An amendment that extends the deadline to file for the Return-to-Work Supplement Program (RTWSP) has been approved by the Office of Administrative Law (OAL) and filed with the Secretary of State, effective March 20, 2017.
The regulation amendment extends the deadline to file for RTWSP benefits for certain individuals who received the Supplemental Job Displacement Benefit (SJDB) voucher between April 13, 2015 and December 1, 2015, and who may not have received notice of their eligibility to apply for the RTWSP benefit.
The amendments to 8 CCR section 17304 are shown below with new language underlined and deleted language struck through:
(a) An application for the Return-to-Work Supplement must be received by the Return-to-Work Supplement Program within one year from the date the Voucher (DWC-AD Form 10133.32 (SJDB) Rev: 10/1/15, or later version) was served on the individual.
(b) Notwithstanding subdivision (a) of this section, an application for the Return-to-Work Supplement from any individual who was issued a Voucher prior to December 1, 2015, for an injury occurring on or after January 1, 2013, must be received by the Return-to-Work Supplement Program no later than or within one year from the effective date of this subdivisionese regulations, whichever is later.
Applicants who were previously denied due to the eligibility deadline due to the eligibility deadline do not need to reapply. Their case will be reopened, reviewed, and a new determination made within 60 days.
The amended regulations can be found on the DIR website ...
The regulation amendment extends the deadline to file for RTWSP benefits for certain individuals who received the Supplemental Job Displacement Benefit (SJDB) voucher between April 13, 2015 and December 1, 2015, and who may not have received notice of their eligibility to apply for the RTWSP benefit.
The amendments to 8 CCR section 17304 are shown below with new language underlined and deleted language struck through:
(a) An application for the Return-to-Work Supplement must be received by the Return-to-Work Supplement Program within one year from the date the Voucher (DWC-AD Form 10133.32 (SJDB) Rev: 10/1/15, or later version) was served on the individual.
(b) Notwithstanding subdivision (a) of this section, an application for the Return-to-Work Supplement from any individual who was issued a Voucher prior to December 1, 2015, for an injury occurring on or after January 1, 2013, must be received by the Return-to-Work Supplement Program no later than or within one year from the effective date of this subdivisionese regulations, whichever is later.
Applicants who were previously denied due to the eligibility deadline due to the eligibility deadline do not need to reapply. Their case will be reopened, reviewed, and a new determination made within 60 days.
The amended regulations can be found on the DIR website ...
A new online system from Chubb will help independent agents quote and issue a comprehensive workers' compensation policy for small businesses.
"Our new workers' compensation system is efficient and fully automated, making it easier for our agents to place and service small business accounts," said Jim Williamson, Division President, Small Commercial Insurance, Chubb North America.
Chubb's workers' compensation policy for small business owners is designed to meet the needs of a wide range of industries, and includes the following coverage highlights:
- Provides coverage for small businesses with as few as one employee up to businesses with revenues of $10M
- Includes small business protection for medical expenses and lost wages to employees, providing security and peace of mind for employers
- Incorporates versatile coverage options including waiver of subrogation and various employer liability limits
- Easy, 24/7 automated system access with the ability to generate a quote and issue a policy in just minutes
When combined with Chubb's business owner's policy (Chubb BOP), Chubb's workers' compensation policy for small businesses provides customers an insurance solution with broad coverage and Chubb's policy and claim service capabilities.
Williamson added, "At Chubb we understand that employees are a small business' most valuable asset and are often like family. Our goal is to provide small business owners the confidence of knowing if an injury or illness occurs on the job, they'll have the right coverage in place to ensure their employees, and their businesses, will return to normal as quickly and cost-effectively as possible."
Chubb is the world's largest publicly traded property and casualty insurance company. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients.
Parent company Chubb Limited is listed on the New York Stock Exchange (NYSE: CB) and is a component of the S&P 500 index. Chubb maintains executive offices in Zurich, New York, London and other locations, and employs approximately 31,000 people worldwide ...
"Our new workers' compensation system is efficient and fully automated, making it easier for our agents to place and service small business accounts," said Jim Williamson, Division President, Small Commercial Insurance, Chubb North America.
Chubb's workers' compensation policy for small business owners is designed to meet the needs of a wide range of industries, and includes the following coverage highlights:
- Provides coverage for small businesses with as few as one employee up to businesses with revenues of $10M
- Includes small business protection for medical expenses and lost wages to employees, providing security and peace of mind for employers
- Incorporates versatile coverage options including waiver of subrogation and various employer liability limits
- Easy, 24/7 automated system access with the ability to generate a quote and issue a policy in just minutes
When combined with Chubb's business owner's policy (Chubb BOP), Chubb's workers' compensation policy for small businesses provides customers an insurance solution with broad coverage and Chubb's policy and claim service capabilities.
Williamson added, "At Chubb we understand that employees are a small business' most valuable asset and are often like family. Our goal is to provide small business owners the confidence of knowing if an injury or illness occurs on the job, they'll have the right coverage in place to ensure their employees, and their businesses, will return to normal as quickly and cost-effectively as possible."
Chubb is the world's largest publicly traded property and casualty insurance company. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients.
Parent company Chubb Limited is listed on the New York Stock Exchange (NYSE: CB) and is a component of the S&P 500 index. Chubb maintains executive offices in Zurich, New York, London and other locations, and employs approximately 31,000 people worldwide ...
A CWCI analysis of the California workers’ comp independent medical review (IMR) process used to resolve medical disputes finds that in 2016, IMR physicians once again upheld about 90% of utilization review (UR) physician’s modifications or denials of treatment, yet IMR volume continued to grow, climbing 6.5% last year.
The California Workers’ Compensation Institute (CWCI) analysis is based on a review of data from 477,045 IMR decision letters issued in 2014, 2015, and 2016 in response to applications submitted to the state after a UR physician modified or denied a requested medical service.
State lawmakers who included IMR in the 2012 workers’ comp reforms expected the process would reduce workers’ comp treatment disputes once doctors, attorneys and other participants came to understand which services could be approved because they meet evidence-based medicine standards. Three years in, however, IMR volume is at a record high, as the Division of Workers’ Compensation reports there were 10,477 more cases in 2016 than in 2015.
The 2016 IMR outcomes data show that IMR physicians upheld the UR doctor’s modification or denial of a requested service 91.2% of the time, which was up from an 88.4% uphold rate in 2015 and matched the rate noted in 2014.
The mix of services reviewed by IMR physicians in 2016 showed little change from the two prior years, as prescription drug requests (28.5% of which were for opioids) again accounted for nearly half of all IMRs, with UR modifications or denials of pharmaceutical requests upheld 92.5% of the time.
Notably, requests for compounded drugs (typically gels or creams) did represent a declining share of the 2016 prescription drug IMRs, as they fell from 8.0% of the 2015 determinations to 6.2% last year, which may have to do with their consistently low IMR overturn rate (IMR physicians deemed them not medically necessary 99% of the time in 2014, 2015, and 2016).
Requests for physical therapy, injections and durable medical equipment together represented about 24% of the 2016 IMRs, while no other medical service category accounted for more than 5% of the disputed requests.
Among the medical service categories, uphold rates in 2016 ranged from 78.9% for evaluation and management services (primarily referrals for consultations) to 93.6% for acupuncture.
As in the prior 2 years, the analysis found that most of the disputed medical services that went through IMR in 2016 were requested by a small number of physicians. The top 10% of physicians named in the 2016 IMR decision letters (1,248 physicians) accounted for 85% of the disputed service requests, while the top 1% (125 providers) accounted for 44%.
Significant geographic variation was again evident as well, as 32.8% of the IMR decision letters were addressed to Los Angeles County recipients even though the region only accounted for 23.6% of all workers’ comp medical services in the state.
IMR volume also was disproportionately high in the Bay Area, which accounted for 20.1% of the IMR letters vs. 15.2% of the medical services; while less populated regions of the state had a disproportionately small share of the IMRs, as did the Inland Empire, Orange County and San Diego.
A complete analysis of the latest IMR results has been released in a CWCI Spotlight Report, "Independent Medical Review Decisions: January 2014 Through December 2016." ...
The California Workers’ Compensation Institute (CWCI) analysis is based on a review of data from 477,045 IMR decision letters issued in 2014, 2015, and 2016 in response to applications submitted to the state after a UR physician modified or denied a requested medical service.
State lawmakers who included IMR in the 2012 workers’ comp reforms expected the process would reduce workers’ comp treatment disputes once doctors, attorneys and other participants came to understand which services could be approved because they meet evidence-based medicine standards. Three years in, however, IMR volume is at a record high, as the Division of Workers’ Compensation reports there were 10,477 more cases in 2016 than in 2015.
The 2016 IMR outcomes data show that IMR physicians upheld the UR doctor’s modification or denial of a requested service 91.2% of the time, which was up from an 88.4% uphold rate in 2015 and matched the rate noted in 2014.
The mix of services reviewed by IMR physicians in 2016 showed little change from the two prior years, as prescription drug requests (28.5% of which were for opioids) again accounted for nearly half of all IMRs, with UR modifications or denials of pharmaceutical requests upheld 92.5% of the time.
Notably, requests for compounded drugs (typically gels or creams) did represent a declining share of the 2016 prescription drug IMRs, as they fell from 8.0% of the 2015 determinations to 6.2% last year, which may have to do with their consistently low IMR overturn rate (IMR physicians deemed them not medically necessary 99% of the time in 2014, 2015, and 2016).
Requests for physical therapy, injections and durable medical equipment together represented about 24% of the 2016 IMRs, while no other medical service category accounted for more than 5% of the disputed requests.
Among the medical service categories, uphold rates in 2016 ranged from 78.9% for evaluation and management services (primarily referrals for consultations) to 93.6% for acupuncture.
As in the prior 2 years, the analysis found that most of the disputed medical services that went through IMR in 2016 were requested by a small number of physicians. The top 10% of physicians named in the 2016 IMR decision letters (1,248 physicians) accounted for 85% of the disputed service requests, while the top 1% (125 providers) accounted for 44%.
Significant geographic variation was again evident as well, as 32.8% of the IMR decision letters were addressed to Los Angeles County recipients even though the region only accounted for 23.6% of all workers’ comp medical services in the state.
IMR volume also was disproportionately high in the Bay Area, which accounted for 20.1% of the IMR letters vs. 15.2% of the medical services; while less populated regions of the state had a disproportionately small share of the IMRs, as did the Inland Empire, Orange County and San Diego.
A complete analysis of the latest IMR results has been released in a CWCI Spotlight Report, "Independent Medical Review Decisions: January 2014 Through December 2016." ...
Rite Aid Corporation has paid $834,200 in civil penalties to the United States to settle claims stemming from alleged violations of the Controlled Substances Act.
Rite Aid paid the civil settlement as part of an agreement reached last week to resolve allegations that certain Rite Aid pharmacies in Los Angeles dispensed and/or recorded controlled substances using a medical practitioner’s incorrect or invalid DEA registration number. The government alleged that the incorrect or invalid registration numbers were used at least 1,298 times as a result of Rite Aid’s failure to adequately maintain its internal database.
The settlement also resolves allegations that Rite Aid pharmacies dispensed, on at least 63 occasions, prescriptions for controlled substances written by a practitioner whose DEA registration number had been revoked by the DEA for cause.
In 1970, the United States Congress passed the Controlled Substances Act (CSA), which created "a closed system" of distribution for controlled substances. The CSA established a regulatory framework to control every facet of the handling of the substances, from their manufacture to their consumption.
The CSA became law against the backdrop of increasing diversion and abuse of legitimate controlled substances, but the law was also designed to ensure an adequate supply of those substances needed to meet the medical and scientific needs of the United States.
"Accurate record keeping at retail pharmacies helps ensure that authorities can keep track of how many controlled substances a pharmacy should have and does have on hand," said United States Attorney Eileen M. Decker. "These federal regulations were put into place to prevent the abuse of powerful drugs that are dispensed by pharmacies and should only be used under the careful watch of a medical professional."
In entering into and paying the settlement, Rite Aid did not admit liability. Prior to entering into the agreement, Rite Aid implemented a DEA registration validation program designed to verify DEA registration numbers for medical professionals who prescribe controlled substances.
"This settlement demonstrates DEA’s commitment to monitoring and holding accountable all potential sources of diversion for controlled substances and maintaining the safety of our communities,” said DEA Special Agent in Charge Steve Comer
This case was investigated by the Drug Enforcement Administration’s Office of Diversion Control, Los Angeles Field Division.
The settlement was negotiated by Assistant United States Attorney Donald W. Yoo of the Civil Fraud Section ...
Rite Aid paid the civil settlement as part of an agreement reached last week to resolve allegations that certain Rite Aid pharmacies in Los Angeles dispensed and/or recorded controlled substances using a medical practitioner’s incorrect or invalid DEA registration number. The government alleged that the incorrect or invalid registration numbers were used at least 1,298 times as a result of Rite Aid’s failure to adequately maintain its internal database.
The settlement also resolves allegations that Rite Aid pharmacies dispensed, on at least 63 occasions, prescriptions for controlled substances written by a practitioner whose DEA registration number had been revoked by the DEA for cause.
In 1970, the United States Congress passed the Controlled Substances Act (CSA), which created "a closed system" of distribution for controlled substances. The CSA established a regulatory framework to control every facet of the handling of the substances, from their manufacture to their consumption.
The CSA became law against the backdrop of increasing diversion and abuse of legitimate controlled substances, but the law was also designed to ensure an adequate supply of those substances needed to meet the medical and scientific needs of the United States.
"Accurate record keeping at retail pharmacies helps ensure that authorities can keep track of how many controlled substances a pharmacy should have and does have on hand," said United States Attorney Eileen M. Decker. "These federal regulations were put into place to prevent the abuse of powerful drugs that are dispensed by pharmacies and should only be used under the careful watch of a medical professional."
In entering into and paying the settlement, Rite Aid did not admit liability. Prior to entering into the agreement, Rite Aid implemented a DEA registration validation program designed to verify DEA registration numbers for medical professionals who prescribe controlled substances.
"This settlement demonstrates DEA’s commitment to monitoring and holding accountable all potential sources of diversion for controlled substances and maintaining the safety of our communities,” said DEA Special Agent in Charge Steve Comer
This case was investigated by the Drug Enforcement Administration’s Office of Diversion Control, Los Angeles Field Division.
The settlement was negotiated by Assistant United States Attorney Donald W. Yoo of the Civil Fraud Section ...
This January, the city of Everett, in Washington filed a first-of-its-kind lawsuit against Purdue Pharma alleging the drug maker "supplied OxyContin to obviously suspicious physicians and pharmacies," ultimately failing "to prevent the illegal diversion of OxyContin into the black market."
While other suits against the company by states and municipalities have accused Purdue Pharma of deceptive marketing - allegedly playing up OxyContin's effectiveness while playing down its addictiveness - Everett's lawsuit is the first to claim the company knew its drugs were being diverted and did nothing to stop it.
In particular, the complaint outlines a drug ring that began with a sham clinic in Los Angeles and ended with a kingpin running OxyContin on the streets of Everett. The unravelling was detailed in a Los Angeles Times investigation that triggered the idea for Everett's lawsuit.
The so-called Los Angeles pill mill was ultimately shut down and the cadre of physicians, pharmacists, and dealers that kept it churning were prosecuted.
In Everett, Washington, the jail is overflowing with addicts, the detox facility is set to double in size, and the city spends a fortune clearing its streets and parks of needles and tiny plastic bags.Those are the hallmarks of a heroin epidemic that began, city officials said, as a crisis dating back to the late 2000s that involved different drugs: opioid prescription painkillers.
Nearly a decade after the opioid onslaught, Everett is still struggling with the cost. And now the city wants the company that manufactured OxyContin to pay the bill.
Key to the complaint are internal Purdue emails outlined by the Los Angeles Times, including a 2009 excerpt from an exchange between the company's compliance director and a sales manager who had become suspicious of the number of OxyContin prescriptions traced back to the clinic's doctors.
After paying the clinic a visit, the sales manager wrote that "the line was out the door, with people who looked like gang members. I feel very certain that this is an organized drug ring."
Purdue Pharma disputes the allegations in the lawsuit. In a statement to NBC News, the company said the city "paints a flawed and inaccurate portrayal of events that led to the crisis in Everett."
The company said it has been a leader in developing abuse-deterrent medications, "which the FDA and National Institute on Drug Abuse have said are making a difference in the fight against abuse." The company also said that OxyContin accounts for less than 2 percent of all opioid prescriptions in the United States.
The first Oxycontin lawsuit to successfully procure a settlement came in 2007. The federal Oxycontin lawsuit alleged that the company had fraudulently encouraged over-prescription of the drug.This Oxycontin lawsuit distributed $130 million to victims of Oxycontin addiction. The "settlement" of the civil case was however part of a package settlement of criminal charges also pending against the company, and may not have been accomplished otherwise.
Private Oxycontin lawsuits concerning side effects have not been widely successful; however, a large number of Oxycontin lawsuits were settled out-of-court.
Santa Clara and Orange counties filed a case in 2015 in Orange County Superior Court. They alleged that Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Actavis violated California's false advertising and unfair competition laws and created a public nuisance. The case was placed on hold in 2015 pending the outcome of FDA investigations that were underway at the time.
Chicago sued Teva Pharmaceuticals, Purdue Pharma Inc. and other drugmakers in 2014, saying they misled doctors and the public about the addictive nature of opiates and pushed prescriptions despite known dangers of addiction. A defense request for a stay order pending FDA investigations was denied in September 2016, and the Chicago case is still active.
The case is City of Chicago v. Purdue Pharma LP et al., case number 1:14-cv-04361, in the U.S. District Court for the Northern District of Illinois. The current federal court docket shows the case to be in the discovery stage with 439 documents filed in the case so far. The Third Amended Complaint filed on October 25, 2016 contains 341 pages of specific allegations against the defendant drugmakers (not counting exhibits) and reads like an organized crime fiction novel laced with intrigue. The information in this document would certainly steer a competent subrogation lawyer in the right direction to find evidence to make a case.
The outcome of these pending cases, and certainly more to follow, will weigh heavily on the answer to the question about the subrogation potential against opiate drugmakers for recovery of the costs of some of our most costly and protracted injury claims ...
While other suits against the company by states and municipalities have accused Purdue Pharma of deceptive marketing - allegedly playing up OxyContin's effectiveness while playing down its addictiveness - Everett's lawsuit is the first to claim the company knew its drugs were being diverted and did nothing to stop it.
In particular, the complaint outlines a drug ring that began with a sham clinic in Los Angeles and ended with a kingpin running OxyContin on the streets of Everett. The unravelling was detailed in a Los Angeles Times investigation that triggered the idea for Everett's lawsuit.
The so-called Los Angeles pill mill was ultimately shut down and the cadre of physicians, pharmacists, and dealers that kept it churning were prosecuted.
In Everett, Washington, the jail is overflowing with addicts, the detox facility is set to double in size, and the city spends a fortune clearing its streets and parks of needles and tiny plastic bags.Those are the hallmarks of a heroin epidemic that began, city officials said, as a crisis dating back to the late 2000s that involved different drugs: opioid prescription painkillers.
Nearly a decade after the opioid onslaught, Everett is still struggling with the cost. And now the city wants the company that manufactured OxyContin to pay the bill.
Key to the complaint are internal Purdue emails outlined by the Los Angeles Times, including a 2009 excerpt from an exchange between the company's compliance director and a sales manager who had become suspicious of the number of OxyContin prescriptions traced back to the clinic's doctors.
After paying the clinic a visit, the sales manager wrote that "the line was out the door, with people who looked like gang members. I feel very certain that this is an organized drug ring."
Purdue Pharma disputes the allegations in the lawsuit. In a statement to NBC News, the company said the city "paints a flawed and inaccurate portrayal of events that led to the crisis in Everett."
The company said it has been a leader in developing abuse-deterrent medications, "which the FDA and National Institute on Drug Abuse have said are making a difference in the fight against abuse." The company also said that OxyContin accounts for less than 2 percent of all opioid prescriptions in the United States.
The first Oxycontin lawsuit to successfully procure a settlement came in 2007. The federal Oxycontin lawsuit alleged that the company had fraudulently encouraged over-prescription of the drug.This Oxycontin lawsuit distributed $130 million to victims of Oxycontin addiction. The "settlement" of the civil case was however part of a package settlement of criminal charges also pending against the company, and may not have been accomplished otherwise.
Private Oxycontin lawsuits concerning side effects have not been widely successful; however, a large number of Oxycontin lawsuits were settled out-of-court.
Santa Clara and Orange counties filed a case in 2015 in Orange County Superior Court. They alleged that Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Actavis violated California's false advertising and unfair competition laws and created a public nuisance. The case was placed on hold in 2015 pending the outcome of FDA investigations that were underway at the time.
Chicago sued Teva Pharmaceuticals, Purdue Pharma Inc. and other drugmakers in 2014, saying they misled doctors and the public about the addictive nature of opiates and pushed prescriptions despite known dangers of addiction. A defense request for a stay order pending FDA investigations was denied in September 2016, and the Chicago case is still active.
The case is City of Chicago v. Purdue Pharma LP et al., case number 1:14-cv-04361, in the U.S. District Court for the Northern District of Illinois. The current federal court docket shows the case to be in the discovery stage with 439 documents filed in the case so far. The Third Amended Complaint filed on October 25, 2016 contains 341 pages of specific allegations against the defendant drugmakers (not counting exhibits) and reads like an organized crime fiction novel laced with intrigue. The information in this document would certainly steer a competent subrogation lawyer in the right direction to find evidence to make a case.
The outcome of these pending cases, and certainly more to follow, will weigh heavily on the answer to the question about the subrogation potential against opiate drugmakers for recovery of the costs of some of our most costly and protracted injury claims ...
It was touted as a mega-bust: the successful end to a five-year investigation aimed at dismantling one of the largest insurance fraud schemes in California history.
More than a dozen people associated with Frontline Medical Associates were accused in 2015 of taking part in a $150-million scam that involved unnecessary surgeries by non-surgeons, doling out kickbacks for illegal patient referrals and fraudulently billing insurance companies.
But the Los Angeles Times reports that over the 18 months that followed, a judge dismissed most of the 132 counts laid out in two indictments. The most serious charges - for aggravated mayhem, carrying a potential life sentence - were dropped for a lack of evidence.
Now, prosecutors are taking a second stab at the case after acknowledging flaws in how they presented it to a grand jury. At their request, Los Angeles County Superior Court Judge Kathleen Kennedy Thursday threw out pending charges in the two indictments against 13 defendants, except for two suspects who are fugitives.
Prosecutors immediately brought new charges against a dozen people, filing three separate criminal complaints listing 194 counts, including aggravated mayhem, money laundering, insurance fraud and unlawful patient referrals. An 82-year-old physician who was accused of overbilling insurance companies was not charged in the new complaint; prosecutors noted that he is suffering serious health issues.
Prosecutors allege that Dr. Munir Uwaydah, the certified orthopedic surgeon patients believed would conduct procedures, instead let a physician’s assistant perform surgeries. The scheme left nearly two dozen patients with lasting scars.
Uwaydah, the accused ringleader who prosecutors initially said had been captured in Germany, remains at large. They believe he is living in Lebanon.
Defense attorneys called the move to drop and then refile charges a transparent stunt to dodge an evidentiary hearing scheduled for next week. They claim that prosecutors and investigators improperly reviewed thousands of records, including communications between defendants and their attorneys, protected by attorney-client privilege.
More than 50 prosecutors - including Mathai - and district attorney’s investigators had been subpoenaed to testify, defense attorneys said.
Defense attorneys alleged in a court filing that some documents that prosecutors and others reviewed were used to bolster the criminal case.
In one example, an investigator developed leads based on correspondence between Uwaydah and one of his attorneys, leading to an undercover operation a year later, according to the filing. The investigator’s testimony before a grand jury led to three of the original counts.
The violation of the privilege could justify throwing county prosecutors off the case, defense attorneys said.
"They want to basically say, ‘We don’t like the way this game is going so we’re turning the board over,’" said Benjamin Gluck, an attorney representing Uwaydah’s business partner, Paul Turley.
"These people are going to be under the spotlight. That’s not a comfortable place to be. But you know what? The case has been going along - they made their bed, they’re going to have to sleep in it." It’s unclear if and when the evidentiary hearing will move forward - and in front of which judge. Kennedy, who ordered the hearing last month, said that the allegations the defense raised aren’t going away.
"All those issues are still going to be there," she said ...
More than a dozen people associated with Frontline Medical Associates were accused in 2015 of taking part in a $150-million scam that involved unnecessary surgeries by non-surgeons, doling out kickbacks for illegal patient referrals and fraudulently billing insurance companies.
But the Los Angeles Times reports that over the 18 months that followed, a judge dismissed most of the 132 counts laid out in two indictments. The most serious charges - for aggravated mayhem, carrying a potential life sentence - were dropped for a lack of evidence.
Now, prosecutors are taking a second stab at the case after acknowledging flaws in how they presented it to a grand jury. At their request, Los Angeles County Superior Court Judge Kathleen Kennedy Thursday threw out pending charges in the two indictments against 13 defendants, except for two suspects who are fugitives.
Prosecutors immediately brought new charges against a dozen people, filing three separate criminal complaints listing 194 counts, including aggravated mayhem, money laundering, insurance fraud and unlawful patient referrals. An 82-year-old physician who was accused of overbilling insurance companies was not charged in the new complaint; prosecutors noted that he is suffering serious health issues.
Prosecutors allege that Dr. Munir Uwaydah, the certified orthopedic surgeon patients believed would conduct procedures, instead let a physician’s assistant perform surgeries. The scheme left nearly two dozen patients with lasting scars.
Uwaydah, the accused ringleader who prosecutors initially said had been captured in Germany, remains at large. They believe he is living in Lebanon.
Defense attorneys called the move to drop and then refile charges a transparent stunt to dodge an evidentiary hearing scheduled for next week. They claim that prosecutors and investigators improperly reviewed thousands of records, including communications between defendants and their attorneys, protected by attorney-client privilege.
More than 50 prosecutors - including Mathai - and district attorney’s investigators had been subpoenaed to testify, defense attorneys said.
Defense attorneys alleged in a court filing that some documents that prosecutors and others reviewed were used to bolster the criminal case.
In one example, an investigator developed leads based on correspondence between Uwaydah and one of his attorneys, leading to an undercover operation a year later, according to the filing. The investigator’s testimony before a grand jury led to three of the original counts.
The violation of the privilege could justify throwing county prosecutors off the case, defense attorneys said.
"They want to basically say, ‘We don’t like the way this game is going so we’re turning the board over,’" said Benjamin Gluck, an attorney representing Uwaydah’s business partner, Paul Turley.
"These people are going to be under the spotlight. That’s not a comfortable place to be. But you know what? The case has been going along - they made their bed, they’re going to have to sleep in it." It’s unclear if and when the evidentiary hearing will move forward - and in front of which judge. Kennedy, who ordered the hearing last month, said that the allegations the defense raised aren’t going away.
"All those issues are still going to be there," she said ...
Munir Uwaydah was an orthopedic surgeon well known as a treating physician in California workers' compensation cases. He has been charged as the ringleader in one of California's biggest health fraud schemes, which included unnecessary operations by an untrained assistant that scarred patients forever, according to indictments unsealed in Los Angeles County.
Los Angeles District Attorney Jackie Lacey alleged in a case filed in 2015 that Uwaydah and 14 associates, including another doctor and a lawyer, bilked insurance companies out of $150 million in the scheme.
The fraud indictment also names Uwaydah's business associate Kelly Soo Park, who was acquitted in a sensational murder trial several years ago of strangling the doctor's ex-girlfriend, college student and aspiring model Juliana Redding.
During that murder trial, prosecutors had described Park as a "female James Bond" who was hired to kill Uwaydah's former girlfriend Redding because of a failed business deal between Redding's father, who is an Arizona pharmacist, and Uwaydah. The doctor was never charged in the murder case and denied any involvement in the killing.
Redding was strangled in Santa Monica in 2008. Karen Thompson of the Santa Monica Police Department was the lead investigator on the murder case. Prosecutors alleged that Park strangled Redding with her bare hands and left overwhelming DNA evidence on the body and around the apartment. They say that Uwaydah who had dated Redding gave Park a six-figure payment to kill her after a business deal soured with Redding's father.
Prosecutors alleged in the murder case that Park turned on a gas stove and lit candles in an effort to blow up the apartment after strangling the victim and dragging her scratched and bruised body into the bedroom.
Prosecutors during the murder trial had presented a link between Park and Uwaydah, alleging she had received $250,000 before Redding's killing from Uwaydah, who was her employer at the time. Over the next 18 months, Park or her company received another $750,000 from Uwaydah's company, according to the prosecutors.
Park is now accused in the pending fraud case of being the office manager and personal assistant to Uwaydah who ran Frontline Medical Associates, which prosecutors allege served as a front to fraudulently bill more than $150 million to insurance companies.
But Kelly Soo Park bites back.
Before her trial on murder charges, the judge ruled that she would not allow Park to present any evidence of third party culpability for the murder after Park’s key witness on that question, Melissa Ayala, invoked her Fifth Amendment privilege and refused to testify when subpoenad as a witness.
As part of her criminal defense, Park sought to introduce evidence that Redding’s killer was actually John Gilmore, the victim’s boyfriend at the time of her death. Gilmore had a history of domestic violence and had previously assaulted Redding.
Park’s investigator interviewed Gilmore’s former girlfriend, Melissa Ayala. During that interview, Ayala told the investigator that Gilmore had been violent toward her and had choked her on at least three occasions. According to Ayala, the first of these incidents occurred after Ayala brought up Redding’s death and accused Gilmore of murdering Redding.
After learning of this potentially exculpatory evidence, Park gave notice to the District Attorney of her intention to call Ayala as a defense witness at trial. Detective Thompson then contacted Ayala and allegedly attempted to dissuade her from testifying for the defense. Park alleges that Thompson later spoke with the El Segundo Police Department about filing charges against Ayala for assault and criminal threats against Gilmore based on an incident that had occurred during the previous year.
After her acquittal, Park sued City of Santa Monica Police Detective Karen Thompson alleging that Thompson violated her constitutional rights by intimidating and attempting to dissuade Ayala from testifying on behalf of the defense. Park asserted that Thompson orchestrated criminal charges against Ayala with the intention that Ayala invoke the Fifth Amendment and refuse to testify on Park’s behalf.
The federal district court dismissed Parks lawsuit against Thompson for failure to state a claim. But the 9th Circuit Court of Appeals reversed this month in the published case of Kelly Soo Park v Karen Thompson.
The majority opinion concluded that "Park’s complaint alleged facts that are "suggestive" of an agreement to engage in "illegal conduct" and reinstated the complaint. Park will now proceed with her case against Detective Thompson ...
Los Angeles District Attorney Jackie Lacey alleged in a case filed in 2015 that Uwaydah and 14 associates, including another doctor and a lawyer, bilked insurance companies out of $150 million in the scheme.
The fraud indictment also names Uwaydah's business associate Kelly Soo Park, who was acquitted in a sensational murder trial several years ago of strangling the doctor's ex-girlfriend, college student and aspiring model Juliana Redding.
During that murder trial, prosecutors had described Park as a "female James Bond" who was hired to kill Uwaydah's former girlfriend Redding because of a failed business deal between Redding's father, who is an Arizona pharmacist, and Uwaydah. The doctor was never charged in the murder case and denied any involvement in the killing.
Redding was strangled in Santa Monica in 2008. Karen Thompson of the Santa Monica Police Department was the lead investigator on the murder case. Prosecutors alleged that Park strangled Redding with her bare hands and left overwhelming DNA evidence on the body and around the apartment. They say that Uwaydah who had dated Redding gave Park a six-figure payment to kill her after a business deal soured with Redding's father.
Prosecutors alleged in the murder case that Park turned on a gas stove and lit candles in an effort to blow up the apartment after strangling the victim and dragging her scratched and bruised body into the bedroom.
Prosecutors during the murder trial had presented a link between Park and Uwaydah, alleging she had received $250,000 before Redding's killing from Uwaydah, who was her employer at the time. Over the next 18 months, Park or her company received another $750,000 from Uwaydah's company, according to the prosecutors.
Park is now accused in the pending fraud case of being the office manager and personal assistant to Uwaydah who ran Frontline Medical Associates, which prosecutors allege served as a front to fraudulently bill more than $150 million to insurance companies.
But Kelly Soo Park bites back.
Before her trial on murder charges, the judge ruled that she would not allow Park to present any evidence of third party culpability for the murder after Park’s key witness on that question, Melissa Ayala, invoked her Fifth Amendment privilege and refused to testify when subpoenad as a witness.
As part of her criminal defense, Park sought to introduce evidence that Redding’s killer was actually John Gilmore, the victim’s boyfriend at the time of her death. Gilmore had a history of domestic violence and had previously assaulted Redding.
Park’s investigator interviewed Gilmore’s former girlfriend, Melissa Ayala. During that interview, Ayala told the investigator that Gilmore had been violent toward her and had choked her on at least three occasions. According to Ayala, the first of these incidents occurred after Ayala brought up Redding’s death and accused Gilmore of murdering Redding.
After learning of this potentially exculpatory evidence, Park gave notice to the District Attorney of her intention to call Ayala as a defense witness at trial. Detective Thompson then contacted Ayala and allegedly attempted to dissuade her from testifying for the defense. Park alleges that Thompson later spoke with the El Segundo Police Department about filing charges against Ayala for assault and criminal threats against Gilmore based on an incident that had occurred during the previous year.
After her acquittal, Park sued City of Santa Monica Police Detective Karen Thompson alleging that Thompson violated her constitutional rights by intimidating and attempting to dissuade Ayala from testifying on behalf of the defense. Park asserted that Thompson orchestrated criminal charges against Ayala with the intention that Ayala invoke the Fifth Amendment and refuse to testify on Park’s behalf.
The federal district court dismissed Parks lawsuit against Thompson for failure to state a claim. But the 9th Circuit Court of Appeals reversed this month in the published case of Kelly Soo Park v Karen Thompson.
The majority opinion concluded that "Park’s complaint alleged facts that are "suggestive" of an agreement to engage in "illegal conduct" and reinstated the complaint. Park will now proceed with her case against Detective Thompson ...
The Department of Industrial Relations’ Division of Workers’ Compensation has issued a notice of public hearing on May 1 for the Medical Treatment Utilization Schedule (MTUS) Drug Formulary regulations, which includes a list of preferred drugs that can be dispensed without the need for prospective utilization review.
The proposed rulemaking implements Assembly Bill 1124 (Statutes 2015, Chapter 525), which mandated the adoption of an evidence-based workers’ compensation drug formulary into the MTUS by July 1, 2017.
"We must ensure that California’s injured workers are prescribed the right medications for their conditions without frictional system delays," said George Parisotto, DWC Acting Administrative Director. DWC is a division of the Department of Industrial Relations (DIR).
The May 1 public hearing on the proposed regulations has been scheduled at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street in Oakland.
Members of the public may also submit written comments on the regulations until 5 p.m. that day.
The MTUS Drug Formulary is based on, and consistent with, medical treatment guidelines created by the American College of Occupational and Environmental Medicine (ACOEM), which are published by Reed Group, Ltd. The preferred drug list was compiled by DWC, with assistance from ACOEM, and takes into consideration medications frequently prescribed for occupational injuries and the evidence-based drug recommendations in the guidelines.
"The formulary, designed to work in tandem with our medical treatment utilization guidelines, will incorporate the evidence-based standards of care that best meet the needs of California’s injured workers," said Christine Baker, Director of DIR.
The proposed formulary regulations are to be adopted at section 9792.27.1, et seq. of Title 8 of the California Code of Regulations. DWC will consider all public comments, and may modify the proposed regulations for consideration during an additional 15-day public comment period.
The notice of rulemaking, text of the regulations, and the initial statement of reasons can be found on the DWC rulemaking web page ...
The proposed rulemaking implements Assembly Bill 1124 (Statutes 2015, Chapter 525), which mandated the adoption of an evidence-based workers’ compensation drug formulary into the MTUS by July 1, 2017.
"We must ensure that California’s injured workers are prescribed the right medications for their conditions without frictional system delays," said George Parisotto, DWC Acting Administrative Director. DWC is a division of the Department of Industrial Relations (DIR).
The May 1 public hearing on the proposed regulations has been scheduled at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street in Oakland.
Members of the public may also submit written comments on the regulations until 5 p.m. that day.
The MTUS Drug Formulary is based on, and consistent with, medical treatment guidelines created by the American College of Occupational and Environmental Medicine (ACOEM), which are published by Reed Group, Ltd. The preferred drug list was compiled by DWC, with assistance from ACOEM, and takes into consideration medications frequently prescribed for occupational injuries and the evidence-based drug recommendations in the guidelines.
"The formulary, designed to work in tandem with our medical treatment utilization guidelines, will incorporate the evidence-based standards of care that best meet the needs of California’s injured workers," said Christine Baker, Director of DIR.
The proposed formulary regulations are to be adopted at section 9792.27.1, et seq. of Title 8 of the California Code of Regulations. DWC will consider all public comments, and may modify the proposed regulations for consideration during an additional 15-day public comment period.
The notice of rulemaking, text of the regulations, and the initial statement of reasons can be found on the DWC rulemaking web page ...
Hyok Kwon, owner of Good Neighbor Services, a janitorial company that provided services to some of San Diego's most exclusive hotels and resorts pleaded guilty this week to seven felonies, including premium and employment tax fraud in an elaborate scheme to avoid paying workers' compensation insurance premiums and employment taxes.
Kwon stipulated to an eight-year prison sentence and to pay restitution exceeding $5 million.
Woo Hui Kwon pleaded guilty on December 6, 2016 to two counts of premium fraud and two counts of employment tax fraud. She was sentenced to four years and eight months, and restitution that totaled over $5 million to insurance carriers and Employment Development Department.
The two defendants own a janitorial company that provides cleaning staff to major hotels across San Diego, Los Angeles and Riverside Counties, including The Hotel Del Coronado, Loews Coronado, La Costa Resort and Spa, The Grand Del Marin La Jolla, L'Auberge Del Mar, The Ritz Carlton, Four Seasons, Hilton and Hyatt hotel chains.
The Kwons were indicted by a grand jury on 11 counts of workers' compensation premium fraud, 18 counts of payroll tax evasion and one count of extortion.
The investigation uncovered a methodical and systematic shell game involving six straw owners. These straw owners were used to conceal the existence of hundreds of hotel workers to avoid paying millions of dollars in insurance premiums and payroll taxes. If convicted of all charges, they each would have faced up to 31 years in prison.
For nearly a decade, Good Neighbor Services concealed their real payroll information in order to fraudulently obtain workers' compensation insurance from multiple companies including Travelers, Norguard, AIG, Southern Insurance, Everest National, Preferred Employers, State Compensation Insurance Fund and Employers Compensation Insurance.
Employees who were interviewed said they were paid with checks bearing the name of businesses other than Good Neighbor Services throughout the course of their employment, even though they wore uniforms with the Good Neighbor Services' logo and identified the Kwons as the owners.
The employees also said they did not receive overtime pay or workers' compensation benefits when they were injured on the job, and they feared retaliation if they reported their injuries. One employee said she had to repeatedly ask for medical attention for her injury. When she was finally sent to a doctor, she found out later the Kwons sent her to a dentist rather than a physician.
Six co-defendants have also been charged with workers' compensation premium fraud and tax evasion. They are Melquiades Brizuela Jr., Manuel Rodriguez, Veronica Lucas Cuin, Aimee Sunmyung Kwon, Daniel Kwon and Hyun Bung Chae for their involvement in the scheme.
The San Diego District Attorney worked with the California Department of Insurance, Employment Development Department, Maintenance Cooperation Trust Fund, and Department of Industrial Relations to bring this complicated, underground economy case to light. The extensive amount of fraud would not have been uncovered without the efforts of these community partners ...
Kwon stipulated to an eight-year prison sentence and to pay restitution exceeding $5 million.
Woo Hui Kwon pleaded guilty on December 6, 2016 to two counts of premium fraud and two counts of employment tax fraud. She was sentenced to four years and eight months, and restitution that totaled over $5 million to insurance carriers and Employment Development Department.
The two defendants own a janitorial company that provides cleaning staff to major hotels across San Diego, Los Angeles and Riverside Counties, including The Hotel Del Coronado, Loews Coronado, La Costa Resort and Spa, The Grand Del Marin La Jolla, L'Auberge Del Mar, The Ritz Carlton, Four Seasons, Hilton and Hyatt hotel chains.
The Kwons were indicted by a grand jury on 11 counts of workers' compensation premium fraud, 18 counts of payroll tax evasion and one count of extortion.
The investigation uncovered a methodical and systematic shell game involving six straw owners. These straw owners were used to conceal the existence of hundreds of hotel workers to avoid paying millions of dollars in insurance premiums and payroll taxes. If convicted of all charges, they each would have faced up to 31 years in prison.
For nearly a decade, Good Neighbor Services concealed their real payroll information in order to fraudulently obtain workers' compensation insurance from multiple companies including Travelers, Norguard, AIG, Southern Insurance, Everest National, Preferred Employers, State Compensation Insurance Fund and Employers Compensation Insurance.
Employees who were interviewed said they were paid with checks bearing the name of businesses other than Good Neighbor Services throughout the course of their employment, even though they wore uniforms with the Good Neighbor Services' logo and identified the Kwons as the owners.
The employees also said they did not receive overtime pay or workers' compensation benefits when they were injured on the job, and they feared retaliation if they reported their injuries. One employee said she had to repeatedly ask for medical attention for her injury. When she was finally sent to a doctor, she found out later the Kwons sent her to a dentist rather than a physician.
Six co-defendants have also been charged with workers' compensation premium fraud and tax evasion. They are Melquiades Brizuela Jr., Manuel Rodriguez, Veronica Lucas Cuin, Aimee Sunmyung Kwon, Daniel Kwon and Hyun Bung Chae for their involvement in the scheme.
The San Diego District Attorney worked with the California Department of Insurance, Employment Development Department, Maintenance Cooperation Trust Fund, and Department of Industrial Relations to bring this complicated, underground economy case to light. The extensive amount of fraud would not have been uncovered without the efforts of these community partners ...
The Los Angeles County District Attorney’s Office announced that two clothing manufacturing executives and their accountant were sentenced this week for their roles in a $3.8 million workers’ compensation fraud scheme.
In December, Sung Hyun Kim and Jae Young Kim each pleaded no contest to two counts of workers’ compensation fraud, while Choi entered her plea to two counts of failure to pay state payroll taxes.
Sung Hyun Kim, 59, was sentenced to two years in local custody or electronic monitoring and two years of mandatory supervision. Jae Young Kim, 73, and Caroline Sung Choi, 61, were each sentenced to one year in custody or electronic monitoring and placed on probation for five years.
Choi and her sister, Sung Hyun Kim, were corporate officers for Meriko, Inc., and its successor, SF Apparel, both garment manufacturing companies that make high-end brand jeans such as the True Religion Brand Jeans. True Religion Brand Jeans was not suspected of any fraud or wrongdoing in this case.
Beginning as early as 2006, Sung Hyun Kim and Jae Young Kim, an accountant, underreported millions of dollars in payroll to insurance carriers. Losses were estimated to be roughly $3.8 million.
The State Fund notified Department of Insurance detectives when they discovered payroll reports submitted to them by the companies showed significantly less total payroll than similar reports submitted to the California Employment Development Department (EDD). Evidence also revealed many employees were paid under the table through a bank account that was never disclosed to EDD or insurance carriers.
Companies pay significantly reduced workers’ compensation premiums when they underreport the number of employees and the amounts actually paid, prosecutors added. Victim insurers include: State Fund, Tower Insurance/AM Trust North America, Star Insurance Company, Granite State Insurance Company (Chartis), Insurance Company of the West, National Liability and Fire Insurance Company (owned by Berkshire Hathaway) and Cypress Insurance Company (owned by Berkshire Hathaway).
Restitution, investigative costs and fines totaling $4.6 million have been paid.
Deputy District Attorney Theresa Mitchell of the Healthcare Fraud Division prosecuted the case. This case was a joint effort of the LA County Premium Fraud Task Force including State Fund and EDD ...
In December, Sung Hyun Kim and Jae Young Kim each pleaded no contest to two counts of workers’ compensation fraud, while Choi entered her plea to two counts of failure to pay state payroll taxes.
Sung Hyun Kim, 59, was sentenced to two years in local custody or electronic monitoring and two years of mandatory supervision. Jae Young Kim, 73, and Caroline Sung Choi, 61, were each sentenced to one year in custody or electronic monitoring and placed on probation for five years.
Choi and her sister, Sung Hyun Kim, were corporate officers for Meriko, Inc., and its successor, SF Apparel, both garment manufacturing companies that make high-end brand jeans such as the True Religion Brand Jeans. True Religion Brand Jeans was not suspected of any fraud or wrongdoing in this case.
Beginning as early as 2006, Sung Hyun Kim and Jae Young Kim, an accountant, underreported millions of dollars in payroll to insurance carriers. Losses were estimated to be roughly $3.8 million.
The State Fund notified Department of Insurance detectives when they discovered payroll reports submitted to them by the companies showed significantly less total payroll than similar reports submitted to the California Employment Development Department (EDD). Evidence also revealed many employees were paid under the table through a bank account that was never disclosed to EDD or insurance carriers.
Companies pay significantly reduced workers’ compensation premiums when they underreport the number of employees and the amounts actually paid, prosecutors added. Victim insurers include: State Fund, Tower Insurance/AM Trust North America, Star Insurance Company, Granite State Insurance Company (Chartis), Insurance Company of the West, National Liability and Fire Insurance Company (owned by Berkshire Hathaway) and Cypress Insurance Company (owned by Berkshire Hathaway).
Restitution, investigative costs and fines totaling $4.6 million have been paid.
Deputy District Attorney Theresa Mitchell of the Healthcare Fraud Division prosecuted the case. This case was a joint effort of the LA County Premium Fraud Task Force including State Fund and EDD ...
Employees of Monsanto Co ghostwrote scientific reports that U.S. regulators relied on to determine that a chemical in its Roundup weed killer does not cause cancer, farmers and others suing the company claimed in court filings.
The documents, which were made public on Tuesday, are part of a mass litigation in federal court in San Francisco claiming Monsanto failed to warn that exposure to Roundup could cause non-Hodgkin's lymphoma, a type of cancer. Roundup is used by farmers, homeowners and others around the globe and brought Monsanto $4.8 billion in revenue in its fiscal 2015.
In the event California farm workers file cancer related industrial injury claims based on exposure to Monsanto farming products, this federal litigation may give rise to subrogation opportunities. Or, successful recoveries in this case by farm workers may later become the basis for benefit credit petitions in individual WCAB cases they may later file.
The company has denied that the product causes cancer. Plaintiffs claim that Monsanto's toxicology manager ghostwrote parts of a scientific report in 2013 that was published under the names of several academic scientists, and his boss ghostwrote parts of another in 2000.
Both reports were used by the EPA to determine that glyphosate, a chemical in Roundup, was safe, they said.
They cited an email from a Monsanto executive proposing to ghostwrite parts of the 2013 report, saying, "we would be keeping the cost down by us doing the writing" while researchers "would just edit & sign their names so to speak."
In an email to Reuters, a Monsanto spokeswoman denied that Monsanto scientists ghostwrote the 2000 report but did not directly address the 2013 report. She said the ghostwriting allegations were based on "cherry-picking" one email out of 10 million pages of documents.
Another filing focused on Jess Rowland, a former deputy director at the Environmental Protection Agency who chaired a committee on cancer risk and who plaintiffs say worked with Monsanto to suppress studies of glyphosate.
The filing includes an email from a Monsanto employee recounting how Rowland told him he "should get a medal" if he could "kill" a study of glyphosate at the Department of Health and Human Services, a separate federal agency.
Rowland, who is retired, is not a defendant in the litigation. He could not immediately be located for comment. The EPA had no immediate comment.
The federal mass litigation includes about 60 lawsuits, according to Aimee Wagstaff, an attorney for the plaintiffs. Several hundred more lawsuits are pending in state courts, she said.
Monsanto is also fending off claims over its past manufacturing of polychlorinated biphenyls (PCBs), which the WHO classifies as known carcinogens. At least 700 lawsuits against Monsanto or Monsanto-related entities are pending, brought by law firms on behalf of people who claim their non-Hodgkin lymphoma was caused by exposure to PCBs that the company had manufactured until the late 1970s.
The case is In re Roundup Products Liability Litigation, U.S. District Court, Northern District of California, No. 16-md-02741 ...
The documents, which were made public on Tuesday, are part of a mass litigation in federal court in San Francisco claiming Monsanto failed to warn that exposure to Roundup could cause non-Hodgkin's lymphoma, a type of cancer. Roundup is used by farmers, homeowners and others around the globe and brought Monsanto $4.8 billion in revenue in its fiscal 2015.
In the event California farm workers file cancer related industrial injury claims based on exposure to Monsanto farming products, this federal litigation may give rise to subrogation opportunities. Or, successful recoveries in this case by farm workers may later become the basis for benefit credit petitions in individual WCAB cases they may later file.
The company has denied that the product causes cancer. Plaintiffs claim that Monsanto's toxicology manager ghostwrote parts of a scientific report in 2013 that was published under the names of several academic scientists, and his boss ghostwrote parts of another in 2000.
Both reports were used by the EPA to determine that glyphosate, a chemical in Roundup, was safe, they said.
They cited an email from a Monsanto executive proposing to ghostwrite parts of the 2013 report, saying, "we would be keeping the cost down by us doing the writing" while researchers "would just edit & sign their names so to speak."
In an email to Reuters, a Monsanto spokeswoman denied that Monsanto scientists ghostwrote the 2000 report but did not directly address the 2013 report. She said the ghostwriting allegations were based on "cherry-picking" one email out of 10 million pages of documents.
Another filing focused on Jess Rowland, a former deputy director at the Environmental Protection Agency who chaired a committee on cancer risk and who plaintiffs say worked with Monsanto to suppress studies of glyphosate.
The filing includes an email from a Monsanto employee recounting how Rowland told him he "should get a medal" if he could "kill" a study of glyphosate at the Department of Health and Human Services, a separate federal agency.
Rowland, who is retired, is not a defendant in the litigation. He could not immediately be located for comment. The EPA had no immediate comment.
The federal mass litigation includes about 60 lawsuits, according to Aimee Wagstaff, an attorney for the plaintiffs. Several hundred more lawsuits are pending in state courts, she said.
Monsanto is also fending off claims over its past manufacturing of polychlorinated biphenyls (PCBs), which the WHO classifies as known carcinogens. At least 700 lawsuits against Monsanto or Monsanto-related entities are pending, brought by law firms on behalf of people who claim their non-Hodgkin lymphoma was caused by exposure to PCBs that the company had manufactured until the late 1970s.
The case is In re Roundup Products Liability Litigation, U.S. District Court, Northern District of California, No. 16-md-02741 ...
The California Workers' Compensation Institute (CWCI) has issued its 7th Regional Score Card, providing data on claims filed by workers from California’s nine northernmost counties for job injuries that occurred between 2005 and 2015.
The Scorecard analyzed data from 63,000 claims that resulted in $738 million in payments for medical and indemnity (lost-time) benefits and found that residents of Del Norte, Humboldt, Lassen, Modoc, Plumas, Shasta, Siskiyou, Tehama, and Trinity Counties accounted for 1.1% of the state’s workforce, but 3.3% of the job injury claims.
Compared to other regions, however, Northern County claims had lower average costs, so they consumed just 2.2% of the state’s total workers’ comp paid losses.
CWCI found that 70.6% of claims from the Northern Counties were filed by men - well above the rate in the rest of the state and the highest level among all 8 regions of California. Given that the area is sparsely populated and heavily forested, agricultural workers (including those in ranching, forestry, fishing, and hunting) filed nearly a quarter of the claims (four times the proportion in other regions) with construction workers accounting for another 13.5%.
Strains represented a relatively large share of the claims, as did specific injury categories such as foreign bodies, punctures, lacerations and fractures, which likely reflects the blue collar workforce. As in other regions, minor wounds and injuries to the skin were the leading diagnoses, followed by strains and sprains of the back, shoulder, arm, knee and lower leg, but claims for degenerative, infective, and metabolic joint disorders were also more prevalent and consumed nearly 15% paid losses in the region vs. 8.3% in other regions.
Overall, employers and claims administrators were notified of the injuries and initial treatment began sooner in the Northern Counties than in other regions; and the claims had lower attorney involvement rates, fewer medical visits, lower rates of permanent disability, and shorter durations.
The Regional Score Card features two dozen exhibits with data and commentary on a wide range of metrics including distributions of claims by industry; premium size; claim type; nature and cause of injury; and diagnosis. Several exhibits, including the percentage of claims with permanent disability; attorney involvement rates; claim closure rates; top medications dispensed; breakdowns of medical development by Fee Schedule Section at 12 and 24 months; network utilization; notice and treatment time lags; and 12-, 24- and 36-month loss development tables compare results for the region against those for all other regions, and many also show statewide results, offering a wealth of detailed data on workers’ comp claims both for the region and for the entire state.
Score Cards are available to CWCI members and subscribers. Others may purchase individual Score Cards by visiting CWCI's online Store.
The final Score Card in the series will focus on claims from the Sierras, encompassing much of the Gold Country and the mountainous areas that border Nevada from north of Lake Tahoe south to Death Valley ...
The Scorecard analyzed data from 63,000 claims that resulted in $738 million in payments for medical and indemnity (lost-time) benefits and found that residents of Del Norte, Humboldt, Lassen, Modoc, Plumas, Shasta, Siskiyou, Tehama, and Trinity Counties accounted for 1.1% of the state’s workforce, but 3.3% of the job injury claims.
Compared to other regions, however, Northern County claims had lower average costs, so they consumed just 2.2% of the state’s total workers’ comp paid losses.
CWCI found that 70.6% of claims from the Northern Counties were filed by men - well above the rate in the rest of the state and the highest level among all 8 regions of California. Given that the area is sparsely populated and heavily forested, agricultural workers (including those in ranching, forestry, fishing, and hunting) filed nearly a quarter of the claims (four times the proportion in other regions) with construction workers accounting for another 13.5%.
Strains represented a relatively large share of the claims, as did specific injury categories such as foreign bodies, punctures, lacerations and fractures, which likely reflects the blue collar workforce. As in other regions, minor wounds and injuries to the skin were the leading diagnoses, followed by strains and sprains of the back, shoulder, arm, knee and lower leg, but claims for degenerative, infective, and metabolic joint disorders were also more prevalent and consumed nearly 15% paid losses in the region vs. 8.3% in other regions.
Overall, employers and claims administrators were notified of the injuries and initial treatment began sooner in the Northern Counties than in other regions; and the claims had lower attorney involvement rates, fewer medical visits, lower rates of permanent disability, and shorter durations.
The Regional Score Card features two dozen exhibits with data and commentary on a wide range of metrics including distributions of claims by industry; premium size; claim type; nature and cause of injury; and diagnosis. Several exhibits, including the percentage of claims with permanent disability; attorney involvement rates; claim closure rates; top medications dispensed; breakdowns of medical development by Fee Schedule Section at 12 and 24 months; network utilization; notice and treatment time lags; and 12-, 24- and 36-month loss development tables compare results for the region against those for all other regions, and many also show statewide results, offering a wealth of detailed data on workers’ comp claims both for the region and for the entire state.
Score Cards are available to CWCI members and subscribers. Others may purchase individual Score Cards by visiting CWCI's online Store.
The final Score Card in the series will focus on claims from the Sierras, encompassing much of the Gold Country and the mountainous areas that border Nevada from north of Lake Tahoe south to Death Valley ...
Theodore Davis filed two applications for adjudication of his workers’ compensation claim alleging he contracted prostate cancer due to both specific industrial exposure and as a cumulative trauma injury through March 31, 2014, while performing his duties as a firefighter for the City of Modesto.
The parties selected Thomas Allems, M.D., as the panel Qualified Medical Examiner (QME) during the discovery process. Dr. Allems produced two medical-legal reports concluding Davis’s cancer was not related to his employment.
At his own expense, Davis hired Gerald Besses, M.D., to review Dr. Allems’s reports and to evaluate him regarding the causation of his prostate cancer. Davis forwarded Dr. Besses’ reporting to Dr. Allems with a request to prepare a supplemental report addressing Dr. Besses’ evaluation, but Modesto objected and filed a declaration of readiness to proceed to a hearing, claiming the request was an attempt to violate the workers’ compensation discovery process.
The WCJ concluded Dr. Besses’ report was not admissible because it was not obtained pursuant to section 4060 (Batten v. Workers’ Comp. Appeals Bd. (2015) 241 Cal.App.4th 1009 (Batten)), but that the report may nevertheless be reviewed and commented on by Dr. Allems as the QME pursuant to Labor Code 4605.
LC 4605 provides that "Nothing contained in this chapter shall limit the right of the employee to provide, at his or her own expense, a consulting physician or any attending physicians whom he or she desires. Any report prepared by consulting or attending physicians pursuant to this section shall not be the sole basis of an award of compensation. A qualified medical evaluator or authorized treating physician shall address any report procured pursuant to this section and shall indicate whether he or she agrees or disagrees with the findings or opinions stated in the report, and shall identify the bases for this opinion."
Modesto petitioned the WCAB for reconsideration. In a July 15, 2016, opinion, the WCAB treated the petition as one for removal, granted removal, dismissed reconsideration, and rescinded the WCJ’s decision concluding that Dr. Besses’ report was not reviewable by the QME
Davis filed a petition for writ of review. In addition to an answer from Modesto, the WCAB filed a letter brief stating it had reviewed the petition and determined it failed to address Labor Code section 4605 in its October 3, 2016, decision. Accordingly, the WCAB asked the court to grant the petition for review, annul the WCAB’s decision, and remand to the WCAB for further proceedings.
The Court of Appeal granted a writ of review in the unpublished decision of Davis v WCAB, and the City of Modesto. The WCAB’s October 3, 2016, Opinion and Orders Denying Petition for Reconsideration and Dismissing Petition for Removal was annulled. The matter was remanded to the WCAB to conduct any further proceedings it deems appropriate.
"Given the WCAB’s admission it did not consider section 4605, which is also apparent from the face of its October 3, 2016, opinion, we conclude the WCAB’s decision fails to 'state the evidence relied upon and specify in detail the reasons for the decision' as required under section 5908.5. 'The purpose of this section requiring the appeals board to specify in detail the reasons for its decision is to assist the reviewing court to ascertain principles relied upon by the lower tribunal to help avoid careless or arbitrary action and to make the right of appeal more meaningful.' (Burbank Studios v. Workers’ Comp. Appeals Bd. (1982) 134 Cal.App.3d 929, 936.) The WCAB’s failure to set forth its reasoning in adequate detail constitutes a sufficient basis to annul the decision and remand for a statement of reasons." ...
The parties selected Thomas Allems, M.D., as the panel Qualified Medical Examiner (QME) during the discovery process. Dr. Allems produced two medical-legal reports concluding Davis’s cancer was not related to his employment.
At his own expense, Davis hired Gerald Besses, M.D., to review Dr. Allems’s reports and to evaluate him regarding the causation of his prostate cancer. Davis forwarded Dr. Besses’ reporting to Dr. Allems with a request to prepare a supplemental report addressing Dr. Besses’ evaluation, but Modesto objected and filed a declaration of readiness to proceed to a hearing, claiming the request was an attempt to violate the workers’ compensation discovery process.
The WCJ concluded Dr. Besses’ report was not admissible because it was not obtained pursuant to section 4060 (Batten v. Workers’ Comp. Appeals Bd. (2015) 241 Cal.App.4th 1009 (Batten)), but that the report may nevertheless be reviewed and commented on by Dr. Allems as the QME pursuant to Labor Code 4605.
LC 4605 provides that "Nothing contained in this chapter shall limit the right of the employee to provide, at his or her own expense, a consulting physician or any attending physicians whom he or she desires. Any report prepared by consulting or attending physicians pursuant to this section shall not be the sole basis of an award of compensation. A qualified medical evaluator or authorized treating physician shall address any report procured pursuant to this section and shall indicate whether he or she agrees or disagrees with the findings or opinions stated in the report, and shall identify the bases for this opinion."
Modesto petitioned the WCAB for reconsideration. In a July 15, 2016, opinion, the WCAB treated the petition as one for removal, granted removal, dismissed reconsideration, and rescinded the WCJ’s decision concluding that Dr. Besses’ report was not reviewable by the QME
Davis filed a petition for writ of review. In addition to an answer from Modesto, the WCAB filed a letter brief stating it had reviewed the petition and determined it failed to address Labor Code section 4605 in its October 3, 2016, decision. Accordingly, the WCAB asked the court to grant the petition for review, annul the WCAB’s decision, and remand to the WCAB for further proceedings.
The Court of Appeal granted a writ of review in the unpublished decision of Davis v WCAB, and the City of Modesto. The WCAB’s October 3, 2016, Opinion and Orders Denying Petition for Reconsideration and Dismissing Petition for Removal was annulled. The matter was remanded to the WCAB to conduct any further proceedings it deems appropriate.
"Given the WCAB’s admission it did not consider section 4605, which is also apparent from the face of its October 3, 2016, opinion, we conclude the WCAB’s decision fails to 'state the evidence relied upon and specify in detail the reasons for the decision' as required under section 5908.5. 'The purpose of this section requiring the appeals board to specify in detail the reasons for its decision is to assist the reviewing court to ascertain principles relied upon by the lower tribunal to help avoid careless or arbitrary action and to make the right of appeal more meaningful.' (Burbank Studios v. Workers’ Comp. Appeals Bd. (1982) 134 Cal.App.3d 929, 936.) The WCAB’s failure to set forth its reasoning in adequate detail constitutes a sufficient basis to annul the decision and remand for a statement of reasons." ...
Owners of companies providing professional business services ranging from IT to architecture in California now have the option to purchase workers’ compensation insurance through Hiscox.
The international and national small business insurer made the announcement of the new option recently. Kevin Kerridge, Executive Vice President of Small Business Insurance at Hiscox USA, explains the company’s focus and future plans in the space.
"One of the key insights behind us launching our US small business operation in 2010 was just how underserved small business owners have been by the insurance industry," Kerridge told Small Business Trends.
"We’re proud to add another product offering to what we already provide to those customers. We’ve started in California as a first step, and over the next 12 months we’ll selectively expand our geographic footprint in this new product line." The company is headquartered in Bermuda and listed on the London Stock Exchange. Currently it has California offices in San Francisco and Los Angeles.
Hiscox is a specialist insurer, with roots dating back to 1901. It has offices in 14 countries and operate in all US states and the District of Columbia. The company offers a range of specialty insurance products through US based brokers as well as directly online to small businesses.
This month A.M. Best has affirmed the Financial Strength Ratings of A [Excellent] and the Long-Term Issuer Credit Ratings of "a+" of Hiscox Insurance Company [Bermuda] Limited [Hiscox Bermuda], Hiscox Insurance Company Limited [Hisco] [United Kingdom], Hiscox Insurance Company [Guernsey] Limited [Hiscox Guernsey], Hiscox Insurance Company, Inc. [HICI] [Chicago, Illinois, USA] and Lloyd’s Syndicate 33 [United Kingdom], which is managed by Hiscox Syndicates Limited.
The ratings agency said, "The rating affirmations of Hiscox, Hiscox Bermuda and Hisco reflect the Hiscox group’s strong consolidated risk-adjusted capitalisation and good financial flexibility. The ratings also reflect Hiscox’s strong operating performance, underpinned by an average five-year combined ratio of 86%. Hiscox pursues a successful strategy of balancing volatile international catastrophe and large loss-exposed insurance and reinsurance business with more stable local retail business, which continues to support its profitable performance."
The company reported a profit surge in 2016 to $440.4 million, up 64% from the previous year, bolstered by good investment returns and a favorable foreign exchange gain. CEO Bronek Masojada said "Our retail business has come of age, driving growth and profitability for the group." Mr. Masojada said the Hiscox USA unit’s "outstanding momentum has not stopped," growing 30% in constant currency to $496.9 million, compared with $348.7 million a year ago ...
The international and national small business insurer made the announcement of the new option recently. Kevin Kerridge, Executive Vice President of Small Business Insurance at Hiscox USA, explains the company’s focus and future plans in the space.
"One of the key insights behind us launching our US small business operation in 2010 was just how underserved small business owners have been by the insurance industry," Kerridge told Small Business Trends.
"We’re proud to add another product offering to what we already provide to those customers. We’ve started in California as a first step, and over the next 12 months we’ll selectively expand our geographic footprint in this new product line." The company is headquartered in Bermuda and listed on the London Stock Exchange. Currently it has California offices in San Francisco and Los Angeles.
Hiscox is a specialist insurer, with roots dating back to 1901. It has offices in 14 countries and operate in all US states and the District of Columbia. The company offers a range of specialty insurance products through US based brokers as well as directly online to small businesses.
This month A.M. Best has affirmed the Financial Strength Ratings of A [Excellent] and the Long-Term Issuer Credit Ratings of "a+" of Hiscox Insurance Company [Bermuda] Limited [Hiscox Bermuda], Hiscox Insurance Company Limited [Hisco] [United Kingdom], Hiscox Insurance Company [Guernsey] Limited [Hiscox Guernsey], Hiscox Insurance Company, Inc. [HICI] [Chicago, Illinois, USA] and Lloyd’s Syndicate 33 [United Kingdom], which is managed by Hiscox Syndicates Limited.
The ratings agency said, "The rating affirmations of Hiscox, Hiscox Bermuda and Hisco reflect the Hiscox group’s strong consolidated risk-adjusted capitalisation and good financial flexibility. The ratings also reflect Hiscox’s strong operating performance, underpinned by an average five-year combined ratio of 86%. Hiscox pursues a successful strategy of balancing volatile international catastrophe and large loss-exposed insurance and reinsurance business with more stable local retail business, which continues to support its profitable performance."
The company reported a profit surge in 2016 to $440.4 million, up 64% from the previous year, bolstered by good investment returns and a favorable foreign exchange gain. CEO Bronek Masojada said "Our retail business has come of age, driving growth and profitability for the group." Mr. Masojada said the Hiscox USA unit’s "outstanding momentum has not stopped," growing 30% in constant currency to $496.9 million, compared with $348.7 million a year ago ...
Physical therapy is as effective as surgery in treating carpal tunnel syndrome, according to a new study published in the Journal of Orthopaedic & Sports Physical Therapy® (JOSPT®).
Researchers in Spain and the United States report that one year following treatment, patients with carpal tunnel syndrome who received physical therapy achieved results comparable to outcomes for patients who had surgery for this condition. Further, physical therapy patients saw faster improvements at the one-month mark than did patients treated surgically.
Carpal tunnel syndrome causes pain, numbness, and weakness in the wrist and hand. Nearly half of all work-related injuries are linked to this syndrome, which can result from repetitive movements. Although surgery may be considered when the symptoms are severe, more than a third of patients do not return to work within eight weeks after an operation for carpal tunnel syndrome.
The study demonstrates that physical therapy - and particularly a combination of manual therapy of the neck and median nerve and stretching exercises - may be preferable to surgery, certainly as a starting point for treatment.
"Conservative treatment may be an intervention option for patients with carpal tunnel syndrome as a first line of management prior to or instead of surgery," says lead author César Fernández de las Peñas, PT, PhD, DMSc, with the Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine at Universidad Rey Juan Carlos, Alcorcón, Spain.
Dr. de las Peñas and his fellow researchers studied the cases of 100 women with carpal tunnel syndrome. By random allocation, 50 women were treated with physical therapy and 50 with surgery. Patients assigned to the physical therapy group were treated with manual therapy techniques that focused on the neck and median nerve for 30 minutes, once a week, with stretching exercises at home.
After one month, the patients in the physical therapy group had better hand function during daily activities and better grip strength (also known as pinch strength between the thumb and index finger) than the patients who had surgery. At three, six, and 12 months following treatment, patients in the surgery group were no better than those in the physical therapy group. Both groups showed similar improvements in function and grip strength. Pain also decreased similarly for patients in both groups. The researchers conclude that physical therapy and surgery for carpal tunnel syndrome yield similar benefits one year after treatment. No improvements in cervical range of motion were observed in either patient group.
The researchers caution that because the study only included women from a single hospital, additional research needs to be done to generalize their findings. Further, there are no available data on the most effective dosage for the manual therapy protocol applied.
The study was funded by a research project grant (FIS PI14/ 00364) from the Health Institute Carlos III (PN I+D+I 2014-2017; Spanish Government) ...
Researchers in Spain and the United States report that one year following treatment, patients with carpal tunnel syndrome who received physical therapy achieved results comparable to outcomes for patients who had surgery for this condition. Further, physical therapy patients saw faster improvements at the one-month mark than did patients treated surgically.
Carpal tunnel syndrome causes pain, numbness, and weakness in the wrist and hand. Nearly half of all work-related injuries are linked to this syndrome, which can result from repetitive movements. Although surgery may be considered when the symptoms are severe, more than a third of patients do not return to work within eight weeks after an operation for carpal tunnel syndrome.
The study demonstrates that physical therapy - and particularly a combination of manual therapy of the neck and median nerve and stretching exercises - may be preferable to surgery, certainly as a starting point for treatment.
"Conservative treatment may be an intervention option for patients with carpal tunnel syndrome as a first line of management prior to or instead of surgery," says lead author César Fernández de las Peñas, PT, PhD, DMSc, with the Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine at Universidad Rey Juan Carlos, Alcorcón, Spain.
Dr. de las Peñas and his fellow researchers studied the cases of 100 women with carpal tunnel syndrome. By random allocation, 50 women were treated with physical therapy and 50 with surgery. Patients assigned to the physical therapy group were treated with manual therapy techniques that focused on the neck and median nerve for 30 minutes, once a week, with stretching exercises at home.
After one month, the patients in the physical therapy group had better hand function during daily activities and better grip strength (also known as pinch strength between the thumb and index finger) than the patients who had surgery. At three, six, and 12 months following treatment, patients in the surgery group were no better than those in the physical therapy group. Both groups showed similar improvements in function and grip strength. Pain also decreased similarly for patients in both groups. The researchers conclude that physical therapy and surgery for carpal tunnel syndrome yield similar benefits one year after treatment. No improvements in cervical range of motion were observed in either patient group.
The researchers caution that because the study only included women from a single hospital, additional research needs to be done to generalize their findings. Further, there are no available data on the most effective dosage for the manual therapy protocol applied.
The study was funded by a research project grant (FIS PI14/ 00364) from the Health Institute Carlos III (PN I+D+I 2014-2017; Spanish Government) ...
Doctors issuing mass opioid prescriptions in New Jersey are facing a legal crackdown to combat rampant heroin addiction fueled by painkillers.
A record number of doctors in the state were sanctioned in 2016 over their irresponsible prescribing habits, resulting in long-term suspensions, permanent revocation of medical licenses and in some cases criminal charges. George Beecher, a doctor in Somerset County, was found cashing in on the opioid epidemic with his associates by writing scripts for large quantities of oxycodone, a highly addictive painkiller, to patients he never met or evaluated, reports Fox News.
In total, Beecher wrote prescriptions for roughly 60,000 tablets of oxycodone to more than 24 patients he never came into contact with. David Delmonaco, the father of a 21-year-old U.S. Army officer who committed suicide after getting addicted to oxycodone through Beecher, said the doctor “did it all for money.” The state sanctioned another 30 doctors during 2016 for failing to follow prescribing guidelines or deliberately violating medical standards for profit.
GOP Gov. Chris Christie declared the opioid epidemic a public health crisis Jan. 17 in New Jersey, which has a death rate from heroin higher than the national average. There are roughly 128,000 heroin addicts in the state and health experts fear that number is likely growing. Heroin deaths spiked 22 percent between 2014 and 2015 and the state doubled the national drug overdose death rate with 1,600 fatalities in 2015.
The majority of heroin addicts in the state began with a legal prescription for painkillers, before transitioning after building high tolerances making the pills too expensive.
"When four out of five new heroin users are getting their start by abusing prescription drugs, you have to attack the problem at ground zero - in irresponsibly run doctors’ offices," New Jersey Attorney General Porrino said in a statement. "Physicians who grant easy access to the drugs that are turning New Jersey residents into addicts can be every bit as dangerous as street-corner dealers. Purging the medical community of over-prescribers is as important to our cause as busting heroin rings and locking up drug kingpins."
Beecher currently has a suspended license pending the outcome of criminal charges over the overdose death of an associate’s adult son. He is charged with first degree strict liability for a drug induced death and several second degree counts for conspiracy to distribute controlled substances. Beecher is expected to appear in court in April.
More Americans are taking prescription painkillers than ever before, despite record heroin abuse and rising overdose death rates connected to opioids. A recent survey from Truven Health Analytics and NPR reveals more than half of the U.S. population reports receiving a prescription for opioids at least once from their doctor, a 7 percent increase since 2011.
Only 19 percent of respondents, however, received the painkillers for chronic pain. Seventy-four percent of respondents said doctors doled out prescription narcotics for acute pain, like after a procedure to remove wisdom teeth. Medical professionals say doctors need to start by prescribing the least potent and least addictive pain treatment option, and then cautiously go from there.
A record 33,000 Americans died from opioid related overdoses in 2015, according to the Centers for Disease Control and Prevention. Opioid deaths contributed to the first drop in U.S. life expectancy since 1993 and eclipsed deaths from motor vehicle accidents in 2015 ...
A record number of doctors in the state were sanctioned in 2016 over their irresponsible prescribing habits, resulting in long-term suspensions, permanent revocation of medical licenses and in some cases criminal charges. George Beecher, a doctor in Somerset County, was found cashing in on the opioid epidemic with his associates by writing scripts for large quantities of oxycodone, a highly addictive painkiller, to patients he never met or evaluated, reports Fox News.
In total, Beecher wrote prescriptions for roughly 60,000 tablets of oxycodone to more than 24 patients he never came into contact with. David Delmonaco, the father of a 21-year-old U.S. Army officer who committed suicide after getting addicted to oxycodone through Beecher, said the doctor “did it all for money.” The state sanctioned another 30 doctors during 2016 for failing to follow prescribing guidelines or deliberately violating medical standards for profit.
GOP Gov. Chris Christie declared the opioid epidemic a public health crisis Jan. 17 in New Jersey, which has a death rate from heroin higher than the national average. There are roughly 128,000 heroin addicts in the state and health experts fear that number is likely growing. Heroin deaths spiked 22 percent between 2014 and 2015 and the state doubled the national drug overdose death rate with 1,600 fatalities in 2015.
The majority of heroin addicts in the state began with a legal prescription for painkillers, before transitioning after building high tolerances making the pills too expensive.
"When four out of five new heroin users are getting their start by abusing prescription drugs, you have to attack the problem at ground zero - in irresponsibly run doctors’ offices," New Jersey Attorney General Porrino said in a statement. "Physicians who grant easy access to the drugs that are turning New Jersey residents into addicts can be every bit as dangerous as street-corner dealers. Purging the medical community of over-prescribers is as important to our cause as busting heroin rings and locking up drug kingpins."
Beecher currently has a suspended license pending the outcome of criminal charges over the overdose death of an associate’s adult son. He is charged with first degree strict liability for a drug induced death and several second degree counts for conspiracy to distribute controlled substances. Beecher is expected to appear in court in April.
More Americans are taking prescription painkillers than ever before, despite record heroin abuse and rising overdose death rates connected to opioids. A recent survey from Truven Health Analytics and NPR reveals more than half of the U.S. population reports receiving a prescription for opioids at least once from their doctor, a 7 percent increase since 2011.
Only 19 percent of respondents, however, received the painkillers for chronic pain. Seventy-four percent of respondents said doctors doled out prescription narcotics for acute pain, like after a procedure to remove wisdom teeth. Medical professionals say doctors need to start by prescribing the least potent and least addictive pain treatment option, and then cautiously go from there.
A record 33,000 Americans died from opioid related overdoses in 2015, according to the Centers for Disease Control and Prevention. Opioid deaths contributed to the first drop in U.S. life expectancy since 1993 and eclipsed deaths from motor vehicle accidents in 2015 ...
A 220 page report by the California Senate Committee on Business, Professions and Economic Development says than 635 physicians are currently on administrative probation.
Doctors were disciplined for allegations such as sexual misconduct with patients, performing surgery under the influence of controlled substances and health care fraud.
Although physicians must report their probation to their employer and insurance company, they are not obligated to inform patients. And lawmakers are considering a change to that by requiring physicians to inform each patient that they are on probation.
Issue 28 of the report says that while it is true that important information is available on Medical Board of California (MBC) website, a key issue for the Committees remains how easily available it is for California patients to access easily understandable information about physicians who have been the subject of disciplinary action, placed on probation and are practicing. When the MBC places physicians on probation, generally they continue to practice medicine and see patients under restricted conditions. Terms of probation may include certain practice limitations and requirements, but most commonly physicians on probation are not required to provide any information to their patients regarding discipline taken by MBC.
A determination of probation is a step in a lengthy disciplinary process, conducted in accordance with the Administrative Procedures Act, and offering due process for accused licensees. In reviewing MBC data for current physicians on probation, proven violations that result in probation include gross negligence or incompetence, substance abuse, inappropriate prescribing, sexual misconduct or conviction of a felony.
Probationary status is not secret. MBC only orders probation for a licensee once multiple steps in the life of a case have been taken. Probation is not loosely issued for suspicions or complaints or facts gained during an investigation that lead to the filing of an accusation for which clear and convincing evidence is present.
And the report says that patients may be especially deserving of greater access to information about a physician on probation given the potential for future disciplinary action. The 2008 CRB study reported that physicians who have received serious sanctions in the past are far more likely to receive additional sanctions in the future. According to the CRB report, "These findings strongly imply that disciplinary histories provide patients with important information about the likely qualities of different physicians."
According to MBC data, there are currently 635 physicians on probation (this includes those issued a probationary license at application and those with an out of state address of record, for a total of 497 on probation with an address in California, 83 on probation with an address in another state, 38 with a probationary license with an address in California and 17 with a probationary license with an address in another state.) The Appendix to this report starting on page 70 is a listing by name, location and type of offense of those physicians and surgeons currently on probation.
It would be interesting to review the 635 names to see how many of them currently treat i worker' compensation cases or are members of an approved MPN.
In October, 2012 MBC staff made a proposal to the MBC to require physicians to inform their patients when the physician is on probation and required to have a monitor. In its recommendation staff said, "This would insure the public has the ability to make informed decisions regarding their healthcare provider." MBC did not approve the staff proposal.
Jerry Hill is Chair of the Committee. He says patients need to be able to make appropriate health care decisions.
"There is no one watching or overseeing the physician to make sure that those terms of probation are being followed," Hill says. "It meets and requires, and I think, it mandates that the patient takes responsibility for their own health care in this case."
The committee recommends amending current law to require physicians to tell their patients they're on probation.
A legislative committee will review the report ...
Doctors were disciplined for allegations such as sexual misconduct with patients, performing surgery under the influence of controlled substances and health care fraud.
Although physicians must report their probation to their employer and insurance company, they are not obligated to inform patients. And lawmakers are considering a change to that by requiring physicians to inform each patient that they are on probation.
Issue 28 of the report says that while it is true that important information is available on Medical Board of California (MBC) website, a key issue for the Committees remains how easily available it is for California patients to access easily understandable information about physicians who have been the subject of disciplinary action, placed on probation and are practicing. When the MBC places physicians on probation, generally they continue to practice medicine and see patients under restricted conditions. Terms of probation may include certain practice limitations and requirements, but most commonly physicians on probation are not required to provide any information to their patients regarding discipline taken by MBC.
A determination of probation is a step in a lengthy disciplinary process, conducted in accordance with the Administrative Procedures Act, and offering due process for accused licensees. In reviewing MBC data for current physicians on probation, proven violations that result in probation include gross negligence or incompetence, substance abuse, inappropriate prescribing, sexual misconduct or conviction of a felony.
Probationary status is not secret. MBC only orders probation for a licensee once multiple steps in the life of a case have been taken. Probation is not loosely issued for suspicions or complaints or facts gained during an investigation that lead to the filing of an accusation for which clear and convincing evidence is present.
And the report says that patients may be especially deserving of greater access to information about a physician on probation given the potential for future disciplinary action. The 2008 CRB study reported that physicians who have received serious sanctions in the past are far more likely to receive additional sanctions in the future. According to the CRB report, "These findings strongly imply that disciplinary histories provide patients with important information about the likely qualities of different physicians."
According to MBC data, there are currently 635 physicians on probation (this includes those issued a probationary license at application and those with an out of state address of record, for a total of 497 on probation with an address in California, 83 on probation with an address in another state, 38 with a probationary license with an address in California and 17 with a probationary license with an address in another state.) The Appendix to this report starting on page 70 is a listing by name, location and type of offense of those physicians and surgeons currently on probation.
It would be interesting to review the 635 names to see how many of them currently treat i worker' compensation cases or are members of an approved MPN.
In October, 2012 MBC staff made a proposal to the MBC to require physicians to inform their patients when the physician is on probation and required to have a monitor. In its recommendation staff said, "This would insure the public has the ability to make informed decisions regarding their healthcare provider." MBC did not approve the staff proposal.
Jerry Hill is Chair of the Committee. He says patients need to be able to make appropriate health care decisions.
"There is no one watching or overseeing the physician to make sure that those terms of probation are being followed," Hill says. "It meets and requires, and I think, it mandates that the patient takes responsibility for their own health care in this case."
The committee recommends amending current law to require physicians to tell their patients they're on probation.
A legislative committee will review the report ...
AssuredPartners Inc. is making a significant move into California with the purchase of Keenan & Associates in a deal that will push AssuredPartners’ annual revenue over $800 million.
Business Insurance reports that the deal announced Thursday is one of the largest mergers of privately held insurance brokers and will give Lake Mary, Florida-based AssuredPartners, which has bought nearly 70 rival brokers and agents over the past two years, a well-established operation in California that focuses on insurance and employee benefits programs for school districts, other public entities and the health care sector.
The acquisition is expected to close in late March or early April. Terms of the deal were not disclosed.
AssuredPartners, which ranked as the 13th-largest broker of U.S. business in Business Insurance’s most recent ranking, has more than $670 million in annual revenue, according to a statement announcing the deal. Torrance, California-based Keenan ranked 22nd and has about $170 million in annual revenue.
AssuredPartners Chairman and CEO Jim Henderson said in the statement: "We focus on partnering with agencies with strong management that demonstrate a dedication to growth and building lasting relationships - we have found this with Keenan."
The purchase is the biggest deal that AssuredPartners has sealed since it was established six years ago, Mr. Henderson said, in an interview.
And it is the brokerage's first major deal in California. Last month, AssuredPartners bought Dealey, Renton & Associates Insurance Brokers, a roughly $16 million revenue professional liability specialist in Oakland, California, but prior to that its presence in California was limited, he said.
The size of deal will not restrict AssuredPartners from continuing its acquisition-fueled growth, Mr. Henderson said.
"We will continue with our very aggressive plan," he said. "We have significant support so we can continue to do smaller deals and big deals, should we choose to do that."
Keenan will continue to operate under the Keenan brand and be led by President and CEO Sean Smith. It will be the largest insurance agency in the AssuredPartners network.
"This partnership is extremely exciting for Keenan. We will have access to additional capital and a national footprint that will enable us to grow," Mr. Smith said in the statement.
Keenan, which has nearly 700 employees, was founded in 1972 by John R. Keenan and three associates. Mr. Keenan died in 2014.
AssuredPartners, which has more than 3,000 employees, was founded in 2011 and was bought by London-based private equity firm Apax Partners L.L.P. in 2015 ...
Business Insurance reports that the deal announced Thursday is one of the largest mergers of privately held insurance brokers and will give Lake Mary, Florida-based AssuredPartners, which has bought nearly 70 rival brokers and agents over the past two years, a well-established operation in California that focuses on insurance and employee benefits programs for school districts, other public entities and the health care sector.
The acquisition is expected to close in late March or early April. Terms of the deal were not disclosed.
AssuredPartners, which ranked as the 13th-largest broker of U.S. business in Business Insurance’s most recent ranking, has more than $670 million in annual revenue, according to a statement announcing the deal. Torrance, California-based Keenan ranked 22nd and has about $170 million in annual revenue.
AssuredPartners Chairman and CEO Jim Henderson said in the statement: "We focus on partnering with agencies with strong management that demonstrate a dedication to growth and building lasting relationships - we have found this with Keenan."
The purchase is the biggest deal that AssuredPartners has sealed since it was established six years ago, Mr. Henderson said, in an interview.
And it is the brokerage's first major deal in California. Last month, AssuredPartners bought Dealey, Renton & Associates Insurance Brokers, a roughly $16 million revenue professional liability specialist in Oakland, California, but prior to that its presence in California was limited, he said.
The size of deal will not restrict AssuredPartners from continuing its acquisition-fueled growth, Mr. Henderson said.
"We will continue with our very aggressive plan," he said. "We have significant support so we can continue to do smaller deals and big deals, should we choose to do that."
Keenan will continue to operate under the Keenan brand and be led by President and CEO Sean Smith. It will be the largest insurance agency in the AssuredPartners network.
"This partnership is extremely exciting for Keenan. We will have access to additional capital and a national footprint that will enable us to grow," Mr. Smith said in the statement.
Keenan, which has nearly 700 employees, was founded in 1972 by John R. Keenan and three associates. Mr. Keenan died in 2014.
AssuredPartners, which has more than 3,000 employees, was founded in 2011 and was bought by London-based private equity firm Apax Partners L.L.P. in 2015 ...
The operator of rehabilitation clinic in Walnut was sentenced to 63 months in prison for his role in a $3.4 million Medicare fraud scheme that involved billing for occupational therapy services that were not medically necessary and not provided.
Simon Hong, 55, of Brea, was sentenced by U.S. District Judge George H. Wu, who also ordered to pay $2,407,857 in restitution. Hong pleaded guilty on December 15 to one count of conspiracy to commit health care fraud.
"This defendant has now been convicted and sentenced to federal prison in two separate schemes that cost taxpayers millions of dollars," said United States Attorney Decker. "This type of fraudulent conduct is a burden on the entire health care system, drives up costs for patients and compromises the delivery of services to people who legitimately need care."
In addition to today’s sentence, Hong was sentenced in January to over 10 years in prison in a separate case. The 63-month sentence imposed by Judge Wu will run concurrently to the sentence imposed by Judge Carter.
As part of the guilty plea that led to the current sentencing, Hong admitted that he owned JH Physical Therapy Inc., an occupational therapy clinic in Walnut, but hid his ownership in the name of a straw or nominee owner in an effort to execute and conceal the fraudulent scheme. Hong admitted that as part of the scheme, he billed Medicare for occupational therapy services when no such services were provided to the Medicare beneficiaries. Instead, the Medicare beneficiaries received acupuncture and massage services, which were not reimbursable by Medicare. Hong further admitted that he directed co-conspirator therapists to falsify medical records to make it appear as if the services billed had been actually provided and funneled 87 percent of the proceeds from Medicare to himself.
Through this scheme, Hong admitted that he and his co-conspirators billed Medicare approximately $3,454,485 from October 2009 until December 2012 in false claims and received approximately $2,407,857.
Hong was charged by indictment on June 16, 2016, along with Grace Hong, 51, of Brea, and Keith Canlapan, 38, of West Covina. Canlapan pleaded guilty to one count of conspiring to commit health care fraud, and Grace Hong is scheduled for trial March 21.
HHS-OIG investigated the case. The Criminal Division’s Fraud Section Trial Attorney Niall M. O’Donnell and Former Fraud Section Trial Attorney Blanca Quintero prosecuted the case ...
Simon Hong, 55, of Brea, was sentenced by U.S. District Judge George H. Wu, who also ordered to pay $2,407,857 in restitution. Hong pleaded guilty on December 15 to one count of conspiracy to commit health care fraud.
"This defendant has now been convicted and sentenced to federal prison in two separate schemes that cost taxpayers millions of dollars," said United States Attorney Decker. "This type of fraudulent conduct is a burden on the entire health care system, drives up costs for patients and compromises the delivery of services to people who legitimately need care."
In addition to today’s sentence, Hong was sentenced in January to over 10 years in prison in a separate case. The 63-month sentence imposed by Judge Wu will run concurrently to the sentence imposed by Judge Carter.
As part of the guilty plea that led to the current sentencing, Hong admitted that he owned JH Physical Therapy Inc., an occupational therapy clinic in Walnut, but hid his ownership in the name of a straw or nominee owner in an effort to execute and conceal the fraudulent scheme. Hong admitted that as part of the scheme, he billed Medicare for occupational therapy services when no such services were provided to the Medicare beneficiaries. Instead, the Medicare beneficiaries received acupuncture and massage services, which were not reimbursable by Medicare. Hong further admitted that he directed co-conspirator therapists to falsify medical records to make it appear as if the services billed had been actually provided and funneled 87 percent of the proceeds from Medicare to himself.
Through this scheme, Hong admitted that he and his co-conspirators billed Medicare approximately $3,454,485 from October 2009 until December 2012 in false claims and received approximately $2,407,857.
Hong was charged by indictment on June 16, 2016, along with Grace Hong, 51, of Brea, and Keith Canlapan, 38, of West Covina. Canlapan pleaded guilty to one count of conspiring to commit health care fraud, and Grace Hong is scheduled for trial March 21.
HHS-OIG investigated the case. The Criminal Division’s Fraud Section Trial Attorney Niall M. O’Donnell and Former Fraud Section Trial Attorney Blanca Quintero prosecuted the case ...
Denise Niber has been named Claims and Medical Director of the California Workers’ Compensation Institute (CWCI). Niber will take over the position from Brenda Ramirez who is planning to retire in June after having served in the role since 2004.
Ms. Niber is a Bay Area native and graduate of U.C. Berkeley, where she earned a bachelor’s degree in Business Administration.
Her tenure in the California workers’ compensation industry spans more than 25 years, with the majority of that time spent in senior-level claims positions at Associated Claims Management, Zenith Insurance, Innovative Care Systems, TIG Insurance, and most recently at Contra Costa County, where she has been the senior claims adjuster since 2005.
During that time her duties included handling complex and high-dollar claims, monitoring and implementing legislative and regulatory reforms, and serving as a mentor and trainer to the County’s claims staff.
She also has worked extensively with other stakeholders in the community, serving as an advanced workers’ compensation instructor for the Insurance Educational Association; providing testimony to the State Legislature on workers’ comp pharmaceutical abuses; serving as a subject matter expert for the Commission on Health, Safety and Workers’ Compensation on compound drug legislation; and providing technical input on CWCI research.
In her new role, Ms. Niber will oversee CWCI’s activities related to claims administration and medical services; serve as staff liaison to CWCI’s Claims and Medical Care Committees; and work with Institute staff, members, and others in the community on research, regulatory testimony, and education in those key areas.
Ms. Niber will join CWCI this week to allow for a seamless transition as Ms. Ramirez moves toward retirement. Ms. Niber can be reached at dniber@cwci.org or by calling CWCI at 510-251-9470 ...
Ms. Niber is a Bay Area native and graduate of U.C. Berkeley, where she earned a bachelor’s degree in Business Administration.
Her tenure in the California workers’ compensation industry spans more than 25 years, with the majority of that time spent in senior-level claims positions at Associated Claims Management, Zenith Insurance, Innovative Care Systems, TIG Insurance, and most recently at Contra Costa County, where she has been the senior claims adjuster since 2005.
During that time her duties included handling complex and high-dollar claims, monitoring and implementing legislative and regulatory reforms, and serving as a mentor and trainer to the County’s claims staff.
She also has worked extensively with other stakeholders in the community, serving as an advanced workers’ compensation instructor for the Insurance Educational Association; providing testimony to the State Legislature on workers’ comp pharmaceutical abuses; serving as a subject matter expert for the Commission on Health, Safety and Workers’ Compensation on compound drug legislation; and providing technical input on CWCI research.
In her new role, Ms. Niber will oversee CWCI’s activities related to claims administration and medical services; serve as staff liaison to CWCI’s Claims and Medical Care Committees; and work with Institute staff, members, and others in the community on research, regulatory testimony, and education in those key areas.
Ms. Niber will join CWCI this week to allow for a seamless transition as Ms. Ramirez moves toward retirement. Ms. Niber can be reached at dniber@cwci.org or by calling CWCI at 510-251-9470 ...
