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. The study findings are generally released in the fall of each even-numbered year, in summary form. A full report, including detailed data and notes on methodology, is released several months later. Oregon has been doing these studies in even-numbered years since 1986.

DCBS surveys insurance regulators and workers' compensation rating bureaus in each of the 50 states plus Washington, D.C., for rate information, as of Jan. 1 of the study year.

The study is based on methods that put states’ workers’ compensation rates on a comparable basis, using a constant set of risk classifications for each state. This study used classification codes from the National Council on Compensation Insurance (NCCI). Of approximately 450 active classes in Oregon, 50 were selected based on relative importance as measured by share of losses in Oregon. To control for differences in industry distributions, each state’s rates were weighted by 2010-2012 Oregon payroll to obtain an average manual rate for that state. Listed in Table 1 of the study are Oregon’s rankings in the top 10 (by payroll) of the 50 classifications used.

According to the 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%.

On the other end of the spectrum, North Dakota was the lowest cost at 48% of the study median, followed by Indiana at 57%, Arkansas at 58%, West Virginia at 66%, and Virginia at 67% of the study median.

Workers Compensation costs are not the only indicator of concern. California also has the distinction of being the absolute worst in other areas of importance to business.

Between 2008 and 2015 at least 9,000 companies have left California for a better business environment, according to the 378 page study by Spectrum Location Solutions titled, California’s Forty Year Legacy of Hostility to Business.

Joseph Vranich, president of site selection consultants Spectrum Location Solutions (VLS) in Irvine, places the blame on the Golden State’s "hostile" business environment.

The 2015 Chief Executive Magazine annual survey of business climates was completed by 511 CEOs across the U.S. States were measured across three key categories to achieve their overall ranking: Taxes and regulations, quality of the workforce, and living environment, which includes such considerations as quality of education, cost of living, affordable housing, social amenities and crime rates.

For the 11th year in a row, Chief Executive Magazine found California to be the "worst state for business in 2015." This placement is not "near the worst" but actually "THE WORST" ranked as 50 out of 50, the lowest rank possible for each of 11 years. CEO’s comments include: "California could hardly do more to discourage business if that was the goal." "The state regulates and taxes companies unreasonably." "California is getting worse, if that is even possible."

Well, yes that is possible. Yet another national study continues to place California at the absolute bottom in the eyes of business officials ...

The California Department of Insurance has awarded $34.9 million in grants to 37 district attorney offices representing 44 counties across California to combat workers' compensation insurance fraud.

The grants, funded through employer assessments, support law enforcement efforts in investigating and prosecuting workers' compensation insurance fraud.

Workers' compensation insurance fraud includes medical provider fraud, employer premium fraud, employer defrauding employee, insider fraud, claimant fraud, and the willfully uninsured operating in the underground economy. These cases, when successfully prosecuted, help level the playing field for honest businesses and discourage future fraudulent activity.

Grant funding is based on assessments from California insured and self-insured employers. California district attorneys apply for workers' compensation insurance fraud grant funds. The commissioner's panel reviews the applications and makes funding recommendations to the commissioner, based on multiple criteria, including past performance, the county's problem statement, and their program strategy for the upcoming year. The panel makes a recommendation to the insurance commissioner, who either accepts or amends the panel's recommendation. The commissioner's recommendation is submitted to the Fraud Assessment Commission for their advice and consent, and then the grants are awarded.

This year the grants were distributed to the several counties as follows:


Alameda

$1,511,933

Sacramento

$952,027

Amador

$393,896

San Bernardino

$1,968,662

Butte

$76,378

San Diego

$5,028,198

Contra Costa

$864,000

San Francisco

$758,121

El Dorado

$292,828

San Joaquin

$472,972

Fresno

$1,116,000

San Luis Obispo

$54,419

Humboldt

$200,000

San Mateo

$677,353

Imperial

$125,450

Santa Barbara

$331,499

Kern

$752,904

Santa Clara

$2,626,811

Kings

$263,875

Santa Cruz

$49,000

Los Angeles

$6,729,177

Shasta

$137,307

Marin

$245,000

Siskiyou

$46,832

Merced

$175,209

Solano

$169,476

Monterey

$660,000

Sonoma

$82,120

Napa

$123,609

Tehama

$112,127

Nevada

$75,049

Tulare

$501,165

Orange

$4,152,802

Ventura

$708,652

Placer

$175,000

Yolo

$257,010

Riverside

$2,084,970

-------------------------------

----------------------------






TOTAL
$34,951,831
...

An oncologist in suburban Detroit ordered "lifetime" chemotherapy, with all its adverse effects, for patients whose cancer was in remission. He ordered it for patients on their deathbed with stage IV cancer. And perhaps worst of all, Dr Fata ordered chemotherapy for patients who never had cancer but believed that they did because of his fabricated diagnoses. Now serving a 45-year prison sentence for fraud, Dr Fata was taken down by a team of Department of Justice (DOJ) prosecutors who included Gejaa Gobena.

Besides personally tackling cases such as Dr Fata's, Gobena headed the healthcare fraud unit in the DOJ's criminal division overseeing the prosecution of close to 1000 individuals across the country. Bringing Medicare fraudsters to justice earned Gobena a number of honors, including the Award for Excellence from the Office of Inspector General in the Department of Health and Human Services.

He was interviewed about his work. Medscape just published an article about what he said. "Medicare's under full assault by fraudsters," Gobena told Medscape Medical News in the recent interview.

Medscape asked Gobena how and why a tiny minority of physicians are breaking bad, whether it's cheating Medicare or writing painkiller prescriptions every 10 minutes at an outlaw pill mill. Here are his answers.

Gobena said that the most common factor is financial difficulty. Sometimes it intersects with another factor, which is age. Because you have a doctor in a tough financial situation towards the end of their career, participating in these schemes gives them a way to make some money very quickly. Oftentimes it is personal bankruptcy, or someone who's been married a couple times, got divorced, has various alimony or child support obligations.

What about medical specialties? Do some types of physicians show up disproportionally in fraud schemes?

Gobena said there were not a ton of specialists that he saw. It's usually the opposite. He saw a lot of internists billing for tests and services that didn't make sense and probably should have been billed by specialists in the first place. A primary care physician suddenly billing for an unusually high percentage of, let's say, nerve conduction tests. Very expensive, and usually done by neurologists.

Medscape asked about opioid pill mills. "In some cases, you'd have physicians working for nonphysicians. How widespread is that?"

Gobena said it was definitely common in a lot of the schemes that he personally prosecuted or oversaw. It's a reflection of the fact that until the last few years, the vetting of people who could open a clinic, open a home health agency, was not as strong as it could have been. CMS in the last few years has really stepped up its efforts to screen potential providers. CMS now does criminal background checks. When he first started prosecuting cases, what he saw was people running multiple clinics with no medical background.

One other thing that CMS is doing. In certain regions, they're putting "freezes" on the ability to open up certain types of services. There has been a freeze in Houston on ambulance companies for a while. There is rampant ambulance fraud down there. So they're freezing the number of ambulance companies that can be signed up as Medicare providers. Home health, as well, in Houston, South Florida, and Detroit.

In Michigan, it was very easy to open a home health agency if you're a fraudster. Home health agencies were popping up all over the place, and statistically, it didn't even make sense when you looked at the population.

Medscape asked about physicians who work for criminals especially where physicians were recruited into pill mills and did the bidding of people who had gangster nicknames and guns. The physicians were pressured, and sometimes bullied, to keep up a certain level of prescribing and not make waves. "That astounded me."

Gobena said that there are instances where doctors get into a scheme and then can't get out. They may not want to prescribe the amount of OxyContin or fentanyl that they're prescribing. It's often difficult to get out when the owner of the place is a hardened criminal. But I can't think of any instance when, at least initially, the doctor didn't voluntarily agree to be part of the scheme.

Many criminal practices employ patient recruiters who offer people fast food, cash, or some other kind of benefit to visit the office and receive services. An example based on a case he prosecuted 5 or 6 years ago, was a general-practice clinic that came onto his radar because they billed nerve conduction studies for 75% or 80% of patients, an outrageously high percentage given that a typical neurologist will perform these on 30% to 40%.

There were doctors who were signing off on the tests. In addition, there was the owner who hired patient recruiters who would go into the poorer parts of Detroit. They would recruit in low-income housing and soup kitchens, offering $50 to $100 to anyone who had a Medicare card to come to this clinic.

The recruiters would coach the patients based on instructions from the owners. The medical records have to show that there is medical necessity for these nerve conduction studies. So they'd coach the beneficiaries to say that they had pain or that their back or arms had tingling sensations, to show that there was some sort of nerve damage. They told the beneficiaries to tell the doctor that.

The doctors would sign off even though it didn't make sense to have that high of a percentage coming to a general practice having these exact same symptoms. They often would prescribe opioids in addition.

At the end of the day, the doctor was able to bill for their professional services. The clinic was able to bill for the nerve conduction studies, which would run something like $2500 to $3000 a study. The recruiters would get paid by the owners of the clinic. There ...

A West Los Angeles man who was the owner of a medical supply company has been sentenced to five years in federal prison for his role in a scheme that fraudulently billed more than $4 million to Medicare.

Valery Bogomolny, 44, of Westwood, was sentenced by United States District Judge S. James Otero, who also ordered the defendant to pay $1,266,860 in restitution.

The sentencing of Bogomolny was announced by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division; United States Attorney Eileen M. Decker; Assistant Director in Charge Deirdre L. Fike of the FBI’s Los Angeles Field Office; and Special Agent in Charge Christian Schrank of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Los Angeles Region.

Bogomolny was found guilty by a federal jury in November 2015 of six counts of health care fraud. According to evidence presented at trial, between January 2006 and October 2009, Bogomolny used his company, Royal Medical Supply in the Beverly Grove district of Los Angeles, to bill Medicare $4 million for power wheelchairs, back braces and knee braces that were medically unnecessary, not provided to beneficiaries or both.

The evidence further showed that Bogomolny created false documentation to support his false billing claims, including creating fake reports of home assessments that never occurred. Power wheelchairs were delivered to beneficiaries who were able to walk without assistance. In other cases, Bogomolny signed documents stating that he had delivered equipment when, in fact, the equipment was not actually delivered.

"Royal Medical Supply was a complete fraud," said United States Attorney Eileen M. Decker. "Many purported patients lived over 100 miles away from the storefront, most of the prescriptions were issued under the names of doctors either associated with or the victims of fraud, and most of the patients never received the equipment paid for by Medicare. Mr. Bogomolny supervised this scheme victimizing U.S. taxpayers, warranting this significant sentence."

The FBI and HHS-OIG investigated the case, which 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 of the Central District of California. DOJ Fraud Section Trial Attorneys Ritesh Srivastava and Claire Yan prosecuted the case.

Since its inception in March 2007, the Medicare Fraud Strike Force, which now operates in nine cities across the country, has charged over 2,900 defendants who collectively have billed the Medicare program for more than $10 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers ...

Defense giant Northrop Grumman has signed a nearly $92-million contract with the Centers for Medicare and Medicaid Services to build the second phase of a computer system that’s currently focused on reducing fraud but down the road will play a greater role in anticipating beneficiaries’ medical disorders.

The story in the Los Angeles Times says it’s the most prominent example of how public and private insurers are spending millions of dollars on "big data" - using advanced technology to predict people’s future healthcare needs based on their interactions with doctors, hospitals and pharmacies, as well as information gleaned from other sources, such as social media.

Such systems, known as predictive analytics, aim to make healthcare more efficient and effective by opening the door to addressing medical issues before they become serious problems.

"There are tremendous advantages to big data in healthcare," said Gerard Magill, a professor of healthcare ethics at Duquesne University in Pittsburgh. "It’s about creating a comprehensive approach to using medical information."

The trade-off: Say goodbye to individual privacy.

"Big data requires that information; it’s nonnegotiable," Magill said. "Individual privacy is gone for the common good."

Medicare’s contract with Northrop Grumman is one of the largest efforts underway to create a healthcare crystal ball capable of looking into patients’ futures.

"The use of data in healthcare is absolutely critical," said Dr. Shantanu Agrawal, director of Medicare’s Center for Program Integrity, which is tasked with lowering costs. "Having it be predictive of various issues is extremely important."

Medicare has been criticized in the past for using a "pay and chase" approach to fraud - that is, paying all 4.5 million claims that are submitted daily and then attempting to determine which ones may have been bogus and trying to reclaim the funds.

Rep. Peter Roskam (R-Ill.), chairman of the House Ways and Means Oversight Subcommittee, said at a hearing on healthcare fraud last month that the agency needs to move faster in implementing "better data analysis and predictive analytics."

Medicare says the first phase of its Northrop-designed fraud-detection system produced more than $1 billion in savings over the last two years.

Amy Caro, vice president of the health solutions division of Northrop Grumman Technology Services, told me it’s clear that sophisticated algorithms are the best way to spot and crack down on fraudulent medical claims. They’re capable of sifting through millions of submissions and recognizing signs and patterns that indicate a claim may not be on the up and up.

The next step, she said, will be using big data capabilities to get ahead of Medicare and Medicaid beneficiaries’ healthcare needs.

"You have all types of data out there and available," Caro said. "You’re able to drill down and look for signs of certain diseases or conditions."
...

If the previous occupant of a hospital bed received antibiotics, the next patient who uses that bed may be at higher risk for a severe form of infectious diarrhea, according to a new study reviewed in Reuters Health.

Clostridium difficile (C. diff) diarrhea causes 27,000 deaths each year in the U.S. Hospital patients taking antibiotics are particularly at risk for it, say the authors of the study. Antibiotics disturb the normal healthy bacteria of the gut so a C. diff infection can take hold.

The new study shows that "antibiotics given to one patient may alter the local microenvironment to influence a different patient’s risk" for C. diff infection, the researchers wrote in JAMA Internal Medicine.

"Other studies have also demonstrated that antibiotics can have a ‘herd’ effect - in other words, that antibiotics can affect people who do not themselves receive the antibiotics," said lead author Dr. Daniel Freedberg of Columbia University Medical Center in New York.

Freedberg and his colleagues studied more than 100,000 pairs of patients who sequentially occupied a given hospital bed in four institutions between 2010 and 2015, not including those who had recent C. diff infection or whose prior bed occupant was in the bed for less than 24 hours.

More than 500 patients, or less than 1 percent of the total group, developed a C. diff infection as the second bed occupant.

The infections were 22 percent more likely when then previous occupant had received antibiotics.

Other factors about the previous bed occupant were not associated with C. diff risk.

People can be carrying C. diff organisms without having any symptoms, Freedberg told Reuters Health by email. When these colonized patients receive antibiotics, C. diff may expand within their gut microbiome and start shedding more spores, which means more spores on the bed, the bedside table, the floor, and other areas, he said.

"The next patient who enters the room is thus more likely to be exposed to C. diff spores," he said. "It’s not easy to sterilize the room/bed between patients because C. diff spores are extremely hardy. To be killed, they need to be soaked in a bleach-containing cleaning agent for an adequate amount of time."

About half of patients in acute care facilities take antibiotics on any given day, said Kevin Brown of the University of Toronto Dalla Lana School of Public Health, who was not part of the new study.

"That’s a huge portion of patients that could be involved in spreading the infection," Brown told Reuters Health by email.

But the increased risk is modest, Freedberg added.

"There was a 22 percent relative increase in risk for C. diff with the prior patient’s antibiotics but there was a four-fold increase in risk related to the antibiotics received by the patient him- or herself," he said.

Other patients, such as other antibiotic user patients within the ward, could have contributed increased risk as well, Brown said.

"Doctors (and patients) should avoid antibiotics in situations where they are not necessary," Freedberg said. "Too often, antibiotics are prescribed without clear indications."

"I think this evidence needs to be taken just as an association that needs further exploration," said Jack A. Gilbert of Argonne National Laboratory in Argonne, Illinois, who was not part of the new study. "While it would be tempting to use these results to change policy, there are so many uncertainties here that such a move would not be advisable." ...

Intense physical exertion or extreme emotional upset can each trigger a heart attack, and the risk may be highest if the two are combined, according to a new study reviewed in Reuters Health.

"Our study is the largest study exploring this issue, and unlike previous studies we included people from many different countries and ethnicities," said lead author Andrew Smyth of the Population Health Research Institute at McMaster University in Hamilton, Ontario, Canada.

The association between the triggers and the onset of heart attack was similar across all locations, he added.

The researchers used data from more than 12,000 cases of first heart attack in 52 countries, recorded in the INTERHEART study. After the heart attack, study staff asked patients if they had been engaged in heavy physical exertion or were angry or emotionally upset in the hour leading up to the heart attack and in the same hour on the previous day.

Almost 14 percent said they had been engaged in heavy physical exertion and 14 percent said they were angry or emotionally upset in the hour leading up to the heart attack.

Being angry or physically strained roughly doubled the heart attack risk. If the two factors were combined, heart attack was about three times as likely, as reported in Circulation.

The researchers didn’t explicitly define "upset" or "exertion" for patients, who decided this for themselves, Smyth told Reuters Health by email.

In terms of heart attack triggers, there was no difference between those with and without diabetes or high blood pressure, he said.

"It’s useful to know that either getting angry to an extreme or exercising to an extreme could potentially be harmful especially for middle aged people with cardiac risk factors," said psychologist Barry Jacobs, director of behavioral sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania, and spokesperson for the American Heart Association, who was not part of the new study.

"One of the weaknesses of the study is that it doesn’t define what an extreme physical exertion experience would be or an extreme anger experience," Jacobs told Reuters Health by phone.

Everyone can benefit from keeping their tempers in check, and when angry, it’s not a good idea to throw yourself into extreme physical exercise, he said ...

Workers’ compensation benefits as a share of payroll are reaching historically low levels, even as employers shoulder more costs, according to a new report from the National Academy of Social Insurance

Until 1995, the U.S. Social Security Administration (SSA) produced the only comprehensive national data on workers’ compensation benefits, coverage, and costs with annual estimates dating back to 1946. SSA discontinued the series in 1995 after publishing data for 1992 -1993. The National Academy of Social Insurance assumed the task of reporting national data on workers’ compensation in 1997. The Academy published its first report that year, extending the data series from 1993 through 1995, and has produced the report annually ever since.

The 19th annual report of the National Academy of Social Insurance on workers’ compensation benefits, coverage, and costs is now available. This report presents new data on workers’ compensation programs for 2014 and updated estimates for 2010 - 2013 with newly available data. The revised estimates in this report replace estimates in the Academy’s prior reports.

The Academy’s measures of benefits and costs are designed to reflect the aggregate experience of two stakeholder groups: workers who rely on compensation for workplace injuries and employers who pay the bills.

Despite growth in employment during the economic recovery - and the corresponding uptick in employees covered by workers’ compensation - benefits per $100 of payroll fell from $0.97 in 2013 to $0.91 in 2014, the lowest level since 1980. Benefits as a percent of payroll declined in 46 states between 2010 and 2014, continuing a national trend in lower benefits relative to payroll that began in the 1990s.

Costs to employers, on the other hand, continue to climb. Between 2010 and 2014, employer costs associated with workers’ compensation - such as insurance premiums, reimbursement payments, and administrative costs - grew at a rate nearly 5 times faster than benefits. Nationally, employer costs exceeded total benefits in 2014 by $29.5 billion while costs per $100 of payroll reached $1.35, according to the report, Workers’ Compensation: Benefits, Coverage, and Costs (PDF).

"What we are seeing in these data are still the effects of the economy gradually coming out of the recession of 2008-10," said Marjorie Baldwin, Chair of the Academy’s Study Panel on Workers’ Compensation Data and Professor of Economics in the W. P. Carey School of Business at Arizona State University. "As more workers are hired, employers immediately incur higher costs for workers’ compensation insurance - the increase in benefits paid comes with a lag, especially for the most costly long-term injuries."

The ratio of benefits paid per $1 of employer cost has varied over the last 20 years from a high of $0.82 in 1999 to a low of $0.63 in 2006. The ratio has declined from $0.81 in 2010 to $0.68 in 2014, but it is still greater than in the five years leading up to the recession of 2008.

"Declining levels of workers’ compensation benefits could mean that workers are getting injured less frequently and/or that they are returning to work sooner when they do get injured," said Christopher McLaren, Workers’ Compensation Senior Research Associate at the Academy. "But there have been a number of changes in state laws in recent years limiting access to workers’ compensation benefits, which may also be a factor." ...

In 2011, plaintiff Kristen Nicodemus was admitted to Saint Francis Hospital for treatment of injuries sustained when she was burned. Later she engaged an attorney to represent her in a potential lawsuit. This attorney sent a fax to Saint Francis asking that it provide her copies of her medical records, and attaching a signed authorization to release. This was sent to HealthPort who provided Saint Francis with patient medical record release-of-information services pursuant to a contract.

HealthPort responded to plaintiff’s attorney’s request for medical records, sending a "California Agent Fee Information" sheet and an invoice. In a section explaining the invoice charges, the information sheet quoted section 1158, acknowledging its requirement that medical providers must allow attorneys to inspect and copy patient records on presentation of a patient’s written authorization. The information sheet, however, went on to state: "HealthPort has agreed to copy records for you, upon your hiring of HealthPort as your representative/agent for purposes of making such copies. The rates that HealthPort is charging do not fall under [Evidence Code] 1158."

HealthPort personnel index all requests, assigning them to categories, depending on the context. Requests involving subpoenas or workers’ compensation claims, respectively, for example, are grouped in separate categories.

Evidence Code Section 1158 is designed to require medical providers to produce the medical records demanded by patients prior to litigation in a timely fashion and at a reasonable cost.

At the time of plaintiff’s appeal, section 1158 provided in pertinent part: "Whenever, prior to the filing of any action or the appearance of a defendant in an action, an attorney at law . . . presents a written authorization signed by an adult patient [or by a patient’s guardian, conservator, parent, or personal representative], . . . a licensed hospital . . . shall make all of the patient’s records . . . available for inspection and copying by the attorney at law . . . promptly upon presentation of the written authorization."

The statute authorizes the requesting attorney to employ a professional photocopier to obtain the records on the attorney’s behalf, and the provider must produce the records within five days. (Ibid.) All "reasonable costs" incurred by a medical provider in locating, copying, or making the records available may be charged to the requesting party, subject to limits set forth in the statute, which include $0.10 per page for reproducing documents measuring up to 8.5 by 14 inches, $0.20 per page for producing documents from microfilm, and clerical costs not to exceed $16 per hour per person for locating and making records available.

HealthPort’s invoice to plaintiff’s counsel sought payment of $86.52, and provided directions for payment. The amount included a $30 "basic fee," a $15 "retrieval fee," $25.25 for copying 101 pages at $0.25 per page, $10.30 for shipping, and $5.97 for sales tax. Plaintiff’s attorney paid HealthPort’s invoice in full, noting on the check’s memo line, "under protest - in violation of CA EVID CODE 1158," He later filed suit alleging causes of action for violation of section 1158 and violation of the Unfair Competition Law (UCL) (Bus. & Prof. Code, § 17200 et seq.) and moved to have the action certified as a class action. The trial court denied this motion and plaintiff appealed. The Court of Appeal reversed in the published decision of Nicodemus v Saint Francis Memorial Hospital..

Section 1158 enables the patient to seek freely advice concerning the adequacy of medical care and to create a medical history file for the patient’s information or subsequent use. It operates to prevent a medical provider from maintaining secret notes which can be obtained by the patient only through litigation and potentially protracted discovery proceedings.

"The common question here is the application of section 1158 to HealthPort’s uniform practices in response to attorney requests for medical records. The fact that each class member ultimately may be required to establish his or her records request was submitted before or in contemplation of litigation does not overwhelm the common question regarding those uniform copying practices. The trial court erred in ruling otherwise." ...

Nearly three-quarters of U.S. dermatologists received payments worth a collective $34 million from drug companies in 2014, according to a new analysis of a public database reported by Reuters Health.

In most cases, the payments were worth less than $50, researchers found. But a few doctors were taking industry payments worth at least $93,622.

"Most dermatologist in the U.S. - about 73 percent according to this database - received some form of payment from industry," said lead author Dr. Marie Leger, a dermatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City. "That being said, most dermatologists get a modest amount from industry."

It's difficult to know what these payments mean, but seeing how money flows from industry to the dermatology profession is important to understanding the relationship between those two groups, Leger told Reuters Health.

She and her colleagues analyzed data from the Centers for Medicare and Medicaid Services Sunshine Act Open Payment database, which records payments made to doctors from U.S. medical manufacturers and group-purchasing organizations.

They found that in 2014, 8,333 dermatologists received 208,613 different payments totaling about $34 million. Those payments could take a number of forms, including gifts, grants, education, consulting and food and beverages.

That $34 million, however, represents less than 1 percent of the roughly $6.5 billion paid to doctors in 2014, the researchers report in JAMA Dermatology.

A quarter of dermatologists received less than $100, 63 percent received less than $500 and 78 percent received less than $1,000. The top 10 percent of doctors received at least $3,940, which represented 90 percent of the total paid to dermatologists.

"I think we knew there were interactions, but we didn’t know how many interactions there were," said lead author Dr. Hao Feng, of NYU Langone Medical Center in New York City. "We were surprised that in general it was a modest amount of money."

The top 1 percent of dermatologists received at least $93,622, which accounted for 44 percent of the total.

About 81 percent of the compensation to the dermatologists came from drug companies.

Almost a third of payments were listed as speaking fees, about 22 percent were listed as consulting fees and about 17 percent were listed as research payments.

Dr. Jack Resneck, of the University of California, San Francisco School of Medicine, points out in an accompanying editorial that the payment database is limited.

He wrote that it can be improved if providers are allowed to see what payments industry submit and by the categories better describing interactions.

"Some straightforward changes would substantially improve the situation," he wrote.

Since the database is missing information about the context of these payments, it's difficult to get a better understanding of the interaction between industry and doctors, Feng told Reuters Health.

"That’s something that is really difficult - if not impossible - to get from this database," said Feng.

For example, Leger wondered if the financial connection between industry and dermatology may affect how the specialty advocates for patients in terms of drug costs.

"I think this study maps points of contact in an important way and I think there’s more to explore for what those points of contact mean," she said ...

Current law authorizes workers' compensation insurance policies to be either standard, guaranteed premium policies, or deductible policies and requires insurers to file workers' compensation insurance policies and endorsements with the WCIRB. The WCIRB is the insurance commissioner's designated statistical agent for workers' compensation purposes. There are a range of functions the WCIRB performs on behalf of and with the approval of the commissioner.

Insurers are prohibited from the use of the policy or endorsement until 30 days have passed, or the commissioner has approved the filing. It is unlawful for an insurer to use an ancillary agreement if the commissioner notifies the insurer that the agreement does not comply with the law

AB 1922 was introduced this legislative session to modify this requirement. It attempted to establish exceptions from workers' compensation insurance policy filing requirements for large employers that purchase high deductible policies. It was supported by the American Insurance Association (AIA), the California Chamber of Commerce, Liberty Mutual Insurance, and the National Association of Mutual Insurance Companies (NAMIC).

It was opposed by the California Department of Insurance. It however was approved by both houses of the legislature and sent to Governor Brown for signature. He vetoed the law.

In his veto message he said "I am supportive of efforts to increase the ability of insurance carriers to efficiently conduct their business. This bill, however, reverses Department of Insurance regulations that have been in effect less than six months. These regulations are designed to promote consumer protection and transparency. Let's allow time for them to work."

And the Insurance Commissioner was appreciative of his Veto. "I thank Governor Brown for his thoughtful and reasoned veto of AB 1922," Commissioner Jones said. "I opposed the bill, because it would have created a loophole enabling workers' compensation insurers to limit or avoid prior review of terms and conditions imposed on businesses. AB 1922 undercut the Department of Insurance's ability to protect businesses from becoming victimized by some workers' compensation insurer contracts and it would have resulted in more litigation between businesses and insurers. The bill was bad for employers of all sizes."

Recent cases highlighted problems when CDI lacks oversight.

Last month, after the department served on them an order to show cause why the insurers should not be barred from selling the policies, two Berkshire Hathaway companies agreed to stop selling certain workers' compensation policies with provisions not filed with CDI. The policies had serious and unexpected negative consequences for many California employers, including cancellation penalties of $1 million, non-renewal penalties, provisions shifting most if not all of the risk back to the employer, and provisions requiring any disputes with the insurer to be resolved in the British Virgin Islands under Nebraska law. These unfiled policies were successfully challenged by Shasta Linen, a small business in Sacramento."

A range of business groups joined the Insurance Commissioner in opposing the bill, including the California Hispanic Chambers of Commerce, the California Small Business Association, the Asian Business Association, and the Sacramento Rainbow Chamber of Commerce ...

A new report from the Labor Department had harsh words for the current condition of various state workers' compensation systems.

For example, the DOL says "Despite the sizable cost of workers’ compensation, only a small portion of the overall costs of occupational injury and illness is borne by employers. Costs are instead shifted away from employers, often to workers, their families and communities. Other social benefit systems - including Social Security retirement benefits, Social Security Disability Insurance (SSDI), Medicare, and, most recently, health care provided under the Affordable Care Act - have expanded our social safety net, while the workers’ compensation safety net has been shrinking. There is growing evidence that costs of workplace-related disability are being transferred to other benefit programs, placing additional strains on these programs at a time when they are already under considerable stress.

The report calls for "exploration" of "the establishment of standards that would trigger increased federal oversight if workers' compensation programs fail to meet those standards."

Not unexpectedly, the report caused a firestorm of controversy, and industry rebuttal.

The Property and Casualty Insurers Association of America is composed of nearly 1,000 member companies, representing the broadest cross section of insurers of any national trade association.

PCI members write more than $183 billion in annual premium, 35 percent of the nation's property casualty insurance. Member companies write 42 percent of the U.S. automobile insurance market, 27 percent of the homeowners market, 32 percent of the commercial property and liability market and 34 percent of the private workers compensation market. It is one of the major industry organizations that has formulated a response.

PCI says that "while the Department of Labor report highlights some of the challenges state workers compensation systems are facing, in many sections it provides an inaccurate assessment of how the system really works for the vast majority of injured workers."

"Overall, today’s work environment is safer which means fewer workplace accidents. When workers are injured, on average they are receiving higher benefits than in the past, and health outcomes for injured workers have improved. This means workers are able to return to work sooner and resume productive employment. These improvements to the state workers compensation system have all been achieved without federal involvement."

"While no system is perfect, the state-based system has significantly evolved and will continue to evolve. For over a century, state workers compensation laws have successfully sought to strike a balance between the interests of employers and their employees while promoting safe workplaces. State workers compensation systems guarantee that injured workers receive medical treatment at no cost to the worker and compensation for lost wages and permanent injury, while avoiding cost shifting to families and public assistance programs."

"Employers and insurers are dedicated to supporting reforms that will improve the effectiveness of the state workers compensation system for all stakeholders. PCI and its members will continue to support reforms at the state level that are targeted to maintain an effective and balanced system for all stakeholders."
...

A Corcoran labor contractor who cheated a workers’ compensation insurer out of millions of dollars in premiums has been sentenced to nine months in jail,

Michael Harold Kreger, 63, of Visalia, owner of Michael Kreger Contracting, was sentenced in California Superior Court in Kings County after his conviction on three felony counts of insurance fraud with a white collar crime enhancement charge for cheating his workers' compensation insurer out of more than $5.4 million in premiums.

After receiving a referral from Kreger's workers' compensation insurer, detectives from the California Department of Insurance launched an investigation into Kreger's business practices.

The investigation included an audit of Kreger's payroll records provided to his insurer and what he provided to the Employment Development Department, which revealed that for over four years Kreger intentionally underreported his payroll in order to mislead his workers' compensation insurer and obtain artificially low workers' compensation insurance premiums.

Kreger pleaded no contest to three felony counts of insurance fraud with a white collar crime enhancement.

He was released on house arrest and electronic monitoring after two days in jail, according to jail records.

"This case is a clear example of Kings County's prosecution team standing up for every business owner and employee who is affected by fraudulent business practices that manipulate the system and seek financial gain at the expense of injured employees and upstanding business owner. I am proud of the contribution and work done by all the investigation teams, especially Deputy District Attorney Michael Casaus, Senior Investigator Nicole Lucero, and Legal Secretary Lynn Rikard on behalf of our office." said Kings County District Attorney Keith Fagundes.

The Kings County District Attorney successfully prosecuted this case, leading to Kreger's conviction and sentencing of 270 days (9 months) in jail, five years probation, 1500 hours of community service, and ordered restitution exceeding $5.4 million ...

An article on the ProPublica/NPR website proudly announces that a "race to the bottom" in state workers' compensation laws has the Labor Department calling for "exploration" of federal oversight and federal minimum benefits.

This announcement is the culmination of many ProPublica/NPR stories that featured injured workers who lost their homes, were denied surgeries or were even denied prosthetic devices recommended by their doctors.

The ProPublica/NPR series prompted a letter last fall from 10 prominent Democratic lawmakers, who urged Labor Department action to protect injured workers in the wake of a ProPublica/NPR series on changes in workers' comp laws in 33 states. The ten ranking Democrats on key Senate and House committees claimed there was a "pattern of detrimental changes in state workers' compensation laws" that have reduced protections and benefits for injured workers over the past decade.

The response to this letter was a report from the Labor Department that calls for "exploration" of "the establishment of standards that would trigger increased federal oversight if workers' compensation programs fail to meet those standards."

The report claims that there "have seen significant changes to the workers’ compensation laws, procedures, and policies in numerous states, which have limited benefits, reduced the likelihood of successful application for workers’ compensation, and/or discouraged injured workers from applying for benefits. These include changes that have resulted in the denial of claims that were previously compensated, a decrease in the adequacy of cash benefits to those awarded compensation, imposition of restrictions regarding the medical care provided to injured workers, and the institution of new procedural and evidentiary rules that create barriers for injured workers who file claims. In addition, the elimination by several state legislatures of Second Injury Funds - that is, state-administered funds that provide compensation for injuries not otherwise covered - creates additional holes in the fabric of insurance and coverage.

The agency also suggests a fresh look at reestablishing a 1972 Nixon administration commission that recommended minimum benefits and urged Congress to act if states failed to comply.

To clearly understand the implications of this recommendation, it is important to know the history of the financial waste triggered by the Nixon Commission report after it was published in 1972. In essence, the report was critical of just about every aspect of the various state workers' compensation systems, and recommended improvements or enhancements to every specie of benefits. If states did not improve their programs in conformity to these recommendations, there was a threat of a federal takeover of all state systems.

For example, the Nixon Commission concluded in 1972 that "Many disabled workers fail to receive vocational services partly because they are not aware of their rights, partly because they lack motivation because of a fear they will lose compensation benefits if rehabilitated, and partly because they cannot afford the out-of-pocket costs of maintenance during instruction." Thus the report went on to "recommend that the medical-rehabilitation division within each State's workmen's compensation agency be given the specific responsibility of assuring that every worker who could benefit from vocational rehabilitation services be offered those services".

A few years later, California, as well as many other states, appeased the federal government by adopting some of the Nixon Commission mandates. For example California adopted mandatory vocational rehabilitation. The history of that financial disaster is well documented. Rehabilitation programs easily cost more than $100,000 per claim and rarely produced a return to work outcome. A whole cottage industry of vendors grew around the program. The futility of the program became apparent about 20 years later when a $16,000 cap was placed on the costs of a rehabilitation program. That "reform" was subsequently ineffective, so vocational rehabilitation as a program was scrapped, and instead there have been various forms of training vouchers that pay for training, but no financial benefit to the worker directly. The voucher program is largely unused.

If someone were to add up the industry costs of vocational rehabilitation alone from its birth to its death, it would be a staggering amount of wasted money, spent mostly to appease the federal wonks who thought they knew what they are doing.

With this history in mind, the big question is "is the industry about to face another costly Nixon Commission redux?" ...

A major U.S. hospital chain, Tenet Healthcare Corporation, and two of its subsidiaries will pay over $513 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States and to pay kickbacks in exchange for patient referrals.

In addition, two Tenet subsidiaries have agreed to plead guilty to conspiracy to defraud the United States and to pay health care kickbacks and bribes in violation of the Anti-Kickback Statute (AKS). The plea agreements remain subject to acceptance by the court. Up until April 2016, Tenet subsidiaries Atlanta Medical Center Inc. and North Fulton Medical Center Inc. owned and operated acute-care hospitals located in the greater Atlanta metropolitan area.

These subsidiaries were charged in a criminal information filed in federal court in Atlanta with conspiracy to defraud the United States by obstructing the lawful government functions of HHS and to violate the AKS, which, among other things, prohibits payments to induce the referral of patients for services paid for by federal health care programs. The two Tenet subsidiaries have agreed to plead guilty to the charges alleged in the criminal information and will forfeit over $145 million to the United States - which represents the amount paid to Atlanta Medical Center Inc. and North Fulton Medical Center Inc. by the Medicare and Georgia Medicaid programs for services provided to patients referred as part of the scheme.

And this is not the first offense! The criminal information also charges the subsidiaries with conspiring to defraud HHS in its administration and oversight of the Medicare and Medicaid Programs, including HHS-OIG’s enforcement of Tenet’s September 2006 corporate integrity agreement (the CIA). The criminal information and the civil complaint allege that many of the unlawful payments happened while Tenet was under the CIA. The criminal information further alleges that certain executives of Atlanta Medical Center Inc., North Fulton Medical Center Inc. and others concealed these unlawful payments from HHS-OIG during the pendency of the CIA by, among other things, falsely certifying compliance with the requirements of the CIA and failing to disclose reportable events relating to the unlawful relationship under the CIA.

Tenet HealthSystem Medical Inc. and its subsidiaries (collectively THSM) entered into a non-prosecution agreement (NPA) with the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Northern District of Georgia related to the charges in the criminal information. THSM is the parent company of Atlanta Medical Center Inc., North Fulton Medical Center Inc., Spalding Regional Medical Center Inc. and Hilton Head Hospital, and employed their executives. THSM is a subsidiary of Tenet Healthcare Corporation. Under the terms of the NPA, THSM and Tenet will avoid prosecution if they, among other requirements, cooperate with the government’s ongoing investigation and enhance their compliance and ethics program and internal controls. Tenet has also agreed to retain an independent compliance monitor to address and reduce the risk of any recurrence of violations of the AKS by any entity owned in whole, or in part, by Tenet. The term of THSM’s and Tenet’s obligations under the NPA is three years, but the NPA may be extended for up to one year.

In the civil settlement, Tenet agreed to pay $368 million to the federal government, the state of Georgia and the state of South Carolina to resolve claims asserted in United States ex rel. Williams v. Health Mgmt. Assocs., Tenet Healthcare, et al., a lawsuit filed by Ralph D. Williams, a Georgia resident, in the Middle District of Georgia, under the federal and Georgia False Claims Acts. The acts permit whistleblowers to file suit for false claims against the government entities and to share in any recovery. The federal share of the civil settlement is $244,227,535.30, the state of Georgia will recover $122,880,339.70 and the state of South Carolina will recover $892,125. Mr. Williams’ share of the combined civil settlement amount is approximately $84.43 million.

As alleged in the criminal information as well as civil complaints filed by the department and the state of Georgia in 2014 and 2013, Atlanta Medical Center Inc., North Fulton Medical Center Inc., Spalding Regional Medical Center Inc. and Hilton Head Hospital paid bribes and kickbacks to the owners and operators of prenatal care clinics serving primarily undocumented Hispanic women in return for the referral of those patients for labor and delivery medical services at Tenet hospitals. These kickbacks and bribes allegedly helped Tenet obtain more than $145 million in Medicaid and Medicare funds based on the resulting patient referrals.

There seems to be no end in sight to corruption and fraud perpetrated by major national providers ...

Governor Brown signed AB 2503 into law. The new law will require a physician providing treatment to an injured worker to send any requests for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity according to rules adopted by the administrative director. The bill would also make technical changes to existing law. This new law would incorporate changes to Section 4610 of the Labor Code provided by this bill and the companion sweeping overhaul to the UR process specified in SB 1160 which has also been signed by the Governor. They were in effect companion bills.

According to the author of this law, "it is often difficult for health care providers in the workers' compensation system to obtain timely approval for treatment of injured workers because it is difficult to know where to send RFAs".

"Whether it is intentionally complex systems, or bureaucratic inefficiency, physicians report that upon sending RFAs to what appears to be the correct recipient, they are frequently advised that the RFA and attendant medical materials must be sent elsewhere."

Further, the timeframes within which responses from the UR entity must be provided do not begin to run until the RFA is sent to the "correct" location. The bill is intended to clarify where the RFA and related materials must be sent, so that the time frames specified in statute will be more effective.

According to the author and sponsor, the silence in existing law on where a physician should send a RFA is creating difficulty for healthcare providers and is creating delays in the provision of medical treatment.

Specifically, AB 2503 would require that a RFA is submitted directly to a claims administrator, rather than a UR vendor or some other third party. In doing so, AB 2503 will make precisely clear where a RFA should be submitted so that a request for medical treatment can be timely assessed, avoiding unnecessary delays.

The sponsor of this bill, the California Orthopaedic Association (COA), argued that existing law's silence on where a physician should submit a request for authorization of medical treatment has the potential to create great mischief.

Specifically, COA notes that different employers/insurers have different policies for where a RFA should be submitted, which can lead to confusion for physicians. COA argues that, by specifically stating where a RFA must be submitted, AB 2503 will minimize confusion and delays, leading to better medical treatment for injured workers.

There was no opposition to this law noted in the legislative record.
...

Governor Brown vetoed SB 897. The proposed law would have extended an additional year of injury leave for city police officers, city, county, or district firefighters, and sheriffs if: 1) The injured worker is employed on a regular, full-time basis regardless of their period of service; 2) The injured worker suffers a "catastrophic injury at the hands of another" during active duty through the actions of another or through active firefighting operations without respect to the cause of the fire.

Proponents of the bill noted that California's firefighters, police officers, and sheriffs face significant risks on the job, including a higher likelihood of injury. Proponents argue that the existing leave provisions reflect that, as the Governor and Legislature wanted to ensure that a peace officer facing those risks would not face financial devastation. Proponents argue that AB 897 continues this tradition by granting California's firefighters, police officers, and sheriffs an additional year of leave in order to return to active duty after a catastrophic injury. Proponents note that this extra year will allow firefighters, police officers, and sheriffs to heal from their injuries and return to work when they can, rather than rush back to work still injured and possibly hurt themselves and others.

Opponents of the bill noted that, under current law, police officers, sheriffs, and firefighters have access to a year of paid leave under Labor Code Section 4850, as well as a year of 2/3 wage replacement through TD benefits, both of which are tax-free benefits. Opponents argue that these benefits are significant, and are paid out by self-insured cities and counties on a pay-as-you-go basis. Opponents argue that requiring additional disability benefits will require cities and counties to remove funding from existing services, without necessarily resulting in the injured police officer, sheriff, or fire fighter returning to work.

In Governor Browns veto message he said "This bill doubles from one to two years special leave benefits for police officers, firefighters, or sheriffs who are disabled by a qualifying catastrophic injury. This leave is required to be provided at full salary and tax-free, resulting in take home pay that is higher than pre-injury wages."

"I was concerned when told this bill was prompted by a City of Riverside police officer who nearly lost his health benefits while on temporary disability. In that case, the City chose to extend the officer's benefits. Upon closer review, I have not found any other city which terminates the health benefits of police officers while they are on temporary disability."

"As noted in my veto of AB 1451 last year, this disability leave benefit drives up costs significantly. Many local agencies are under significant financial stress. They must consider employee benefit increases in light of competing demands for critical services and long term pension and health care debts. In light of all this, I believe the decision on how to handle cases such as this is best left to the local jurisdiction." ...

Governor Brown signed SB 1160 into law on the last day of the legislative session. This bill makes a series of significant, wide-ranging changes to the operation and UR processes, approval of UR processes, and lien filing and collection. This bill expedites medical care at the beginning of an injured worker's claim, modernizes data collection in the workers' compensation system, and implements anti-fraud measures in the filing and collection of liens.

Specifically, with respect to UR operation, this bill:

1) Provides that, with respect to medical treatment that is provided through a medical provider network (MPN), a health care organization (HCO), other employer-directed provider, or a pre-designated physician, no prospective UR may be undertaken for the first 30 days of treatment.
2) Provides several exceptions to the "no UR" rule, including surgery, medications not covered by the formulary, psychological treatment, non x-ray imaging, durable medical equipment (DME) if total costs for all DME exceeds $250, and home health care services.
3) Requires any treatment provided within the first 30 days to be reported to the employer or claims administrator - failure by the provider to properly report treatment can lead to revocation of the "no UR" rule.
4) Authorizes an employer to conduct retrospective UR to ensure compliance with evidence-based medicine standards, and if a pattern of non-compliance is discovered, the "no UR" rule could be revoked or the provider removed from the MPN.

With respect to UR Process Approval:

5) Prohibits explicitly an employer or claims administrator from providing a UR organization with financial incentives to deny or modify treatment.
6) Requires financial interest disclosure of UR entities be shared with DWC.
7) Requires any UR organization to be accredited by an entity specified by the DWC, subject to exceptions for certain public entities that have internal systems approved by the DWC. The entity must be independent and non-profit. Until the rules are approved by the AD, the entity will be URAC.
8) Provides authority to the DWC to approve UR processes.

With respect to UR and Medical Guideline Modernization:

9) Requires, through the URAC accreditation process, the availability of peer-to-peer communication in the event of a UR modification or denial.
10)Requires the AD to develop a mandatory electronic system for sharing documents necessary to conduct UR.
11)Adopts new procedures designed to better facilitate delivery of information for purposes of IMR.
12)Establishes an expedited five-day time frame for IMR decisions related to medications on the formulary.
13)Provides that MTUS may be updated with evidence-based medicine standards by an expedited process.

With respect to Anti-Fraud Measures:

14)Requires, for liens filed on or after January 1, 2017, a lien filer to specify in the lien filing the basis upon which the lien is authorized.
15)Requires these same data elements to be added to pre-existing liens, but allows until July 1, 2017, for lien filers to comply.
16)Provides that the failure to comply with the requirements noted above results in a dismissal of the lien with prejudice.
17)Provides that in the event a lien filer is charged with workers' compensation fraud, Medi-Cal fraud, or Medicare fraud, all liens are stayed pending resolution of the charges.
18)Prohibits, for liens on or after January 1, 2017, any assignment of liens unless the person has ceased doing business in the capacity held at the time the expenses were incurred and has assigned all rights, title, and interest in the remaining accounts receivable to the assignee. The assignment of a lien, in violation of this paragraph is invalid by operation of law.
19)Clarifies existing law on liens assigned between 2013 and 2016 by codifying Chorn v. WCAB (Workers' Compensation Appeals Board) (2016), 2016 Cal. App. LEXIS 232 and states these amendments to be declaratory of existing law ...

Governor Brown vetoed Assembly Bill 1643. This bill would have prohibited apportionment in cases of physical injury based on pregnancy, menopause, osteoporosis, and carpal tunnel syndrome and requires that breast cancer not be less than the comparable impairment rating for prostate cancer.

The sponsor of this bill, the California Applicants' Attorneys Association (CAAA), argues that AB 1643 will eliminate gender bias from apportionment when determining permanent disability ratings. CAAA argues that factors such as pregnancy and menopause are used as factors to lower permanent disability. CAAA also cites several cases where apportionment is purported to have occurred due to risk factors and immutable characteristics, rather than proven conditions. CAAA also notes that AB 1643 will make breast cancer eligible for the same disability rating as prostate cancer. Finally, CAAA argues that the workers' compensation system treats being a woman as a pre-existing condition, and that AB 1643 will ensure that women receive the level of permanent disability they deserve.

In his veto message the Governor said "I am vetoing this bill for many of the same reasons that I returned a similar measure, AB305, last year. This bill is poorly drafted and reflects a seriously flawed understanding of both the workers' compensation system and the nature of physical disability that may result from a workrelated injury. The bill would, among other provisions, mandate that impairment ratings for breast cancer be no less than the ratings for prostate cancer. It would also create broad genderbased exceptions to the core principle of apportionment: that employers are liable only for the permanent disability directly caused by their employee's work-related injury."

"This measure seeks to draw a false comparison between disability ratings resulting from prostate and breast cancers, notwithstanding that these organs neither perform analogous physiological functions nor do their treatments result in similar physical limitations. There is a wide disparity in impairment levels that may result among individual women diagnosed with breast cancer and individual men diagnosed with prostate cancer, and individuals of all genders diagnosed with any form of cancer, depending on the stage at which the cancer was diagnosed, the nature of the treatment, and the degree and process of recovery. The suggestion that these two very different conditions should be rated equivalently in all cases has no basis in medical fact and upends the goals of ensuring consistency, uniformity and objectivity in ratings supported by substantial medical evidence."

"On the issue of apportionment, this bill creates broad, gender-based exceptions to the rule that employers are liable only for the percentage of permanent disability directly caused by a workrelated injury. As written, the bill would prohibit apportionment to, and thus require emplbyers to pay for, a permanent disability that actually resulted from pregnancy or menopause, or from osteoporosis or carpal _tunnel syndrome where these are preexisting conditions or unrelated to work."

"As I said last year, there is no place for gender discrimination in the workers' compensation system. Current law, however, already prohibits apportionment to risk factors, including gender, age, and family history. There is ample opportunity within the workers' compensation adjudicatory process for workers, their counsel, and others to raise any concerns or allegations of improper and impermissible gender discrimination in the medical evaluation or apportionment process."

"California's workers' compensation system strives to treat all injured workers fairly and to ensure that all workers, regardless of gender, are adequately compensated for any permanent disability directly caused by work-related injuries. Rather than promoting equality, the statutory changes proposed by this measure would create new gender-based classifications and spur additional and costly litigation, undermining the successful reforms enacted in 20 12 and the sustainability of the system."

"I urge proponents of this bill to support efforts to educate medical evaluators on current laws prohibiting bias and to collaborate with my administration." ...

Aon Global Risk Consulting, released its biennial Health Care Workers’ Compensation Barometer report, which explores trends in frequency, severity and overall loss rates related to workers’ compensation in the health care industry. The report finds that for the 2017 accident year, health care systems will face a complex environment of emerging risks that will have a direct impact on workers’ compensation.

The report, which analyzed data from approximately 1,600 heath care facilities across the country, found that while the severity of workers’ compensation claims has been increasing at a rate of two percent annually, the frequency of claims is expected to decrease one percent annually. The report also found that the industry should see loss rates increase by a projected one percent.

"As has been the case historically, the health care industry has experienced little volatility in workers’ compensation loss rates and, to augment that, claims frequency continues on a slow and steady decline," said Martha Bronson, associate director and actuary for Aon Risk Solutions. "However, an aging workforce, safe patient handling issues and workplace violence are all emerging risks that need to be top of mind for the industry."

Data from Aon’s 2016 Health Care Workers’ Compensation Barometer report finds that workers’ compensation claim costs increase as health care workers age, with the majority of those claims resulting from injuries to the back and shoulders. Fifty three percent of working nurses - a demographic that is the most frequently injured - are over the age of 50. A likely consideration for controlling these types of claims in the future and helping to ensure a healthy and safe workforce is education, specifically mentoring of the younger nursing population. While the report found that 58 percent of respondents have a program that develops younger workers, 61 percent do not have policies or programs that help transition older workers to a different work setting.

Aon’s Health Care Workers’ Compensation Barometer report also provides statistical information on historical frequency, severity, and overall loss rates specific to 11 states. Notably, the report finds that loss rates in California are almost double the countrywide rate and that claims severity is nearly three times that of the countrywide average of $23,950.

While loss prevention was the area of most concern for respondents, safe patient handling policies and controls are also top-of-mind in regards to minimizing risk of injury to health care workers. The report’s findings suggest that focusing on patient handling initiatives and best practices can aid in preventing workers’ compensation claims, thus helping mitigate both concerns. The average cost of a claim for systems that use Safe Patient Handling and Mobility standards is lower versus a facility that does not - $6,000 versus $7,800 - and overall these standards have reduced the incidence of health care worker injuries by up to 95 percent.

An alarming number of survey respondents - 91 percent - have experienced workplace violence in the past three years. However, approximately half of respondents indicate they are prepared for such an incident, with another 27 percent being very prepared. Eighty-one percent of respondents have a formal Workplace Violence Prevention Policy in place.

Dominic Colaizzo, chairman and U.S. Health Care practice leader for Aon Risk Solutions added, "While we recognize these emerging risks that are facing our industry in the year ahead, we also see that health care systems are ahead of the game. They are adhering to standards and utilizing best practices that are no doubt having a direct, positive effect on the number of workers’ compensation claims." ...