside County Superior Court Judge John Molloy.

Starting in 2014, the Boston-based company launched a nationwide television ad campaign touting its "accident forgiveness" program that protects drivers from having their insurance rates increase if they are responsible for an accident.

However, California consumer protection laws prohibit accident forgiveness programs from being offered in California. Liberty Mutual estimates the ad campaign reached 70 to 80 percent of the households in California.

"California consumers rightfully expect clear and accurate advertising about what is and is not contained in the automobile insurance policies offered to them," said District Attorney Lacey. Prosecutors also said the ads had a disclaimer that was obscured, used small type and was on the screen for no more than three to four seconds. California law requires all advertising must be clearly disclosed.

Under the terms of the judgment, which will be entered without admission of liability, Liberty Mutual will be subject to an injunction requiring full compliance with state law with its accident forgiveness advertising, including the disclosure of the fact that such programs are not available in California.

The $925,000 settlement will be split among the three counties. The case was handled for the Los Angeles County District Attorney’s Office by Ellen Aragon of the Consumer Protection Division ...

Newly adopted AB 2883 provides that all business workers’ comp insurance policies will be required to cover certain officers and directors of private corporations and working members of partnerships and limited liability companies that may have been previously excluded from coverage beginning on Jan. 1, 2017.

Unfortunately, AB 2883 did not include any language exempting in-force policies or delaying its effective date so as not to impact in-force policies.

And the Insurance Journal reports that John Norwood, with lobbying firm Norwood & Associates, said not only does AB 2883 present implementation problems for insurers, it presents an errors and omissions issue for insurance agents and brokers, especially with those entities that today do not purchase a workers’ comp policy because only the owners are involved in the business.

"Literally everybody in the industry responsible for legislative issues missed the application issue relative to this bill, yours truly included in that list, and the same with all legislative and committee staff until after the governor signed the bill into law," Norwood said. "There may be an opportunity to address the application issue early next legislative session but some coverage will be afforded to individuals with in-force policies if and until a fix-it bill can be passed through both houses of the Legislature and signed by the governor.

According to Insurance Commissioner Jones, the Department of Industrial Relations, the American Insurers Association, and the Association of California Insurance Companies, all agree that this change in law applies to in-force policies.

Prior to the passage of the law, officers, directors and working partners were not required to be covered under the business’s workers’ comp policy unless they opted to be covered and were not listed on a limiting and restricting endorsement.

Going forward officers, directors and partners are required to be covered under the employer’s workers’ comp policy unless they meet a narrower definition of excluded employee. Under this narrower definition, officers, directors, and partners can only opt out of coverage by signing a waiver under penalty of perjury and filing the waiver with their employer’s insurer.

Insurance companies are required to identify and provide notice to each employer that may have employees that were previously excluded from coverage and are affected by the new law, and they are required to report the premium and loss experience associated of those who have not chosen to opt of the coverage.

The Insurance Journal reports that Blake Longo, with Pasadena-based AJLongo Insurance Brokers, shot an email to his clients and business associates on Monday warning them of the changes. Longo said he’s already been talking to some of his clients about it. "They’re not happy about the change," Longo said. "They don’t believe it adds any benefit to them and that it will certainly add extra costs."

Longo said the changes will also make life tougher on brokers like him, because it will be brokers who businesses will first turn to if the new rules affect them."You are delivering the bad news and you’re delivering the additional premium," he said. "That does not bring smiles to people’s faces."

According to Norwood, the bill was originally worded to be a bill authorizing a study on paperless systems for the approval of treatment requests in the workers’ comp system. However, that language was gutted and amended to address the issue of exemptions for officers and directors of corporations, partnerships and LLCs.

The bill’s new language was added because some insureds were allegedly abusing the exemption process under current law by listing everyone in their organization as an officer or director to avoid purchasing workers’ comp, Norwood explained.

The biggest issue with AB 2883 is that it applies to all workers’ comp insurance policies that will be in effect on or after Jan. 1, 2017, including those policies in force any time after the first of the year. Katie Pettibone, AIA’s vice president for state affairs, said her group is working with CDI and DIR to help address this.

"Publicly the bill was supposed apply to new policies and renewals after the effective date of January 1, 2017, thus there was no opposition," Pettibone said. "However, there was ambiguity in the drafting and it appears the bill is going to be broader than just policies written after Jan. 1 or renewals " it will be applicable to in-force policies. Stakeholders have been working with the California Department of Insurance and Department of Industrial Relations to help address this unintended effect."
...

The California Department of Insurance moved to stop a central valley company from selling workers' compensation and liability policies because it claims they are not properly registered with the Department of Insurance, which means those insured through the company may not have valid insurance coverage.

In the cease and desist order, served Monday, October 17, 2016, the department alleges Agricultural Contracting Services Association, Incorporated, doing business as American Labor Alliance and its affiliate CompOne USA, are soliciting, marketing, selling, and issuing to employers statewide what the company claims are valid workers' compensation policies, when in fact the department's Investigation Division found the company is not properly registered with the regulator and is allegedly transacting insurance without proper authority.

According to the allegations of the Order, "Respondents are not currently licensed or authorized by the Insurance Commissioner to act in any capacity regarding the transaction of insurance in California, and during relevant periods herein, did not hold any license, Certificate of Authority, or permit , issued by the Insurance Commissioner, to act in any capacity regarding the transaction of insurance in California."

Insurance Code § 12921.8(a) authorizes the Insurance Commissioner to issue a Cease and Desist Order to a person who has acted in a capacity for which a license, registration, permit, or Certificate of Authority from the Insurance Commissioner was required but not possessed.

"Employers who purchased insurance from American Labor Alliance are likely at great financial risk," said Insurance Commissioner Dave Jones. "Employers must protect themselves, their employees, and their business by checking with the Department of Insurance to verify the company and agent or broker's license is valid and that the policy they purchased is also valid."

CDI claims that "American Labor Alliance attracted customers by marketing low workers' compensation premium rates, but the end result is employers holding worthless pieces of paper, as the policies are not valid, which means the employers have no coverage - leaving them and their employees at great risk."

The order is effective immediately. Employers transacting business with Agricultural Contracting Services Association, Inc., American Labor Alliance, or affiliate CompOne USA, should contact the Department of Insurance Investigations Division at 661-253-7500 for assistance in determining the validity of their workers' compensation coverage.

American Labor Alliance has requested an administrative hearing before an administrative law judge. The hearing is not yet scheduled. If American Labor Alliance continues marketing and selling the alleged illegal products, in defiance of the department's cease and desist order, they face fines up to $5,000 per day for each day they do not comply ...

The California Insurance Commissioner issued a decision regarding the WCIRB’s January 1, 2017 Regulatory Filing which was submitted to the California Department of Insurance (CDI) on June 28, 2016 and subject to a public comment period that ended on September 28, 2016. In the Decision, the Commissioner approved all of the WCIRB’s proposed changes effective January 1, 2017 to the California Workers’ Compensation Uniform Statistical Reporting Plan - 1995 (USRP), Miscellaneous Regulations for the Recording and Reporting of Data - 1995 (Miscellaneous Regulations), and California Workers’ Compensation Experience Rating Plan - 1995 (ERP) with one exception.

A number of clarifying changes to Classifications 5474(1)/5482(1), 5506, 6218(2)/6220(2), 5507 and 8227 were not approved due to a pending appeal before the CDI Administrative Hearing Bureau.

The proposed amendments would define first aid claims and require that they be included in insurer reporting. First aid claims have been a longstanding concern because some insurers do not report first aid claims as currently required under the USRP, which, according to the CDI, gives their policyholders an unfair advantage in the market.

The current regulations do not specifically mention first aid claims; thus, some insurers have interpreted the regulations to mean that they need not report medical payments for first aid claims. However, the USRP does not provide any exceptions that would enable insurers to refrain from reporting any medical loss, including first aid medical losses. The confusion may stem from the fact that first aid claims are treated differently than indemnity claims under the Labor Code in the workers' compensation system. The proposed amendments clarify the existing obligations to report all claims and will enhance the WCIRB's ability to properly account for first aid claims when determining appropriate statewide experience modifications.

The WCIRB's planned study regarding whether to exempt a certain amount of medical loss from the reporting requirements may or may not come to fruition in 2019; thus, there is no basis to conclude that the market will benefit from delaying implementation. Also, the WCIRB's inability to quantify the extent to which insurers underreport claims underscores the immediate need for the implementation of these amendments, which will clarify the regulations to all insurers and policyholders and foster the proper reporting of all claims, in furtherance of a fair and equitable system.

All the proposed amendments to the ERP including the WCIRB’s proposed 2017 rating values to be used in the computation of 2017 experience modifications in accordance with the variable split experience rating formula adopted by the Commissioner in 2015 to be effective January 1, 2017. The approved 2017 experience rating eligibility threshold is $10,100. (View the approved revised tables.)

The WCIRB is in the process of updating the USRP, Miscellaneous Regulations and ERP. Once complete, these documents will be posted to the Publications and Filings page of the WCIRB website. In the interim, the WCIRB has prepared the2017 Quick Reference Guide summarizing the approved changes to the Commissioner’s regulations.

The Decision pertains only to the WCIRB’s Regulatory Filing and does not include amendments to advisory pure premium rates. Changes to advisory pure premium rates were proposed in the WCIRB’s amended January 1, 2017 Pure Premium Rate Filing submitted on October 3, 2016 ...

Physicians treating in the California workers' compensation system are required to follow the evidence-based recommendations in the DWC medical treatment utilization schedule (MTUS).

The Division of Workers’ Compensation (DWC) launched a free online education course for physicians treating patients in the California workers’ compensation system. This online one-hour course is for treating physicians, qualified medical examiners, physician reviewers, other health care providers, as well as anyone else interested in learning how to use the MTUS.

"Caring for California’s Injured Workers: Using California’s Medical Treatment Utilization Schedule (MTUS)" is the first entry in a planned series of education modules developed for medical doctors, chiropractors and nurses. The MTUS is the primary source of guidance for treating physicians and physician reviewers for the evaluation and treatment of injured workers.

"All medical providers who treat injured California workers are required to understand and follow the MTUS. The online course is a convenient tool for providers to learn how to use the treatment guidelines designed to improve medical outcomes for injured workers," said DWC Executive Medical Director Dr. Raymond Meister.

The module is available on the DWC website and will be available by mobile app soon.

Medical doctors, chiropractors and nurses who take the course will receive one hour of free CME credit. Qualified medical evaluators (QMEs) may report up to one hour of credit for QME reappointment. The course is also available to anyone else wishing to learn about the MTUS, and a completion certificate is available.

The education module covers:

1) What the MTUS is and how to use it
2) How to navigate the MTUS treatment guidelines and apply recommendations via case scenarios
3) When to consider recommendations outside of the MTUS guidelines for the care of your patient
4) The role of utilization review (UR) and independent medical review (IMR) physicians

Access to the physician education module can be found on the DWC website ...

A Los Angeles County Sheriff’s Deputy (identified as John Doe) and the Association for Los Angeles Deputy Sheriffs (ALADS) filed a complaint against the County of Los Angeles and other parties alleging that the defendants unlawfully accessed Doe’s medical information, and later discriminated and retaliated against him for asserting his right to keep that information confidential.

Doe has been a Sheriff’s Deputy since 1997. In 2009, he suffered a work-related injury to his back for which a physician prescribed narcotic pain medication. Doe became physically dependent on the medication. He received workers’ compensation benefits for both the back injury and his dependency. He entered a drug dependency treatment program. He completed the program successfully in June and was released to return to full time, unrestricted duty. From June 2011 until February 2012, Doe worked full time as a deputy sheriff. He had back surgery in February, then took a leave of absence until July 6, 2012.

In May 2012, while on leave, Doe filled several prescriptions he obtained from different physicians for pain medications. In August 2012, the County’s workers’ compensation administrator noticed that the number of prescriptions was "unusual" and informed the sheriff’s department about the prescriptions. When confronted Doe stated that he had decided to quit taking the medication and destroyed the remaining pills. The last time he took narcotic pain medication was in June 2012.

From August 6, 2012 until June 13, 2013, Doe worked full time without restrictions or problems. The sheriff’s department nevertheless placed him on a performance mentoring program. Doe was required to attend quarterly performance reviews and submit to drug tests. From August 2012 until June 2013, Doe provided the required information and passed all drug tests.

On December 6, 2012, someone in the sheriff’s department accessed Doe’s records within the County’s Prescription Medication Drug Database (PMDD) for the purpose of discovering the medications Doe had been prescribed. Employees of the County and the sheriff’s department reviewed the information. Doe had not authorized access or review, and did not learn of it until November 2013.

Later, five supervisors attempted to get Doe to authorize access to his prescription information, telling him that it would "save [his] job." And three sheriff’s department officers asked him to voluntarily submit to a psychological fitness for duty evaluation. Doe declined both requests. Later he was "ordered to engage in a fitness for duty psychological re-evaluation." The defendants were allegedly aware that Doe would be required to release this information as part of the fitness for duty evaluation.

Doe consented to the evaluation, but refused to authorize the release of his medical records. The psychologist was therefore unable to conduct the evaluation. The next day Doe was ordered to take a medical leave of absence. He complied, even though he was ready, willing, and able to perform his duties. He has been on leave of absence since that time.

Doe filed a civil complaint against the County alleged nine causes of action involving invasion of privacy and retaliation. The defendants filed a special motion to strike the complaint under Code of Civil Procedure section 425.16, commonly referred to as an anti-SLAPP motion. The trial court granted the motion, dismissed the case and awarded $10,230 in attorneys’ fees to the defendants. The Court of Appeal reversed in the unpublished case of Assn. for Los Angeles Deputy Sheriffs v. County of Los Angeles.

Resolving an anti-SLAPP motion involves a two-part inquiry. First, the defendants must make a prima facie showing that the challenged cause of action arises from activity protected by the anti-SLAPP statute. If the defendants satisfy their burden of showing that the cause of action arises from protected activity, the burden shifts to the plaintiffs to make a prima facie showing of facts demonstrating a probability of prevailing on their claim.

The Court of Appeal determined that the plaintiff’s causes of action do not arise from activity protected under the anti-SLAPP statute, the trial court erred in granting defendants’ special motion to strike the complaint and in awarding defendants’ their attorneys’ fees. The order granting the defendants’ special motion to strike the complaint and the award of attorneys’ fees were reversed and his case will proceed ...

The Wall Street Journal reports that finalized rates for big health insurance plans around the country show the magnitude of the challenge facing the Obama administration as it seeks to stabilize the insurance market under the Affordable Care Act in its remaining weeks in office.

Market leaders that are continuing to sell coverage through HealthCare.gov or a state equivalent have been granted average premium increases of 30% or more in Alabama, Delaware, Hawaii, Kansas, Mississippi and Texas.

In states including Arizona, Illinois, Montana, Oklahoma, Pennsylvania and Tennessee, the approved rate increases for the market leader top 50%. In New Mexico, the Blue Cross Blue Shield plan agreed to resume selling plans through the online exchanges after sitting out last year, but has been allowed to increase rates 93% on their 2015 level.

Dominant insurers in Connecticut, Georgia, Indiana, Kentucky, Maine, Maryland and Oregon have been allowed to raise premiums by 20% or more, and rate increases from similarly situated carriers in Colorado, Florida and Idaho are brushing up against that threshold.

The Obama administration has characterized the year as one of "transition," in part because insurers priced aggressively low in the opening enrollment periods for coverage under the law, and has pledged new efforts to encourage healthier people to sign up.

"The situation is serious," said Alissa Fox, senior vice president of the Office of Policy and Representation for the Blue Cross Blue Shield Association. "The reason the premiums are where they are is that the people we are covering have serious conditions and they’re using a lot of medical services because of their chronic illnesses. That’s clear. And there’s not enough young, healthy people to balance out those costs."

House Speaker Paul Ryan, a Wisconsin Republican, said the insurance markets are already in a "death spiral,’" and that "we’re going to have to change this thing."

Insurers had warned of a turbulent year as they came to terms with the impact of sicker people rushing forward to buy insurance under new rules that required them to accept all buyers regardless of their medical history. A number of popular plans have folded, such as the "cooperative" startups funded by the law, sparking an exodus of their members onto the remaining insurers.

The danger for insurers and supporters of the law now is that high prices and limited choices further deter low-risk people from signing up, and that the increases continue and become irreversible ...

The California Department of Insurance notified all workers' compensation insurers writing policies in California of the changes to definitions of and procedures related to excluded employees due to the Legislature's enactment of Assembly Bill 2883 (Assembly Insurance Committee).

Beginning January 1, 2017 all business workers' compensation insurance policies, including in-force policies, will be required to cover, among others, certain officers and directors of private corporations and working members of partnerships and limited liability companies that may have been previously excluded from coverage.

According to the legislative analysis "current law has resulted in abuses". One proponent of the new law provided an example where an insurer found a company trying to exclude the "vice-president of dishwashing." In another example, a company provided coverage for all of their employees, but during the post audit conducted by the insurer, the company retroactively declared that several employees with a tiny ownership share were exempt under the corporate officer statute and demanded a premium refund. The proponents argue that AB 2883 addresses these issues by removing the uncertainty found in existing law by clearly defining what constitutes an eligible employee for a policy exclusion.

"The existing election process to opt out of coverage is not very clear. Beyond one limited statutory reference and very little regulatory guidance, insurers and LLCs are left to figure it out for themselves.The Association of California Insurance Companies (ACIC), one of the supporters of this bill, argues that this lack of clarity has led to abuses that have hurt injured workers and driven fraudulent activity."

To resolve this abuse, the new law creates an explicit process through which an officer or member of a board of directors or working members of a partnership or LLC may elect to be excluded from a workers' compensation policy. Specifically, AB 2283 would: permit an officer or member of the board of directors to opt out of a workers' compensation policy if he or she owns at least 15 percent of the issued and outstanding stock of the corporation and executes a written waiver of his or her rights under this chapter stating under penalty of perjury that the person is a qualifying officer or director. Permit an individual who is a general partner of a partnership or a managing member of a limited liability company to opt out of a workers' compensation policy if he or she executes a written waiver of his or her rights under this chapter stating under penalty of perjury that the person is a qualifying general partner or managing member.

The Commissioner met with the American Insurance Association (AIA) and Association of California Insurance Companies (ACIC), who supported AB 2883, and the Department of Industrial Relations (DIR) to discuss its implementation.

"AB 2883 is going to cause significant disruption for workers' compensation insurers and employers. We have issued a notice today to workers' compensation insurers so that they know what the new law requires of them and we directed insurers to provide notice to employers so they are made aware of the new law," said Commissioner Dave Jones. "Unfortunately, AB 2883 did not include any language exempting in-force policies or delaying its effective date so as not to impact in-force policies. The DIR, AIA and ACIC agree that this change in law applies to in-force policies."

Insurance companies are required to identify and provide notice to each employer that may have employees that were previously excluded from coverage and are affected by the new law. Insurers are also required to determine and report the premium and loss experience associated of those who have not chosen to opt of the coverage. Employers who believe they may be affected by this change in law are encouraged to contact their workers' compensation insurer or their workers' compensation agent or broker ...

The California workers' compensation Official Medical Fee Schedule is based upon a "pay for procedure" model which encourages medical professionals to provide as many procedures as possible to increase income. The next evolution of payment for medical services is known as "pay for performance." Under this new model medical professionals will be paid more money for better outcomes, rather than for procedures that have little or no effect on outcome.

Changing the way it does business, Medicare on Friday unveiled a far-reaching overhaul of how it pays doctors and other clinicians consistent with the "pay for performance" model.

The goal is to reward quality, penalize poor performance, and avoid paying piecemeal for services. Whether it succeeds or fails, it's one of the biggest changes in Medicare's 50-year history.

The complex regulation is nearly 2,400 pages long and will take years to fully implement. It's meant to carry out bipartisan legislation passed by Congress and signed by President Barack Obama last year.

The concept of paying for quality has broad support, but the details have been a concern for some clinicians, who worry that the new system will force small practices and old-fashioned solo doctors to join big groups. Patients may soon start hearing about the changes from their physicians, but it's still too early to discern the impacts.

The Obama administration sought to calm concerns Friday. "Transforming something of this size is something we have focused on with great care," said Andy Slavitt, head of the federal Centers for Medicare and Medicaid Services.

Officials said they considered more than 4,000 formal comments and held meetings around the country attended by more than 100,000 people before issuing the final rule. It eases some timelines the administration initially proposed, and gives doctors more pathways for complying.

The American Medical Association said its first look suggests that the administration "has been responsive" to many concerns that doctors raised.

In Congress, staffers were poring over the details. Rep. Tom Price, R-Ga., who worries that Medicare's new direction could damage the doctor-patient relationship, said he's going to give the regulation "careful scrutiny." Sen. Orrin Hatch, R-Utah, chairman of a panel that oversees Medicare, called it an "important step forward," but said the administration needs to keep listening to concerns.

MACRA, the Medicare Access and CHIP Reauthorization Act, creates two new payment systems, or tracks, for clinicians. It affects more than 600,000 doctors, nurse practitioners, physician assistants and therapists, a majority of clinicians billing Medicare. Medical practices must decide next year what track they will take.

Starting in 2019, clinicians can earn higher reimbursements if they learn new ways of doing business, joining a leading-edge track that's called Alternative Payment Models. That involves being willing to accept financial risk and reward for performance, reporting quality measures to the government, and using electronic medical records.

...