What started as a workplace dispute at an Irvine industrial plant, culminating with an alleged attack on a co-worker, led to insurance fraud charges for a 65-year-old Lake Forest man.
The Orange County Register reports that Randal Brown McKay was arrested on charges stemming from the fracas with a co-worker in June 2014. McKay quickly posted $25,000 bail.
Senior Deputy District Attorney Pamela Leitao said McKay had "a habit of being a difficult and angry person" with his former co-workers . "He's been known to throw things at other employees."
Leitao said the dispute began when he arrived at work on June 6, 2014, and berated a longtime forklift driver for not opening up large, transparent plastic strips at a door of the plant to allow more air in.
At some point, McKay "jumped in front of the forklift" the victim was driving and "dared him to hit him," the prosecutor alleged.
The co-worker managed to stop just short of McKay, who claimed he was struck by a pallet on the forklift, Leitao said.
As a manager attempted to sort through the dispute, the forklift driver, "who is a quiet and humble guy and was shaking over all this controversy," laughed nervously, she said.
Witnesses told investigators that "McKay, cursing again, literally runs toward him and runs and leaps and clocks him in the head and tries to knee him," according to Leitao.
McKay left work, contacted Irvine police to report that he was assaulted and later filed a workers' compensation claim.
On June 11, 2014, McKay filed a claim with CompWest Insurance Co. alleging work related injuries for being struck by a forklift, and on July 14, 2015, he repeated the lie while under oath during a Worker's Compensation Appeals Board trial, the OCDA says.
The WCALJ determined McKay was not struck by a forklift and did not sustain any injuries, states the OCDA, which notes its own fraud investigation began after prosecutors were contacted by CompWest Insurance Company.
The victim had to receive eight stitches as a result of the attack and as recently as late last year still suffered from blurred vision, Leitao said.
The forklift driver was initially reluctant to seek a criminal complaint against McKay out of fear, but is now more willing to testify since the defendant is facing insurance fraud charges, as well, Leitao said.
McKay is charged with assault with force likely to produce great bodily injury, three counts of insurance fraud and perjury, along with a sentence-enhancing allegation of causing great bodily injury.
McKay could face up to 11 years in prison if convicted ...
The Orange County Register reports that Randal Brown McKay was arrested on charges stemming from the fracas with a co-worker in June 2014. McKay quickly posted $25,000 bail.
Senior Deputy District Attorney Pamela Leitao said McKay had "a habit of being a difficult and angry person" with his former co-workers . "He's been known to throw things at other employees."
Leitao said the dispute began when he arrived at work on June 6, 2014, and berated a longtime forklift driver for not opening up large, transparent plastic strips at a door of the plant to allow more air in.
At some point, McKay "jumped in front of the forklift" the victim was driving and "dared him to hit him," the prosecutor alleged.
The co-worker managed to stop just short of McKay, who claimed he was struck by a pallet on the forklift, Leitao said.
As a manager attempted to sort through the dispute, the forklift driver, "who is a quiet and humble guy and was shaking over all this controversy," laughed nervously, she said.
Witnesses told investigators that "McKay, cursing again, literally runs toward him and runs and leaps and clocks him in the head and tries to knee him," according to Leitao.
McKay left work, contacted Irvine police to report that he was assaulted and later filed a workers' compensation claim.
On June 11, 2014, McKay filed a claim with CompWest Insurance Co. alleging work related injuries for being struck by a forklift, and on July 14, 2015, he repeated the lie while under oath during a Worker's Compensation Appeals Board trial, the OCDA says.
The WCALJ determined McKay was not struck by a forklift and did not sustain any injuries, states the OCDA, which notes its own fraud investigation began after prosecutors were contacted by CompWest Insurance Company.
The victim had to receive eight stitches as a result of the attack and as recently as late last year still suffered from blurred vision, Leitao said.
The forklift driver was initially reluctant to seek a criminal complaint against McKay out of fear, but is now more willing to testify since the defendant is facing insurance fraud charges, as well, Leitao said.
McKay is charged with assault with force likely to produce great bodily injury, three counts of insurance fraud and perjury, along with a sentence-enhancing allegation of causing great bodily injury.
McKay could face up to 11 years in prison if convicted ...
The Internet is flooded with illegal advertisements posted by unlicensed contractors.
And investigators from the Contractors State License Board (CSLB) caught 21 of them during an undercover sting operation in Bakersfield. Sixteen out of the 21 people cited did not have workers’ compensation insurance for their employees and one suspect was taken into custody on an outstanding arrest warrant.
On February 22-23, 2017, investigators from CSLB’s Statewide Investigative Fraud Team (SWIFT) searched through online and local advertisements to compile a list of suspected unlicensed contractors. Posing as homeowners, investigators invited the suspects to place bids on home improvement projects for a single-family home near Meadows Field Airport.
Bids ranged from $1,000 for concrete work to $8,400 for installing French doors. Twenty people placed bids above the legal limit and received a citation for contracting without a license (Business and Professions Code section 7028). A state contractor license is required if the quoted value of the construction materials and/or labor is $500 or higher.
Suspects were cited with the assistance of the California Department of Insurance and the Kern County District Attorney’s Office.
During the sting, officers found that one suspect had an outstanding $24,000 arrest warrant for domestic violence. He was arrested and taken to county jail.
All 21 suspects who showed-up to the sting were cited for illegal advertising. State law requires unlicensed contractors to state in all advertising that they are not licensed.
Two thirds of the suspects caught during the sting were also cited for neglecting to purchase workers’ compensation insurance policies for their employees (Labor Code section 3700.5). Licensed contractors without employees must file a WC exemption with CSLB, which is noted on the license record. The exception is for roofing contractors, who must carry WC insurance, whether they work solo or have employees.
Eleven of the bidders required an excessive down payment before starting work and were also written-up for that violation. It is illegal for contractors to ask for more than 10 percent down or $1,000, whichever is less (BPC §7159.5 (a)(3)(b)).
All offenders were ordered to appear in court on May 3, 2017, at 8:30 a.m. in Kern County Superior Court, 1415 Truxtun Ave # 212, Bakersfield, CA 93301 ...
And investigators from the Contractors State License Board (CSLB) caught 21 of them during an undercover sting operation in Bakersfield. Sixteen out of the 21 people cited did not have workers’ compensation insurance for their employees and one suspect was taken into custody on an outstanding arrest warrant.
On February 22-23, 2017, investigators from CSLB’s Statewide Investigative Fraud Team (SWIFT) searched through online and local advertisements to compile a list of suspected unlicensed contractors. Posing as homeowners, investigators invited the suspects to place bids on home improvement projects for a single-family home near Meadows Field Airport.
Bids ranged from $1,000 for concrete work to $8,400 for installing French doors. Twenty people placed bids above the legal limit and received a citation for contracting without a license (Business and Professions Code section 7028). A state contractor license is required if the quoted value of the construction materials and/or labor is $500 or higher.
Suspects were cited with the assistance of the California Department of Insurance and the Kern County District Attorney’s Office.
During the sting, officers found that one suspect had an outstanding $24,000 arrest warrant for domestic violence. He was arrested and taken to county jail.
All 21 suspects who showed-up to the sting were cited for illegal advertising. State law requires unlicensed contractors to state in all advertising that they are not licensed.
Two thirds of the suspects caught during the sting were also cited for neglecting to purchase workers’ compensation insurance policies for their employees (Labor Code section 3700.5). Licensed contractors without employees must file a WC exemption with CSLB, which is noted on the license record. The exception is for roofing contractors, who must carry WC insurance, whether they work solo or have employees.
Eleven of the bidders required an excessive down payment before starting work and were also written-up for that violation. It is illegal for contractors to ask for more than 10 percent down or $1,000, whichever is less (BPC §7159.5 (a)(3)(b)).
All offenders were ordered to appear in court on May 3, 2017, at 8:30 a.m. in Kern County Superior Court, 1415 Truxtun Ave # 212, Bakersfield, CA 93301 ...
In 1990, Leticia Flethez became an employee of San Bernardino County. He worked as an equipment operator from 1991 until 2000. In 1998, he was injured while performing his job duties. His last day of work was on January 28, 2000.
On June 12, 2008, Flethez filed an application with SBCERA for a service-related disability retirement and allowance. It was rejected for omission of a signed medical records authorization.
A little more than one year later, Flethez filed a complete application, including a signed medical records authorization and a supporting physician’s report. In August 2010, SBCERA granted Flethez’s application for service-related disability retirement benefits, effective as of the date of his initial application in 2008.
Flethez then filed a request for review and reconsideration limited to the question of the starting date for his benefits. When SBCERA maintained its original decision setting June 12, 2008 as the commencement date for his benefits, Flethez requested a formal administrative hearing on the issue. An administrative hearing rejected his request to make payment retroactive to July 15, 2000.
Flethez filed a petition for writ of mandate in the superior court seeking a writ ordering SBCERA to set aside its decision and grant him service-related disability retirement benefits effective as of July 15, 2000. He also sought interest at the legal rate on all retroactive amounts.
The superior court issued a peremptory writ commanding SBCERA to grant Flethez a service-connected disability retirement allowance retroactive to July 15, 2000. The superior court also ruled Flethez was entitled to prejudgment interest under section 3287(a) at the legal rate from the date that each payment of retroactive disability retirements benefits would have been due, starting from July 15, 2000. The interest payments on all retroactive amounts totaled $132,865.37. SBCERA timely filed a notice of appeal "limited to the issue of interest."
The Court of Appeal reversed the judgment insofar as it awarded prejudgment interest retroactive to July 15, 2000. It concluded that "in the context of disability retirement benefits, a retiring member is entitled to recover section 3287(a) prejudgment interest on a court award of disability retirement benefits from the day on which his or her right to recover those benefit payments became vested," which was "not until the retiring member establishes his or her entitlement" to those benefits.
The Supreme Court reviewed the Court of Appeal in the published case of Flethez v San Bernardino County Employee's Retirement Association and concluded that prejudgment interest begins to run only when a county retirement board wrongfully denies a member’s application for retroactive disability retirement benefits.
Flethez’s disability retirement benefits under the CERL were not due before SBCERA received his application and made a determination of his eligibility. Flethez experienced a wrongful withholding of his benefits when the Board erroneously denied his application for a retroactive disability retirement allowance under the inability to ascertain permanency clause. His entitlement to prejudgment interest under section 3287(a) commenced on the date of wrongful denial ...
On June 12, 2008, Flethez filed an application with SBCERA for a service-related disability retirement and allowance. It was rejected for omission of a signed medical records authorization.
A little more than one year later, Flethez filed a complete application, including a signed medical records authorization and a supporting physician’s report. In August 2010, SBCERA granted Flethez’s application for service-related disability retirement benefits, effective as of the date of his initial application in 2008.
Flethez then filed a request for review and reconsideration limited to the question of the starting date for his benefits. When SBCERA maintained its original decision setting June 12, 2008 as the commencement date for his benefits, Flethez requested a formal administrative hearing on the issue. An administrative hearing rejected his request to make payment retroactive to July 15, 2000.
Flethez filed a petition for writ of mandate in the superior court seeking a writ ordering SBCERA to set aside its decision and grant him service-related disability retirement benefits effective as of July 15, 2000. He also sought interest at the legal rate on all retroactive amounts.
The superior court issued a peremptory writ commanding SBCERA to grant Flethez a service-connected disability retirement allowance retroactive to July 15, 2000. The superior court also ruled Flethez was entitled to prejudgment interest under section 3287(a) at the legal rate from the date that each payment of retroactive disability retirements benefits would have been due, starting from July 15, 2000. The interest payments on all retroactive amounts totaled $132,865.37. SBCERA timely filed a notice of appeal "limited to the issue of interest."
The Court of Appeal reversed the judgment insofar as it awarded prejudgment interest retroactive to July 15, 2000. It concluded that "in the context of disability retirement benefits, a retiring member is entitled to recover section 3287(a) prejudgment interest on a court award of disability retirement benefits from the day on which his or her right to recover those benefit payments became vested," which was "not until the retiring member establishes his or her entitlement" to those benefits.
The Supreme Court reviewed the Court of Appeal in the published case of Flethez v San Bernardino County Employee's Retirement Association and concluded that prejudgment interest begins to run only when a county retirement board wrongfully denies a member’s application for retroactive disability retirement benefits.
Flethez’s disability retirement benefits under the CERL were not due before SBCERA received his application and made a determination of his eligibility. Flethez experienced a wrongful withholding of his benefits when the Board erroneously denied his application for a retroactive disability retirement allowance under the inability to ascertain permanency clause. His entitlement to prejudgment interest under section 3287(a) commenced on the date of wrongful denial ...
The Monterey County District Attorney announced that Chang Tai Lin, age 53, of Salinas, pled to two counts of making a material misrepresentation in order to obtain a lower workers’ compensation insurance premium and one count of willfully failing to file payroll tax returns with intent to evade tax.
The defendant was the owner of the AA Buffet, located in Valley Center, 910 S. Main Street, Salinas. Its lunchtime customers often include tourists on charter buses.
Sentencing is scheduled for April 19, 2017 in front of the Honorable Andrew G. Liu. The maximum sentence for the charges is six years, eight months incarceration; however it is anticipated the defendant will be placed on felony probation. The restitution of $42,778.81 to EIG Services and Sequoia Insurance was paid in full at the time of the plea.
In May, 2015, operating on a tip from District Attorney Investigator Fred Lombardi, the Monterey County District Attorney’s Office [MCDA], Workers’ Compensation Fraud Unit began an investigation into the AA Buffet conducting surveillance, obtaining documents from the Salinas Police Department, Monterey County Health Department, insurance companies and state government agencies.
A search warrant was served on March 10, 2016 at the AA Buffet and the defendant’s home. MCDA was assisted in the service of the search warrant by the California Department of Insurance and the Labor Commissioner’s Office.
The investigation revealed the defendant had committed premium fraud from April 2010 through April 2016 by under reporting the number of employees and falsely reporting payroll wages as he paid many employees in cash.
The defendant was also charged with tax evasion in that from Oct 2010 through Jan 2016 he did not accurately report employee wages and payroll taxes to the Employment Development Department.
The defendant was served with an administrative citation issued by the Labor Commissioner’s Office in the amount of $200,224.98, of which almost $150,000.00 involved the underpayment of employees and would be returned to the employees upon payment.
The case was investigated by MCDA District Attorney Investigators George Costa and Martin Sanchez.
...
The defendant was the owner of the AA Buffet, located in Valley Center, 910 S. Main Street, Salinas. Its lunchtime customers often include tourists on charter buses.
Sentencing is scheduled for April 19, 2017 in front of the Honorable Andrew G. Liu. The maximum sentence for the charges is six years, eight months incarceration; however it is anticipated the defendant will be placed on felony probation. The restitution of $42,778.81 to EIG Services and Sequoia Insurance was paid in full at the time of the plea.
In May, 2015, operating on a tip from District Attorney Investigator Fred Lombardi, the Monterey County District Attorney’s Office [MCDA], Workers’ Compensation Fraud Unit began an investigation into the AA Buffet conducting surveillance, obtaining documents from the Salinas Police Department, Monterey County Health Department, insurance companies and state government agencies.
A search warrant was served on March 10, 2016 at the AA Buffet and the defendant’s home. MCDA was assisted in the service of the search warrant by the California Department of Insurance and the Labor Commissioner’s Office.
The investigation revealed the defendant had committed premium fraud from April 2010 through April 2016 by under reporting the number of employees and falsely reporting payroll wages as he paid many employees in cash.
The defendant was also charged with tax evasion in that from Oct 2010 through Jan 2016 he did not accurately report employee wages and payroll taxes to the Employment Development Department.
The defendant was served with an administrative citation issued by the Labor Commissioner’s Office in the amount of $200,224.98, of which almost $150,000.00 involved the underpayment of employees and would be returned to the employees upon payment.
The case was investigated by MCDA District Attorney Investigators George Costa and Martin Sanchez.
...
Pfizer’s Senior Principal Scientist has quietly left the company, following allegations of data manipulation in several of her published papers.
Cancer researcher Min-Jean Yin was with Pfizer in LaJolla California for 13 years and published multiple scientific articles during that time. Now, the pharmaceutical giant is retracting five of them and correcting a sixth, after PubPeer raised suspicions of image duplication.
A private corporate inquiry found the images in Yin’s papers were in fact duplicates. Pfizer has recommended, along with the researcher herself, that the journals retract five of these articles on the efficiency of Pfizer’s own pharmacological enzyme inhibitors, and publish a correction to a sixth.
An article in Pharmaceutical Investing News says that this issue "image duplication" is rather prevalent in biomedical publications. In fact, recent research indicates that as much as 3.8 percent of them may contain inaccurate date. It’s an honest mistake most of the time - or at least in 50 percent of cases. Researchers accidentally replicate western blot images, for example - but they also deliberately splice and duplicate select, clinically promising, parts of a gel band.
The reported irregularities in Yin’s papers, according to watchdog blog For Better Science, included duplicated western blots and duplicated bands within western blots. The problem articles span a four year period, from 2010 to 2014.
Pfizer is keeping mum on the exact nature of the duplication and the circumstances around Yin’s departure. But while the company has only said that she is "no longer employed" at Pfizer, some suspect the researcher was let go - perhaps as a result of the image duplication incidents.
In September 2016, she joined Diagnologix, a small San Diego-based biotech startup. Once Pfizer’s Senior Principal Scientist, her business card now reads "general manager."
C. Glenn Begley, former head of oncology and hematology research at Amgen, believes this latest example of flawed research is just the tip of the iceberg - not for industry specifically, but for all published science.
"These retractions appear to be intentional image duplication, but there’s an entire spectrum of flawed research published in journals at every tier," Begley said in an interview last week.
While Big Pharma fraud attracts more attention, Begley said the incentives are far greater for academic scientists to exaggerate, "cherry-pick," or deliberately bias their results. A 2013 study of 140 cancer research trainees found over 30 percent had felt pressure to confirm a mentor’s hypothesis, even when the science wasn’t there ...
Cancer researcher Min-Jean Yin was with Pfizer in LaJolla California for 13 years and published multiple scientific articles during that time. Now, the pharmaceutical giant is retracting five of them and correcting a sixth, after PubPeer raised suspicions of image duplication.
A private corporate inquiry found the images in Yin’s papers were in fact duplicates. Pfizer has recommended, along with the researcher herself, that the journals retract five of these articles on the efficiency of Pfizer’s own pharmacological enzyme inhibitors, and publish a correction to a sixth.
An article in Pharmaceutical Investing News says that this issue "image duplication" is rather prevalent in biomedical publications. In fact, recent research indicates that as much as 3.8 percent of them may contain inaccurate date. It’s an honest mistake most of the time - or at least in 50 percent of cases. Researchers accidentally replicate western blot images, for example - but they also deliberately splice and duplicate select, clinically promising, parts of a gel band.
The reported irregularities in Yin’s papers, according to watchdog blog For Better Science, included duplicated western blots and duplicated bands within western blots. The problem articles span a four year period, from 2010 to 2014.
Pfizer is keeping mum on the exact nature of the duplication and the circumstances around Yin’s departure. But while the company has only said that she is "no longer employed" at Pfizer, some suspect the researcher was let go - perhaps as a result of the image duplication incidents.
In September 2016, she joined Diagnologix, a small San Diego-based biotech startup. Once Pfizer’s Senior Principal Scientist, her business card now reads "general manager."
C. Glenn Begley, former head of oncology and hematology research at Amgen, believes this latest example of flawed research is just the tip of the iceberg - not for industry specifically, but for all published science.
"These retractions appear to be intentional image duplication, but there’s an entire spectrum of flawed research published in journals at every tier," Begley said in an interview last week.
While Big Pharma fraud attracts more attention, Begley said the incentives are far greater for academic scientists to exaggerate, "cherry-pick," or deliberately bias their results. A 2013 study of 140 cancer research trainees found over 30 percent had felt pressure to confirm a mentor’s hypothesis, even when the science wasn’t there ...
California Insurance Commissioner Dave Jones received the Dr. Nathan Davis Award for Outstanding Government Service at the American Medical Association (AMA)'s National Advocacy Conference.
The AMA established the Dr. Nathan Davis awards in 1989 to recognize outstanding public service in the advancement of public health. These awards are named for the founder of the AMA, Dr. Nathan Davis.
The list of past notable recipients of Dr. Nathan Davis awards include Senator John McCain, Senator Dianne Feinstein and former Florida Governor Jeb Bush.
Jones was honored for his work improving public health both as a leader in the Assembly and as Insurance Commissioner.
"It means a great deal to me to receive this award from the American Medical Association, whose physician members work hard every day to provide quality health care and advocate for health care system improvements and affordable access to care for all Americans," said Commissioner Jones. "I look forward to continuing to work closely in partnership with physicians to make access to quality health care a reality for all Californians."
This award, considered one of the most prestigious awards honoring elected officials and career government employees, recognizes Jones' contributions to advancing public health including his leadership in implementing the Affordable Care Act, improving provider network adequacy, and moving closer to achieving mental health parity.
Jones has been a national leader in the effort to block the anti-competitive mergers of Anthem and Cigna and Aetna and Humana and in improving access to quality health care for children with autism and transgender persons.
The California Medical Association nominated Commissioner Jones for this award.
"From his work to improve network adequacy to his fierce defense of the Affordable Care Act, Commissioner Jones has been a true champion of health care in California," said California Medical Association President Ruth E. Haskins, M.D. "He's shown sincere dedication to improving access to quality, affordable health care for all Californians, and we appreciate his leadership and partnership as we work to make all of California healthy and thriving."
The American Medical Association solicits annual nominations for the Dr. Nathan Davis Awards ...
The AMA established the Dr. Nathan Davis awards in 1989 to recognize outstanding public service in the advancement of public health. These awards are named for the founder of the AMA, Dr. Nathan Davis.
The list of past notable recipients of Dr. Nathan Davis awards include Senator John McCain, Senator Dianne Feinstein and former Florida Governor Jeb Bush.
Jones was honored for his work improving public health both as a leader in the Assembly and as Insurance Commissioner.
"It means a great deal to me to receive this award from the American Medical Association, whose physician members work hard every day to provide quality health care and advocate for health care system improvements and affordable access to care for all Americans," said Commissioner Jones. "I look forward to continuing to work closely in partnership with physicians to make access to quality health care a reality for all Californians."
This award, considered one of the most prestigious awards honoring elected officials and career government employees, recognizes Jones' contributions to advancing public health including his leadership in implementing the Affordable Care Act, improving provider network adequacy, and moving closer to achieving mental health parity.
Jones has been a national leader in the effort to block the anti-competitive mergers of Anthem and Cigna and Aetna and Humana and in improving access to quality health care for children with autism and transgender persons.
The California Medical Association nominated Commissioner Jones for this award.
"From his work to improve network adequacy to his fierce defense of the Affordable Care Act, Commissioner Jones has been a true champion of health care in California," said California Medical Association President Ruth E. Haskins, M.D. "He's shown sincere dedication to improving access to quality, affordable health care for all Californians, and we appreciate his leadership and partnership as we work to make all of California healthy and thriving."
The American Medical Association solicits annual nominations for the Dr. Nathan Davis Awards ...
The Division of Workers’ Compensation has concluded its investigation into San Bernardino County’s handling of cases involving victims of the Dec. 2, 2015, terror attack at the Inland Regional Center, finding that denials for treatment have been rare and that delays were mainly attributed to doctors failing to submit the appropriate information.
State officials, in an eight-page report, concluded that a significant number of cases involved "a provider’s failure to provide an adequate clinical rationale or appropriate documentation to justify requests for extended or new prescriptions, extended or alternative therapies, or special equipment that veered away from standard medical treatment guidelines and limits."
In a letter accompanying the report, addressed to Department of Industrial Relations Director Christine Baker from George Parisotto, acting administrative director for the Division of Workers’ Compensation, Parisotto noted that as claims matured, the county increased its scrutiny of treatment requests, leading to modifications and denials.
Until mid-April 2016, the county was routinely approving nearly all requests, according to the report.
"While the (independent medical review) decisions generally upheld the county’s actions, often because doctors failed to document or fully explain their requests, employees who were still suffering and expected their doctors’ recommendations to be followed were frustrated by the denials," Parisotto wrote in his letter to Baker.
The report also stated that better documentation at the time requests were submitted might have reduced the number of denials and independent medical review requests.
State officials credited the county with hiring nurse case managers to facilitate treatment requests, according to a county news release.
In December, the Board of Supervisors allocated $100,000 to hire an outside firm to help expedite workers’ compensation claims by establishing the Workers’ Comp Claim Expediter Reserve fund.
Of the 2,146 requests for medical and psychological treatment and prescription medications for the 58 survivors, 2,000, or 90 percent, were approved, while two cases were neither approved nor denied, with one being classified as a "disputed liability" and another providing no information about the decision. Three percent of the requests received modified approval.
Among the 144 treatments that were denied, only nine were overturned on appeal - less than one percent of the total number of requests. In all, there were 68 appeals filed by 11 employees, according to the county’s news release.
The county denied claims of 25 employees alleging psychological injury from the terror attack, according to the report.
"According to the county, a common thread among these denials was that the employees were not present at the training center when the incident occurred," the report states.
The report also noted that a large percentage of denied claims was concentrated among a relatively small number of providers, suggesting a "particular problem with certain providers and not typical or characteristic of interactions as a whole."
...
State officials, in an eight-page report, concluded that a significant number of cases involved "a provider’s failure to provide an adequate clinical rationale or appropriate documentation to justify requests for extended or new prescriptions, extended or alternative therapies, or special equipment that veered away from standard medical treatment guidelines and limits."
In a letter accompanying the report, addressed to Department of Industrial Relations Director Christine Baker from George Parisotto, acting administrative director for the Division of Workers’ Compensation, Parisotto noted that as claims matured, the county increased its scrutiny of treatment requests, leading to modifications and denials.
Until mid-April 2016, the county was routinely approving nearly all requests, according to the report.
"While the (independent medical review) decisions generally upheld the county’s actions, often because doctors failed to document or fully explain their requests, employees who were still suffering and expected their doctors’ recommendations to be followed were frustrated by the denials," Parisotto wrote in his letter to Baker.
The report also stated that better documentation at the time requests were submitted might have reduced the number of denials and independent medical review requests.
State officials credited the county with hiring nurse case managers to facilitate treatment requests, according to a county news release.
In December, the Board of Supervisors allocated $100,000 to hire an outside firm to help expedite workers’ compensation claims by establishing the Workers’ Comp Claim Expediter Reserve fund.
Of the 2,146 requests for medical and psychological treatment and prescription medications for the 58 survivors, 2,000, or 90 percent, were approved, while two cases were neither approved nor denied, with one being classified as a "disputed liability" and another providing no information about the decision. Three percent of the requests received modified approval.
Among the 144 treatments that were denied, only nine were overturned on appeal - less than one percent of the total number of requests. In all, there were 68 appeals filed by 11 employees, according to the county’s news release.
The county denied claims of 25 employees alleging psychological injury from the terror attack, according to the report.
"According to the county, a common thread among these denials was that the employees were not present at the training center when the incident occurred," the report states.
The report also noted that a large percentage of denied claims was concentrated among a relatively small number of providers, suggesting a "particular problem with certain providers and not typical or characteristic of interactions as a whole."
...
The Insurance Journal reports that Congressmen speaking at the WCRI annual conference in Boston predicted that the workers’ compensation system could end up feeling some pain if changes to health care and other social insurance programs by Congress and the Trump Administration mean some Americans lose benefits.
Former U.S. Representative Harry Waxman, Democrat of California, one of the framers of the ACA, told the roomful of workers’ compensation experts that divisions among Republicans are likely to get in the way of an effective compromise on health care.
Former U.S. Senator Tom Coburn, Republican of Oklahoma, told the same group that while he believes Congress will pass something, whatever bill passes probably won’t attack the real problems plaguing the health care system.
In the area of health care, Coburn predicted Congress will pass a bill similar to what is known as the Burr-Hatch-Upton proposal. This 2015 Republican bill, also known as the CARE Act, keeps popular ACA features including pre-existing condition protections while eliminating the individual mandate, allowing individuals and small business employees to use tax credits to purchase insurance, capping Medicaid funds to states, and reforming medical malpractice laws.
WCRI CEO John Ruser asked if claims will shift to workers’ compensation and social insurance programs if more people end up being uninsured because of changes to the ACA or other programs.
"I have no doubt about it. I think that’s going to be the result," said Waxman.
Coburn said he has more faith in giving people the "freedom to buy what they want" and believes states can and will do more with less for those who need Medicaid.
The two agreed that the workers’ compensation industry probably doesn’t have to worry about the federal government getting involved in its business anytime soon.
"It will be difficult to get to that issue. I don’t see that happening," said Waxman, suggesting Congress has many other issues on its plate.
He was responding to a question on whether Congress would follow up on a report from the Obama Administration’s Department of Labor that questioned whether states are upholding the original "grand bargain" of workers’ compensation of providing injured workers fair benefits in exchange for them giving up their right to sue their employers for their injuries.
"I don’t think anything will happen on that," agreed Coburn, adding that he doesn’t think Congress should be telling states what to do on workers’ compensation anyway.
Coburn also told the workers’ compensation specialists to expect to benefit from changes coming in medicine over the next two decades in areas of "personalized precision medicine" and "cures for chronic problems." He predicted that "at first it’s going to cost a lot but the outcomes especially in terms of workman’s comp" will be great "in ways we can’t imagine." ...
Former U.S. Representative Harry Waxman, Democrat of California, one of the framers of the ACA, told the roomful of workers’ compensation experts that divisions among Republicans are likely to get in the way of an effective compromise on health care.
Former U.S. Senator Tom Coburn, Republican of Oklahoma, told the same group that while he believes Congress will pass something, whatever bill passes probably won’t attack the real problems plaguing the health care system.
In the area of health care, Coburn predicted Congress will pass a bill similar to what is known as the Burr-Hatch-Upton proposal. This 2015 Republican bill, also known as the CARE Act, keeps popular ACA features including pre-existing condition protections while eliminating the individual mandate, allowing individuals and small business employees to use tax credits to purchase insurance, capping Medicaid funds to states, and reforming medical malpractice laws.
WCRI CEO John Ruser asked if claims will shift to workers’ compensation and social insurance programs if more people end up being uninsured because of changes to the ACA or other programs.
"I have no doubt about it. I think that’s going to be the result," said Waxman.
Coburn said he has more faith in giving people the "freedom to buy what they want" and believes states can and will do more with less for those who need Medicaid.
The two agreed that the workers’ compensation industry probably doesn’t have to worry about the federal government getting involved in its business anytime soon.
"It will be difficult to get to that issue. I don’t see that happening," said Waxman, suggesting Congress has many other issues on its plate.
He was responding to a question on whether Congress would follow up on a report from the Obama Administration’s Department of Labor that questioned whether states are upholding the original "grand bargain" of workers’ compensation of providing injured workers fair benefits in exchange for them giving up their right to sue their employers for their injuries.
"I don’t think anything will happen on that," agreed Coburn, adding that he doesn’t think Congress should be telling states what to do on workers’ compensation anyway.
Coburn also told the workers’ compensation specialists to expect to benefit from changes coming in medicine over the next two decades in areas of "personalized precision medicine" and "cures for chronic problems." He predicted that "at first it’s going to cost a lot but the outcomes especially in terms of workman’s comp" will be great "in ways we can’t imagine." ...
Most people aren't aware that surgeons are sometimes involved in multiple operations happening at the same time, and many patients might object to the practice if they knew about it. The practice also raises questions about the correct payment formula under the Official Medical Fee Schedule.
In the study published in the Journal of the American College of Surgeons, researchers focused on what's known as overlapping surgery, when a senior surgeon performs critical components of one operation at the same time that a trainee surgeon or physician assistant handles a non-critical portion of another procedure.
Only about 4 percent of the 1,454 people surveyed for the study had heard of overlapping surgery, the study found. Just 31 percent of them strongly supported the practice once it was explained, and nearly all of the participants thought patients should be told before surgery exactly what aspects of their operations might be handled by a senior surgeon or by a trainee, or resident, surgeon or an assistant.
"Surgeons should discuss overlapping surgery with patients beforehand and obtain their consent if this is part of their practice," said lead study author Dr. Michael Kent of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
"Respondents understood that overlapping surgery allows surgeons to potentially perform more operations in a given day, so patients may not need to wait as long for their procedure," Kent said. "They also understand that complications may occur when a surgeon's attention is divided, and this may have an impact on patient safety."
For the study, Kent and colleagues surveyed participants about their knowledge of overlapping surgery, their expectations regarding disclosure during the informed consent process and their willingness to have this type of surgery as a patient.
During the survey, researchers randomly selected one of three scenarios to illustrate what happens during overlapping surgery: a hip replacement, a procedure to remove a brain tumor or a heart valve replacement. All three scenarios offered similar descriptions of the roles filled by senior surgeons and assistants.
Overall, about 92 percent of respondents thought surgeons should document what portion of the operations they were present for, researchers report in the Journal of the American College of Surgeons.
After overlapping surgery was described, about 70 percent of participants thought the practice might be acceptable in certain circumstances, such as lower-risk procedures or in situations when an emergency occurred in another operating room.
The study focused on the more accepted practice of overlapping surgery, not situations, known as concurrent surgery, when one senior surgeon is in charge of crucial portions of two different operations at the same time.
Concurrent surgery, is rare and generally should be avoided unless there's an urgent or unplanned situation, said Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University's Feinberg School of Medicine in Chicago.
Overlapping surgeries, like the kind examined in the study, are more common and relatively safe, Bilimoria, who wasn't involved in the study, added by email ...
In the study published in the Journal of the American College of Surgeons, researchers focused on what's known as overlapping surgery, when a senior surgeon performs critical components of one operation at the same time that a trainee surgeon or physician assistant handles a non-critical portion of another procedure.
Only about 4 percent of the 1,454 people surveyed for the study had heard of overlapping surgery, the study found. Just 31 percent of them strongly supported the practice once it was explained, and nearly all of the participants thought patients should be told before surgery exactly what aspects of their operations might be handled by a senior surgeon or by a trainee, or resident, surgeon or an assistant.
"Surgeons should discuss overlapping surgery with patients beforehand and obtain their consent if this is part of their practice," said lead study author Dr. Michael Kent of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
"Respondents understood that overlapping surgery allows surgeons to potentially perform more operations in a given day, so patients may not need to wait as long for their procedure," Kent said. "They also understand that complications may occur when a surgeon's attention is divided, and this may have an impact on patient safety."
For the study, Kent and colleagues surveyed participants about their knowledge of overlapping surgery, their expectations regarding disclosure during the informed consent process and their willingness to have this type of surgery as a patient.
During the survey, researchers randomly selected one of three scenarios to illustrate what happens during overlapping surgery: a hip replacement, a procedure to remove a brain tumor or a heart valve replacement. All three scenarios offered similar descriptions of the roles filled by senior surgeons and assistants.
Overall, about 92 percent of respondents thought surgeons should document what portion of the operations they were present for, researchers report in the Journal of the American College of Surgeons.
After overlapping surgery was described, about 70 percent of participants thought the practice might be acceptable in certain circumstances, such as lower-risk procedures or in situations when an emergency occurred in another operating room.
The study focused on the more accepted practice of overlapping surgery, not situations, known as concurrent surgery, when one senior surgeon is in charge of crucial portions of two different operations at the same time.
Concurrent surgery, is rare and generally should be avoided unless there's an urgent or unplanned situation, said Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University's Feinberg School of Medicine in Chicago.
Overlapping surgeries, like the kind examined in the study, are more common and relatively safe, Bilimoria, who wasn't involved in the study, added by email ...
The Employer's Fraud Task force meeting this week in Commerce focused on the problems with patient identity theft, a massive and growing health care fraud problem. The speaker - Mike McKee, Senior Special Agent of National Insurance Crime Bureau (NICB) - presented many case examples, including the now infamous breach perpetrated upon Anthem.
So what ever happened to the perpetrators of the Anthem breach?
According to a report by Axios, it's been more than two years since health insurer Anthem publicly announced it was the target of a cyberattack. Hackers stole the birthdays, Social Security numbers and other data for nearly 80 million people - the largest health care data breach ever - yet there are still some unanswered questions.
There's no definitive conclusion of who the hackers were, or whether Anthem faces penalties from the federal government. However, some useful information came from a recent investigation from multiple state departments of insurance.
What we know:
1) Anthem executives have not addressed the cyberattack in any earnings calls since it was announced.
2) Officials say there's no evidence that medical or credit card information was stolen.
3) Anthem has spent at least $260.5 million related to the data breach, most of which went toward improving security and providing credit protection to people who were affected. A spokeswoman said Anthem is still taking "steps to help ensure the security of our systems."
4) The two years of free credit monitoring Anthem provided are up. However, this past December, the National Association of Insurance Commissioners concluded Anthem has to pay more than $15 million for a credit freeze to the roughly 12 million affected Anthem members who were 18 years old or younger at the time of the breach.
What we don't know:
1) Anthem has not disclosed the value of its cyber insurance policy, which defrays some of the costs.
2) The hackers were most likely working on behalf of a foreign government. Many security experts believe it was China, but that has not been proven yet. The FBI would not comment on the pending investigation.
3) It's unclear if Anthem will face a federal penalty. It's by far the largest health care data breach, and the Department of Health and Human Services has imposed fines in the past. The HHS Office for Civil Rights said it "cannot comment on open or potential investigations." Adam Greene, a former HHS official, said it usually takes three to four years before a settlement is reached, and "it's certainly not a given" that HHS will pursue a fine if it believes Anthem had safeguards in place.
4) We don't know for sure that Anthem was fully protected from this type of attack, and a separate federal agency that had a contract with Anthem previously said the insurer did not have controls in place "to prevent rogue devices...from connecting to its networks."
5) Class-action lawsuits are still pending, and fact-finding discovery ended in December. Anthem could escape big damages if people can't show concrete harm.
Mike McKee made a compelling argument about the use of stolen identities for purposes of billing in California Workers' Compensation claims. Perpetrators have ready access to lists of patient information - for a price - from sellers on the dark web. Patient identities are readily bought and sold as a lucrative commodity ...
So what ever happened to the perpetrators of the Anthem breach?
According to a report by Axios, it's been more than two years since health insurer Anthem publicly announced it was the target of a cyberattack. Hackers stole the birthdays, Social Security numbers and other data for nearly 80 million people - the largest health care data breach ever - yet there are still some unanswered questions.
There's no definitive conclusion of who the hackers were, or whether Anthem faces penalties from the federal government. However, some useful information came from a recent investigation from multiple state departments of insurance.
What we know:
1) Anthem executives have not addressed the cyberattack in any earnings calls since it was announced.
2) Officials say there's no evidence that medical or credit card information was stolen.
3) Anthem has spent at least $260.5 million related to the data breach, most of which went toward improving security and providing credit protection to people who were affected. A spokeswoman said Anthem is still taking "steps to help ensure the security of our systems."
4) The two years of free credit monitoring Anthem provided are up. However, this past December, the National Association of Insurance Commissioners concluded Anthem has to pay more than $15 million for a credit freeze to the roughly 12 million affected Anthem members who were 18 years old or younger at the time of the breach.
What we don't know:
1) Anthem has not disclosed the value of its cyber insurance policy, which defrays some of the costs.
2) The hackers were most likely working on behalf of a foreign government. Many security experts believe it was China, but that has not been proven yet. The FBI would not comment on the pending investigation.
3) It's unclear if Anthem will face a federal penalty. It's by far the largest health care data breach, and the Department of Health and Human Services has imposed fines in the past. The HHS Office for Civil Rights said it "cannot comment on open or potential investigations." Adam Greene, a former HHS official, said it usually takes three to four years before a settlement is reached, and "it's certainly not a given" that HHS will pursue a fine if it believes Anthem had safeguards in place.
4) We don't know for sure that Anthem was fully protected from this type of attack, and a separate federal agency that had a contract with Anthem previously said the insurer did not have controls in place "to prevent rogue devices...from connecting to its networks."
5) Class-action lawsuits are still pending, and fact-finding discovery ended in December. Anthem could escape big damages if people can't show concrete harm.
Mike McKee made a compelling argument about the use of stolen identities for purposes of billing in California Workers' Compensation claims. Perpetrators have ready access to lists of patient information - for a price - from sellers on the dark web. Patient identities are readily bought and sold as a lucrative commodity ...
The Workers’ Compensation Appeals Board (WCAB) has adopted its final Rules of Practice and Procedure (Rules) implementing Senate Bill 1160 (SB 1160).
The Office of Administrative Law has filed the WCAB’s new Rules with the Secretary of State. The new Rules will become effective on March 26, 2017.
Any lien claimant who filed a lien before January 1, 2017 that was subject to a filing fee under Labor Code section 4903.05 is required to file a "Supplemental Lien Form and 4903.05(c) Declaration" on the form approved by the Appeals Board before July 1, 2017.
The Appeals Board has already approved the Supplemental Lien Form and 4903.05(c) Declaration for use as an e-form and lien claimants can use that form now. Lien claimants may wish to file this form in advance of the adoption of the rule requiring it and will not have to re-file the form once the rule goes into effect.
The Division of Workers’ Compensation (DWC) has posted frequently asked questions regarding the use of the lien form and Supplemental Lien Form and 4903.05(c) Declaration on its website.
As part of the regulatory process, the DWC held a public hearing on these proposed rules on January 4, and released a transcript of public comments made that day.
Steve Cattolica who represents the California Society of Industrial Medicine and Surgery, a couple other medical societies, as well as the California Workers' Compensation Interpreters Association, and attorney Steve Rondeau who represents lien claimants both voiced concerns about retroactive requirements for lien documentation under the new rules. They said that some of the required information is not now available or known to the lien claimants since there was not previously a requirement that they collect this information.
Specifically they were concerned with the declaration requirement going forward under Labor Code Section 4903.05 ( c) ( 1) ( e). Lien claimants have to file a declaration under penalty of perjury stating that they have, documentation that treatment has been neglected or unreasonably refused and "many providers are having difficulty assembling this documentation."
Pilar Garcia, the owner of Statewide Interpreters and Carolina Darond who works for the company both testified that the new requirements are running them out of the business after 19 years of providing interpreting services. Most their complains involve the inability to obtain pre-authorization for interpreting services from carriers and TPAs. Commissioner Sweeney probed their testimony and learned that most of their 315 interpreters are not certified as specified by SB 863.
Darond complained "It's not fair whatever the rules are for interpreters. You're putting it so difficult that we can't do business anymore. And here comes -- the other agencies are coming from the other states. Pilar was -- it was the Statewide Interpreters for California back then. No, not anymore. Now we are requested by other agencies from the other states because they have the authorization. There's no money difference between my rates and their rates. It's the authorization what is changing the problem. They're not giving it to us because they want to give it to One Call, and One Call is doing the monopoly of the business as you all -- you all know that; right?"
The newly adopted Rules, and their related Final Statement of Reasons, are posted on the WCAB’s website ...
The Office of Administrative Law has filed the WCAB’s new Rules with the Secretary of State. The new Rules will become effective on March 26, 2017.
Any lien claimant who filed a lien before January 1, 2017 that was subject to a filing fee under Labor Code section 4903.05 is required to file a "Supplemental Lien Form and 4903.05(c) Declaration" on the form approved by the Appeals Board before July 1, 2017.
The Appeals Board has already approved the Supplemental Lien Form and 4903.05(c) Declaration for use as an e-form and lien claimants can use that form now. Lien claimants may wish to file this form in advance of the adoption of the rule requiring it and will not have to re-file the form once the rule goes into effect.
The Division of Workers’ Compensation (DWC) has posted frequently asked questions regarding the use of the lien form and Supplemental Lien Form and 4903.05(c) Declaration on its website.
As part of the regulatory process, the DWC held a public hearing on these proposed rules on January 4, and released a transcript of public comments made that day.
Steve Cattolica who represents the California Society of Industrial Medicine and Surgery, a couple other medical societies, as well as the California Workers' Compensation Interpreters Association, and attorney Steve Rondeau who represents lien claimants both voiced concerns about retroactive requirements for lien documentation under the new rules. They said that some of the required information is not now available or known to the lien claimants since there was not previously a requirement that they collect this information.
Specifically they were concerned with the declaration requirement going forward under Labor Code Section 4903.05 ( c) ( 1) ( e). Lien claimants have to file a declaration under penalty of perjury stating that they have, documentation that treatment has been neglected or unreasonably refused and "many providers are having difficulty assembling this documentation."
Pilar Garcia, the owner of Statewide Interpreters and Carolina Darond who works for the company both testified that the new requirements are running them out of the business after 19 years of providing interpreting services. Most their complains involve the inability to obtain pre-authorization for interpreting services from carriers and TPAs. Commissioner Sweeney probed their testimony and learned that most of their 315 interpreters are not certified as specified by SB 863.
Darond complained "It's not fair whatever the rules are for interpreters. You're putting it so difficult that we can't do business anymore. And here comes -- the other agencies are coming from the other states. Pilar was -- it was the Statewide Interpreters for California back then. No, not anymore. Now we are requested by other agencies from the other states because they have the authorization. There's no money difference between my rates and their rates. It's the authorization what is changing the problem. They're not giving it to us because they want to give it to One Call, and One Call is doing the monopoly of the business as you all -- you all know that; right?"
The newly adopted Rules, and their related Final Statement of Reasons, are posted on the WCAB’s website ...
The Division of Workers’ Compensation (DWC) will begin the process of amending the MTUS regulations by posting the proposed changes to its online forum.
This round of proposed regulatory amendments will be made pursuant to the rulemaking provisions of the Administrative Procedure Act. These changes lay the foundation for the evidence-based guideline updates to the MTUS that for the first time will apply an expedited process pursuant to the recently amended Labor Code section 5307.27(a). Once the formal rulemaking process begins with these proposed regulatory amendments, DWC will begin the expedited process to update the evidence-based guidelines by Administrative Director order.
This round of proposed regulatory amendments makes the following changes:
- Deletes the distinction between the "Clinical Topics" section and "Special Topics" section and incorporates all of the treatment guidelines under a new section entitled "MTUS Treatment Guidelines";
- Revises section numbers as a result of the deletion of the current "Special Topics" section;
- Deletes all of the guidelines under the "General Approaches," "Clinical Topics" and "Special Topics" sections (All of these guidelines will be updated by an Administrative Director order);
- Adds a provision requiring any Medical Evidence Evaluation Advisory Committee (MEEAC) recommendations concerning the drug formulary be referred for consideration by the Pharmacy and Therapeutics Committee;
- Provides non-substantive changes to the language to correct a spelling error, specify when the MTUS Treatment Guidelines are being referenced as opposed to the MTUS in general, and clarify how the MTUS’ presumption of correctness may be challenged.
The proposed amendments to the MTUS regulations start with section 9792.20 of title 8 of the California Code of Regulations.
Members of the public may review and comment on the proposed MTUS changes until 5 p.m. on March 10, 2017. They may also mail in-depth comments to: Division of Workers' Compensation, P.O. Box 420603, San Francisco, CA 94142 - Attn: DWC forums ...
This round of proposed regulatory amendments will be made pursuant to the rulemaking provisions of the Administrative Procedure Act. These changes lay the foundation for the evidence-based guideline updates to the MTUS that for the first time will apply an expedited process pursuant to the recently amended Labor Code section 5307.27(a). Once the formal rulemaking process begins with these proposed regulatory amendments, DWC will begin the expedited process to update the evidence-based guidelines by Administrative Director order.
This round of proposed regulatory amendments makes the following changes:
- Deletes the distinction between the "Clinical Topics" section and "Special Topics" section and incorporates all of the treatment guidelines under a new section entitled "MTUS Treatment Guidelines";
- Revises section numbers as a result of the deletion of the current "Special Topics" section;
- Deletes all of the guidelines under the "General Approaches," "Clinical Topics" and "Special Topics" sections (All of these guidelines will be updated by an Administrative Director order);
- Adds a provision requiring any Medical Evidence Evaluation Advisory Committee (MEEAC) recommendations concerning the drug formulary be referred for consideration by the Pharmacy and Therapeutics Committee;
- Provides non-substantive changes to the language to correct a spelling error, specify when the MTUS Treatment Guidelines are being referenced as opposed to the MTUS in general, and clarify how the MTUS’ presumption of correctness may be challenged.
The proposed amendments to the MTUS regulations start with section 9792.20 of title 8 of the California Code of Regulations.
Members of the public may review and comment on the proposed MTUS changes until 5 p.m. on March 10, 2017. They may also mail in-depth comments to: Division of Workers' Compensation, P.O. Box 420603, San Francisco, CA 94142 - Attn: DWC forums ...
A Washington lawyer at a prominent firm was arrested in a disguise while trying to sell a copy of a secret lawsuit involving a company that was under investigation by the U.S. Justice Department.
Jeffrey Wertkin was taken into custody in the lobby of the Hilton Garden Inn in Cupertino, California, where he believed he was about to collect $310,000 for selling a copy of the sealed whistle-blower lawsuit to the targeted company.
"My life is over," Wertkin told the FBI agent. He was charged with Contempt of Court and Obstruction of Justice in violation of 18 U.S.C. § 401(3).
Attorney Wertkin had previously won a coveted job at the Justice Department in 2010. Working on cases related to health-care, he remained there until April 2016, when he left for a job at Akin Gump Strauss Hauer & Feld LLP in Washington. His government pay was about $150,000 per year. At a firm like Akin Gump, where Wertkin defended companies sued under the whistle-blower law, attorneys with his credentials earn as much as $600,000.
Wertkin believed he would hand a copy of a sealed federal Qui Tam complaint to an employee of the company, which was accused in the complaint by a whistle-blower of falsely billing the government. The Qui Tam civil matter was previously filed under seal in January, 2016, pursuant to 31 U.S.C. § 3730(b)(2) and pending before the Honorable Jacqueline Scott Corley in the San Francisco division of the United States District Court in the Northern District of California. Wertkin, who was wearing a wig and using the name of Dan, was met instead by an FBI agent, according to arrest documents unsealed on Feb. 6.
Prosecutors say Jeffrey Wertkin attempted to sell a whistle-blower’s confidential lawsuit against a Silicon Valley company. FBI agents want to know whether Wertkin, who left the government in April, got the lawsuit from someone inside the Justice Department and if he sold other secrets while working there, according to two people familiar with the matter who weren’t authorized to discuss it publicly.
Wertkin, who appeared in San Francisco federal court Feb. 1, was released on $750,000 bail, which was secured by real estate in Washington, D.C., located on 12th Street, Northwest, according to court filings.
The case began with an employee at an unidentified technology security company in Sunnyvale, California, getting a voice mail on Nov. 30. The caller left a phone number and said a sealed False Claims Act lawsuit had been filed against the company, according to the FBI.
When the employee dialed the number, the caller identified himself as Dan and said he could provide a copy of the complaint for a "consulting fee," the FBI said. He mailed a redacted copy of the cover page to the employee, who notified the FBI. The agency verified that the case has been pending since January 2016.
The employee agreed to secretly record calls to Dan for the FBI. On Dec. 22, Dan said he would provide the full complaint for $300,000, the FBI said. Two weeks later, Dan suggested he get paid in untraceable bitcoins, and said buying the complaint would help the company "get out ahead of the investigation." The employee unsuccessfully sought to negotiate a cheaper price for the sealed lawsuit, according to the court filings.
On Jan. 19, Dan outlined to the employee his plan to meet on Jan. 31 near Sunnyvale, boosting his price to $310,000 to cover his travel expenses, according to the filings. Five days later, the employee said a colleague named Bill would meet him with the money in a hotel lobby. Dan wanted Bill’s cell phone number to text the location. That proved his undoing.
Bill turned out to be FBI agent William Scanlon. As he had agreed, Scanlon wore a gray Titleist hat and carried a blue duffel bag into the lobby of the Hilton Garden Inn. Dan texted him to find the empty chair in the lobby graced with a newspaper, according to the filings.
The case is U.S. v. Wertkin, 17-70131, U.S. District Court, Northern District of California (San Francisco) ...
Jeffrey Wertkin was taken into custody in the lobby of the Hilton Garden Inn in Cupertino, California, where he believed he was about to collect $310,000 for selling a copy of the sealed whistle-blower lawsuit to the targeted company.
"My life is over," Wertkin told the FBI agent. He was charged with Contempt of Court and Obstruction of Justice in violation of 18 U.S.C. § 401(3).
Attorney Wertkin had previously won a coveted job at the Justice Department in 2010. Working on cases related to health-care, he remained there until April 2016, when he left for a job at Akin Gump Strauss Hauer & Feld LLP in Washington. His government pay was about $150,000 per year. At a firm like Akin Gump, where Wertkin defended companies sued under the whistle-blower law, attorneys with his credentials earn as much as $600,000.
Wertkin believed he would hand a copy of a sealed federal Qui Tam complaint to an employee of the company, which was accused in the complaint by a whistle-blower of falsely billing the government. The Qui Tam civil matter was previously filed under seal in January, 2016, pursuant to 31 U.S.C. § 3730(b)(2) and pending before the Honorable Jacqueline Scott Corley in the San Francisco division of the United States District Court in the Northern District of California. Wertkin, who was wearing a wig and using the name of Dan, was met instead by an FBI agent, according to arrest documents unsealed on Feb. 6.
Prosecutors say Jeffrey Wertkin attempted to sell a whistle-blower’s confidential lawsuit against a Silicon Valley company. FBI agents want to know whether Wertkin, who left the government in April, got the lawsuit from someone inside the Justice Department and if he sold other secrets while working there, according to two people familiar with the matter who weren’t authorized to discuss it publicly.
Wertkin, who appeared in San Francisco federal court Feb. 1, was released on $750,000 bail, which was secured by real estate in Washington, D.C., located on 12th Street, Northwest, according to court filings.
The case began with an employee at an unidentified technology security company in Sunnyvale, California, getting a voice mail on Nov. 30. The caller left a phone number and said a sealed False Claims Act lawsuit had been filed against the company, according to the FBI.
When the employee dialed the number, the caller identified himself as Dan and said he could provide a copy of the complaint for a "consulting fee," the FBI said. He mailed a redacted copy of the cover page to the employee, who notified the FBI. The agency verified that the case has been pending since January 2016.
The employee agreed to secretly record calls to Dan for the FBI. On Dec. 22, Dan said he would provide the full complaint for $300,000, the FBI said. Two weeks later, Dan suggested he get paid in untraceable bitcoins, and said buying the complaint would help the company "get out ahead of the investigation." The employee unsuccessfully sought to negotiate a cheaper price for the sealed lawsuit, according to the court filings.
On Jan. 19, Dan outlined to the employee his plan to meet on Jan. 31 near Sunnyvale, boosting his price to $310,000 to cover his travel expenses, according to the filings. Five days later, the employee said a colleague named Bill would meet him with the money in a hotel lobby. Dan wanted Bill’s cell phone number to text the location. That proved his undoing.
Bill turned out to be FBI agent William Scanlon. As he had agreed, Scanlon wore a gray Titleist hat and carried a blue duffel bag into the lobby of the Hilton Garden Inn. Dan texted him to find the empty chair in the lobby graced with a newspaper, according to the filings.
The case is U.S. v. Wertkin, 17-70131, U.S. District Court, Northern District of California (San Francisco) ...
The applicant Jaime Simmons, sustained injury on March 22, 2014 to his right foot and ankle while in the employment of defendant Just Wingin It, Inc. insured by Procentury Insurance Company.
The case was set for trio! to resolve the issue regarding how TI'D was paid to the applicant. After discussion with the parties at the MSC it was clear that there was a disagreement on the method of providing payment to the applicant such that the adjuster would be required to testify at tho upcoming trial.
The WCJ noted that "the defendant cites multiple ways in which the adjuster could be allowed to testify at trial. However, the defendant fails to appreciate that the witness' credibility is being assessed at trial and it is often difficult for the trier of fact to asses credibility if the witness is not present in the courtroom while providing testimony."
Thus the WCJ ordered that defendant's claims adjuster, who lives in Illinois, must appear in person for trials. The employer filed a timely, verified Petition for Removal seeking relief from this order.
Defendant argues that it would suffer substantial prejudice if it were required to produce the claims adjuster at trial "where alternative means of obtaining testimony exists," noting . that verbal testimony can be obtained by courtcall or video conferencing.
Defendant also points out that the purpose of taking the claims adjuster's testimony would be to elicit the claims adjuster's verbal response, and the claims adjuster's "physical presence adds nothing to the verbal testimony that he/she may provide." Defendant states that producing the claims adjuster in person for "one or more hearings" would place a "significant burden" on defendant, in addition to the additional costs required.
The WCAB granted removal in the significant panel decision of Jamie Simmons v Just Wingin' It, Inc. and ProCentury Insurance Company.
"We agree with defendant, and see no reason not to use the alternative means of obtaining the claims adjuster's testimony. We further note that the California Code of Civil Procedure explicitly provides for the taking of depositions by remote electronic means, as do the California Rules of Court. (Cal. Code Civ. Proc. § 2025.310(a)
"A person may take, and any person other than the deponent may attend, a deposition by telephone or other remote electronic means"; Cal. Rules of Court, rule 3.1010(a)- (b). "Any party may take an oral deposition by telephone, videoconference, or other remote electronic means [ ... and] [a]ny party may appear and participate in an oral deposition by telephone, videoconference, or other remote electronic means[.]"), ...
The case was set for trio! to resolve the issue regarding how TI'D was paid to the applicant. After discussion with the parties at the MSC it was clear that there was a disagreement on the method of providing payment to the applicant such that the adjuster would be required to testify at tho upcoming trial.
The WCJ noted that "the defendant cites multiple ways in which the adjuster could be allowed to testify at trial. However, the defendant fails to appreciate that the witness' credibility is being assessed at trial and it is often difficult for the trier of fact to asses credibility if the witness is not present in the courtroom while providing testimony."
Thus the WCJ ordered that defendant's claims adjuster, who lives in Illinois, must appear in person for trials. The employer filed a timely, verified Petition for Removal seeking relief from this order.
Defendant argues that it would suffer substantial prejudice if it were required to produce the claims adjuster at trial "where alternative means of obtaining testimony exists," noting . that verbal testimony can be obtained by courtcall or video conferencing.
Defendant also points out that the purpose of taking the claims adjuster's testimony would be to elicit the claims adjuster's verbal response, and the claims adjuster's "physical presence adds nothing to the verbal testimony that he/she may provide." Defendant states that producing the claims adjuster in person for "one or more hearings" would place a "significant burden" on defendant, in addition to the additional costs required.
The WCAB granted removal in the significant panel decision of Jamie Simmons v Just Wingin' It, Inc. and ProCentury Insurance Company.
"We agree with defendant, and see no reason not to use the alternative means of obtaining the claims adjuster's testimony. We further note that the California Code of Civil Procedure explicitly provides for the taking of depositions by remote electronic means, as do the California Rules of Court. (Cal. Code Civ. Proc. § 2025.310(a)
"A person may take, and any person other than the deponent may attend, a deposition by telephone or other remote electronic means"; Cal. Rules of Court, rule 3.1010(a)- (b). "Any party may take an oral deposition by telephone, videoconference, or other remote electronic means [ ... and] [a]ny party may appear and participate in an oral deposition by telephone, videoconference, or other remote electronic means[.]"), ...
Many patients live with low back pain that radiates to the buttock, groin, thigh, and even knees. The challenge for patients, and often their doctors, is determining the origin of the pain -- the hip, the spine, or both.
A new article published in the February Journal of the American Academy of Orthopaedic Surgeons (JAAOS) outlines the identical symptoms associated with hip and spine pain and discusses the diagnostic steps and tests required to treat them appropriately.
Typically, groin pain, and/or difficulty putting on shoes or getting in and out of a car, are associated with a hip condition.
Buttock or back pain, with or without a tingling sensation, most likely originates in the spine.
However, patients with complex "hip-spine syndrome" have lower back and hip pain with no clear source of the discomfort. Hip arthritis, for example, can increase pressure on the lower back.
"In these instances, similar or overlapping symptoms may delay a correct diagnosis and appropriate treatment," said article author Afshin Razi, MD, an orthopaedic surgeon and clinical assistant professor at NYU Langone Hospital for Joint Diseases.
The article recommends that patients provide a detailed health history and undergo a comprehensive physical examination that includes an assessment of gait (how the patient walks); hip and back range of motion; posture; pelvic, lower limb, and spinal alignment; loss of muscle (atrophy); previous surgical scars; and limb-length discrepancy.
"Plain and advanced imaging studies and diagnostic injections also can be used to further delineate the primary problem and guide the appropriate sequence of treatment," said Dr. Razi.
Diagnoses for hip and spine pain can include hip osteoarthritis, a stress fracture, osteonecrosis of the hip (a blockage in blood flow to the hip), a labral tear (damage to the cartilage that surrounds the hip), disc herniation and possible pinched nerves, stenosis (narrowed spinal canal causing nerve pain), sacroiliac joint dysfunction, and other less common sources of pain.
"Focusing on both the spine and the hip as potential causes of pain and disability may reduce the likelihood of misdiagnosis, and the management of conditions affecting the spine and/or hip may help reduce the likelihood of persistent symptoms," said Dr. Razi ...
A new article published in the February Journal of the American Academy of Orthopaedic Surgeons (JAAOS) outlines the identical symptoms associated with hip and spine pain and discusses the diagnostic steps and tests required to treat them appropriately.
Typically, groin pain, and/or difficulty putting on shoes or getting in and out of a car, are associated with a hip condition.
Buttock or back pain, with or without a tingling sensation, most likely originates in the spine.
However, patients with complex "hip-spine syndrome" have lower back and hip pain with no clear source of the discomfort. Hip arthritis, for example, can increase pressure on the lower back.
"In these instances, similar or overlapping symptoms may delay a correct diagnosis and appropriate treatment," said article author Afshin Razi, MD, an orthopaedic surgeon and clinical assistant professor at NYU Langone Hospital for Joint Diseases.
The article recommends that patients provide a detailed health history and undergo a comprehensive physical examination that includes an assessment of gait (how the patient walks); hip and back range of motion; posture; pelvic, lower limb, and spinal alignment; loss of muscle (atrophy); previous surgical scars; and limb-length discrepancy.
"Plain and advanced imaging studies and diagnostic injections also can be used to further delineate the primary problem and guide the appropriate sequence of treatment," said Dr. Razi.
Diagnoses for hip and spine pain can include hip osteoarthritis, a stress fracture, osteonecrosis of the hip (a blockage in blood flow to the hip), a labral tear (damage to the cartilage that surrounds the hip), disc herniation and possible pinched nerves, stenosis (narrowed spinal canal causing nerve pain), sacroiliac joint dysfunction, and other less common sources of pain.
"Focusing on both the spine and the hip as potential causes of pain and disability may reduce the likelihood of misdiagnosis, and the management of conditions affecting the spine and/or hip may help reduce the likelihood of persistent symptoms," said Dr. Razi ...
Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat patients who have infectious diseases. Since the 1940s, these drugs have greatly reduced illness and death from these infectious diseases.
However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective.
Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.
But a new HealthDay/Harris Poll shows most Americans are clueless about the dangers, More than two-thirds of U.S. adults know "little" or "nothing" about so-called superbugs -- bacterial infections that are resistant to many or all antibiotics. And around half believe, incorrectly, that antibiotics work against viruses.
That's a concern because improper antibiotic use is considered the major driver of the superbug problem -- a problem with deadly consequences.
"This poll shows that public ignorance is a huge part of the problem," said Humphrey Taylor, chairman emeritus of The Harris Poll. "Millions of patients continue to believe that antibiotics will help them recover from colds, flu and other viral infections," Taylor said, "and they can be upset with their doctors if they will not prescribe them."
According to the agency, some of the most dangerous infections include: Clostridium difficile, a gut infection that often arises after someone has been on a long course of antibiotics for a different infection; and antibiotic-resistant strains of gonorrhea, pneumonia and Staphylococcus aureus -- which can infect the skin, lungs or bloodstream.
In the new poll, 69 percent of Americans said they know little to nothing about the superbug problem. Meanwhile, 53 percent said that antibiotics are effective against viral infections, 40 percent said they fight the common cold, and 48 percent said they battle the flu.
Wrong on all counts.
The typical American may not be well-versed in infectious disease, but even a little knowledge can be enough, said Dr. Brad Spellberg, a spokesman for the Infectious Diseases Society of America.
"Most people have probably heard the term 'superbug,' and know they should be afraid of them," said Spellberg, who is also a professor of clinical medicine at the University of Southern California's Keck School of Medicine.
And he had some advice for what the public can do: "Don't pressure your doctor for an antibiotic," he said. "And when your doctor does prescribe one, ask whether it's really necessary. We need to flip the script."
Spellberg also pointed to a less obvious tactic. "Choose to buy antibiotic-free meat. Companies respond to what the public buys." That's important because in the United States, antibiotics are commonly given to food-producing animals to promote their growth. That practice, the CDC says, can cause animals to develop drug-resistant bacteria, which can then be transmitted to humans ...
However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective.
Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.
But a new HealthDay/Harris Poll shows most Americans are clueless about the dangers, More than two-thirds of U.S. adults know "little" or "nothing" about so-called superbugs -- bacterial infections that are resistant to many or all antibiotics. And around half believe, incorrectly, that antibiotics work against viruses.
That's a concern because improper antibiotic use is considered the major driver of the superbug problem -- a problem with deadly consequences.
"This poll shows that public ignorance is a huge part of the problem," said Humphrey Taylor, chairman emeritus of The Harris Poll. "Millions of patients continue to believe that antibiotics will help them recover from colds, flu and other viral infections," Taylor said, "and they can be upset with their doctors if they will not prescribe them."
According to the agency, some of the most dangerous infections include: Clostridium difficile, a gut infection that often arises after someone has been on a long course of antibiotics for a different infection; and antibiotic-resistant strains of gonorrhea, pneumonia and Staphylococcus aureus -- which can infect the skin, lungs or bloodstream.
In the new poll, 69 percent of Americans said they know little to nothing about the superbug problem. Meanwhile, 53 percent said that antibiotics are effective against viral infections, 40 percent said they fight the common cold, and 48 percent said they battle the flu.
Wrong on all counts.
The typical American may not be well-versed in infectious disease, but even a little knowledge can be enough, said Dr. Brad Spellberg, a spokesman for the Infectious Diseases Society of America.
"Most people have probably heard the term 'superbug,' and know they should be afraid of them," said Spellberg, who is also a professor of clinical medicine at the University of Southern California's Keck School of Medicine.
And he had some advice for what the public can do: "Don't pressure your doctor for an antibiotic," he said. "And when your doctor does prescribe one, ask whether it's really necessary. We need to flip the script."
Spellberg also pointed to a less obvious tactic. "Choose to buy antibiotic-free meat. Companies respond to what the public buys." That's important because in the United States, antibiotics are commonly given to food-producing animals to promote their growth. That practice, the CDC says, can cause animals to develop drug-resistant bacteria, which can then be transmitted to humans ...
Bay Sleep Clinic, its related businesses - Qualium Corporation and Amerimed Corporation - and their owners and operators, Anooshiravan Mostowfipour and Tara Nader have agreed to pay $2.6 million to settle allegations that they fraudulently billed the Medicare program. The allegations against the Defendants were set out in an amended False Claims Act complaint filed by the United States on August 8, 2016.
According to the complaint, Saratoga, Calif., residents Mostowfipour, 58, and Nader, 58, own Amerimed Corporation (that was doing business as Amerimed Sleep Diagnostics and Amerimed CPAP Specialists) and Qualium Corporation, which operated twenty sleep clinics doing business as Bay Sleep Clinic.
The government alleged that as early as April 2002, Mostowfipour, Nader, and their businesses fraudulently billed Medicare for sleep tests performed by technicians lacking the licenses or certifications required by Medicare payment rules.
In addition, the Defendants billed Medicare for sleep tests that allegedly were conducted at unenrolled and unapproved locations. Specifically, the government alleged that defendants regularly falsified documents to make it appear that a sleep test had been given at one of the defendants’ two locations which had been approved by Medicare, when, in fact, the test had been conducted at another, unapproved facility.
Additionally, the government alleged the Defendants fraudulently billed Medicare for medical devices in violation of Medicare rules and regulations that prohibit providers of diagnostic sleep tests from supplying medical devices and from sharing a sleep laboratory location with a durable medical equipment supplier.
The whistleblower action, captioned United States ex rel. Dresser v. Qualium Corp., et al., Civil Action No. 12-1745 (N.D. Cal.), was filed under the qui tam provisions of the False Claims Act. The False Claims Act allows for private persons, such as Elma F. Dresser in this case, to file actions to provide the government information about wrongdoing and then obtain a portion of the government’s recovery. Dresser will receive approximately $545,000.
As is permitted by the statute, the United States intervened in the action in May 2015 and filed its initial complaint in intervention in September 2015.
As part of the agreement, the defendants have voluntarily terminated their two existing Medicare enrollments and agreed not to re-enroll as providers or suppliers in the Medicare program for a period of three years.
Assistant U.S. Attorneys Erica Blachman Hitchings, Robin Wall, Kimberly Friday, and Tom Green handled the case with assistance from Jacqueline Hollar, Tina Louie, Bonny Wong, and Stefania Chin. The investigation was conducted by the U.S. Attorney’s Office for the Northern District of California and HHS-OIG.
The claims resolved by this settlement are allegations only and there has been no determination of liability ...
According to the complaint, Saratoga, Calif., residents Mostowfipour, 58, and Nader, 58, own Amerimed Corporation (that was doing business as Amerimed Sleep Diagnostics and Amerimed CPAP Specialists) and Qualium Corporation, which operated twenty sleep clinics doing business as Bay Sleep Clinic.
The government alleged that as early as April 2002, Mostowfipour, Nader, and their businesses fraudulently billed Medicare for sleep tests performed by technicians lacking the licenses or certifications required by Medicare payment rules.
In addition, the Defendants billed Medicare for sleep tests that allegedly were conducted at unenrolled and unapproved locations. Specifically, the government alleged that defendants regularly falsified documents to make it appear that a sleep test had been given at one of the defendants’ two locations which had been approved by Medicare, when, in fact, the test had been conducted at another, unapproved facility.
Additionally, the government alleged the Defendants fraudulently billed Medicare for medical devices in violation of Medicare rules and regulations that prohibit providers of diagnostic sleep tests from supplying medical devices and from sharing a sleep laboratory location with a durable medical equipment supplier.
The whistleblower action, captioned United States ex rel. Dresser v. Qualium Corp., et al., Civil Action No. 12-1745 (N.D. Cal.), was filed under the qui tam provisions of the False Claims Act. The False Claims Act allows for private persons, such as Elma F. Dresser in this case, to file actions to provide the government information about wrongdoing and then obtain a portion of the government’s recovery. Dresser will receive approximately $545,000.
As is permitted by the statute, the United States intervened in the action in May 2015 and filed its initial complaint in intervention in September 2015.
As part of the agreement, the defendants have voluntarily terminated their two existing Medicare enrollments and agreed not to re-enroll as providers or suppliers in the Medicare program for a period of three years.
Assistant U.S. Attorneys Erica Blachman Hitchings, Robin Wall, Kimberly Friday, and Tom Green handled the case with assistance from Jacqueline Hollar, Tina Louie, Bonny Wong, and Stefania Chin. The investigation was conducted by the U.S. Attorney’s Office for the Northern District of California and HHS-OIG.
The claims resolved by this settlement are allegations only and there has been no determination of liability ...
The Office of Self-Insurance Plans (OSIP) has released new application forms for private stand-alone and group insurers as it continues to modernize and simplify steps for employers. The forms were revised to remove unneeded information and language that no longer applies, which significantly reduced the total number of pages required for submission.
The forms can be downloaded for free from the OSIP website and are found under Forms, Publications, and Reports.
Private stand-alone applications:
Form A-1 (1-2016) Application for a Private Entity Certificate of Consent to Self-Insure
Form A-2 (1-2016) Application for a Public Agency Certificate of Consent to Self-Insure
Form A-3A (1-2016) Private Affiliate Interim Application
Form A-3B (1-2016) Application for a Permanent Certificate of Consent to Self-Insure by an Interim Self-Insurer
Form A-4 (1-2016) Guaranty of Workers’ Compensation Liabilities
Form A4-50 Application for a Certificate to Administer Workers’ Compensation Claims
Form A-5 (1-2016) Corporate Resolution Authorizing Application
Form A-6 (1-2016) Agreement and Undertaking for Security Deposit
Group applications:
Form S-1 (1-2016) Group Master Application for Certificate of Consent to Self-insure
Form S-2A (1-2016) Group Affiliate Member Interim Application
Form S-2B (1-2016) Application for Affiliate Certificate of Consent to Self-insure as a Member of a Group Self-insurer
Form S-3 (1-2016) Corporate Resolution
Form S-4 (1-2016) Indemnity Agreement and Power of Attorney
Form S-5 (1-2016) Agreement of Assumption and Guarantee of Workers’ Compensation Liabilities for Group and Affiliate Members
Form S-6 (1-2016) Agreement and Undertaking for Security Deposit
For more information regarding the application forms contact OSIP at (916) 464-7000.
The Office of Self-Insurance Plans (OSIP) is a program within the director's office of the Department of Industrial Relations (DIR) responsible for the oversight and regulation of workers' compensation self-insurance within California. OSIP is also responsible for establishing and insuring that required security deposits are posted by self-insurers in amounts sufficient to collateralize against potential defaults by self-insured employers and groups ...
The forms can be downloaded for free from the OSIP website and are found under Forms, Publications, and Reports.
Private stand-alone applications:
Form A-1 (1-2016) Application for a Private Entity Certificate of Consent to Self-Insure
Form A-2 (1-2016) Application for a Public Agency Certificate of Consent to Self-Insure
Form A-3A (1-2016) Private Affiliate Interim Application
Form A-3B (1-2016) Application for a Permanent Certificate of Consent to Self-Insure by an Interim Self-Insurer
Form A-4 (1-2016) Guaranty of Workers’ Compensation Liabilities
Form A4-50 Application for a Certificate to Administer Workers’ Compensation Claims
Form A-5 (1-2016) Corporate Resolution Authorizing Application
Form A-6 (1-2016) Agreement and Undertaking for Security Deposit
Group applications:
Form S-1 (1-2016) Group Master Application for Certificate of Consent to Self-insure
Form S-2A (1-2016) Group Affiliate Member Interim Application
Form S-2B (1-2016) Application for Affiliate Certificate of Consent to Self-insure as a Member of a Group Self-insurer
Form S-3 (1-2016) Corporate Resolution
Form S-4 (1-2016) Indemnity Agreement and Power of Attorney
Form S-5 (1-2016) Agreement of Assumption and Guarantee of Workers’ Compensation Liabilities for Group and Affiliate Members
Form S-6 (1-2016) Agreement and Undertaking for Security Deposit
For more information regarding the application forms contact OSIP at (916) 464-7000.
The Office of Self-Insurance Plans (OSIP) is a program within the director's office of the Department of Industrial Relations (DIR) responsible for the oversight and regulation of workers' compensation self-insurance within California. OSIP is also responsible for establishing and insuring that required security deposits are posted by self-insurers in amounts sufficient to collateralize against potential defaults by self-insured employers and groups ...
Last year Assemblyman Adam Gray, D-Merced, introduced and successfully passed Assembly Bill 1244 to crack down on medical providers who defraud the system. AB 1244 provides that If a vendor is convicted of fraud, then they are automatically suspended from treating in workers' compensation, and the Administrative Director is to create a list of all names of suspended vendors on their website.
Last week, the Department of Industrial Relations, using new powers from Gray’s bill, announced that seven Southern California medical providers had been suspended from treating workers’ compensation payments for fraudulent billings.
As AB 1244 was moving through the process last year, Gray inserted and then quickly removed other language that seemingly relieved employers and insurers of responsibility for some small claims for "cumulative trauma" - injuries that accumulate over months or years, rather than stem from one incident.
This year he has introduced Assembly Bill 221, a new Gray bill that’s similar in thrust to last year’s abandoned language. The proposed law, if passed, will add the following language to Labor Code section 4600 that defines medical care.
(i) For claims of occupational disease or cumulative injury filed on or after January 1, 2018, the employee shall have no liability for payment for medical treatment and the employer shall have no liability for payment for medical treatment unless one or more of the following has occurred:
(1) The treatment was authorized by the employer.
(2) The injury to the body part or body parts for which the treatment was provided has been accepted by the employer.
(3) The appeals board, after an evidentiary hearing or stipulation of the parties, finds the injury to the body part or body parts for which the treatment was provided was compensable.
(4) The employee has undergone an evaluation by a qualified medical examiner, pursuant to Section 4600, or an agreed medical examiner and the evaluating physician has determined that the claimed occupational disease or cumulative injury was caused, in whole or in part, by the employment.
According to the Sacramento Bee, Gray’s office says it’s just another effort to crack down on fraud, but lobbyists who work the issue believe there are other motives.
Companies that represent medical providers in seeking workers’ compensation payments for patients’ bills have labeled it a maneuver by employers and/or insurers to shed liability.
Another theory is that it’s an indirect slap by workers’ compensation lawyers against labor unions for their 2012 deal with employers. The California Applicants Attorneys Association, however, denies paternity.
Labor killed last year’s language and will probably kill AB 221. Whatever its origin or fate, it indicates that in the next round of "reform," cumulative trauma may be on the table.
Cumulative trauma claims have been increasing rapidly and employers and insurers see them as fraught with fraud, while unions are leery of any changes that could deny legitimate claims.m ...
Last week, the Department of Industrial Relations, using new powers from Gray’s bill, announced that seven Southern California medical providers had been suspended from treating workers’ compensation payments for fraudulent billings.
As AB 1244 was moving through the process last year, Gray inserted and then quickly removed other language that seemingly relieved employers and insurers of responsibility for some small claims for "cumulative trauma" - injuries that accumulate over months or years, rather than stem from one incident.
This year he has introduced Assembly Bill 221, a new Gray bill that’s similar in thrust to last year’s abandoned language. The proposed law, if passed, will add the following language to Labor Code section 4600 that defines medical care.
(i) For claims of occupational disease or cumulative injury filed on or after January 1, 2018, the employee shall have no liability for payment for medical treatment and the employer shall have no liability for payment for medical treatment unless one or more of the following has occurred:
(1) The treatment was authorized by the employer.
(2) The injury to the body part or body parts for which the treatment was provided has been accepted by the employer.
(3) The appeals board, after an evidentiary hearing or stipulation of the parties, finds the injury to the body part or body parts for which the treatment was provided was compensable.
(4) The employee has undergone an evaluation by a qualified medical examiner, pursuant to Section 4600, or an agreed medical examiner and the evaluating physician has determined that the claimed occupational disease or cumulative injury was caused, in whole or in part, by the employment.
According to the Sacramento Bee, Gray’s office says it’s just another effort to crack down on fraud, but lobbyists who work the issue believe there are other motives.
Companies that represent medical providers in seeking workers’ compensation payments for patients’ bills have labeled it a maneuver by employers and/or insurers to shed liability.
Another theory is that it’s an indirect slap by workers’ compensation lawyers against labor unions for their 2012 deal with employers. The California Applicants Attorneys Association, however, denies paternity.
Labor killed last year’s language and will probably kill AB 221. Whatever its origin or fate, it indicates that in the next round of "reform," cumulative trauma may be on the table.
Cumulative trauma claims have been increasing rapidly and employers and insurers see them as fraught with fraud, while unions are leery of any changes that could deny legitimate claims.m ...
New evidence suggests that receiving low intensity pulsed ultrasound (LIPUS) to speed up bone healing after fracture has little or no impact on pain or recovery time, say a panel of international experts in The BMJ.
According to the story in Medical News Today, they say LIPUS does not represent an efficient use of health resources and recommend that it should be stopped.
Their advice is part of The BMJ's 'Rapid Recommendations' initiative - to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients. Both the new evidence and the guidance are published by The BMJ.
Every year around 4 in 100 people of all ages have a fracture - and up to 10% of these experience slow or complicated healing. As such, fractures have been a target for numerous interventions to aid recovery.
LIPUS was approved for fracture healing by the US Food and Drug Administration (FDA) in 1994 and is also supported by the UK National Institute for Health and Care Excellence (NICE).
Each device costs between US$1300 and $5000 and data suggest it is commonly used in clinical practice. But some studies have shown that the potential benefits of LIPUS on bone healing are highly uncertain.
So The BMJ's guideline panel - made up of bone surgeons, physiotherapists, clinicians and patients with experience of fractures - carried out a detailed analysis of the latest evidence.
They judged, with moderate to high certainty, that LIPUS has little or no impact on time to return to work, time to full weight bearing, pain, the number of subsequent operations, or time to healing assessed with radiographs (known as radiographic healing).
As such, they unanimously recommend against LIPUS for patients with any bone fractures or osteotomy (the surgical cutting of a bone to allow realignment).
"We have moderate to high certainty of a lack of benefit for outcomes important to patients, and, combined with the high costs of treatment, LIPUS represents an inefficient use of limited healthcare resources," they write.
It is unlikely that new trials will alter the evidence, they add. And they suggest that future research "should focus on other interventions that have a greater probability to speed up healing." ...
According to the story in Medical News Today, they say LIPUS does not represent an efficient use of health resources and recommend that it should be stopped.
Their advice is part of The BMJ's 'Rapid Recommendations' initiative - to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients. Both the new evidence and the guidance are published by The BMJ.
Every year around 4 in 100 people of all ages have a fracture - and up to 10% of these experience slow or complicated healing. As such, fractures have been a target for numerous interventions to aid recovery.
LIPUS was approved for fracture healing by the US Food and Drug Administration (FDA) in 1994 and is also supported by the UK National Institute for Health and Care Excellence (NICE).
Each device costs between US$1300 and $5000 and data suggest it is commonly used in clinical practice. But some studies have shown that the potential benefits of LIPUS on bone healing are highly uncertain.
So The BMJ's guideline panel - made up of bone surgeons, physiotherapists, clinicians and patients with experience of fractures - carried out a detailed analysis of the latest evidence.
They judged, with moderate to high certainty, that LIPUS has little or no impact on time to return to work, time to full weight bearing, pain, the number of subsequent operations, or time to healing assessed with radiographs (known as radiographic healing).
As such, they unanimously recommend against LIPUS for patients with any bone fractures or osteotomy (the surgical cutting of a bone to allow realignment).
"We have moderate to high certainty of a lack of benefit for outcomes important to patients, and, combined with the high costs of treatment, LIPUS represents an inefficient use of limited healthcare resources," they write.
It is unlikely that new trials will alter the evidence, they add. And they suggest that future research "should focus on other interventions that have a greater probability to speed up healing." ...
